Grade A Supervisor Reports
Field Supervisor
First Name
Last Name
Date of Report
-
Month
-
Day
Year
Date
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Southbury
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Southbury
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Southbury
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Southbury
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Newfield
Hope Street
Brookfield
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Newfield
Hope Street
Brookfield
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Newfield
Hope Street
Brookfield
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Newfield
Hope Street
Brookfield
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Newfield
Hope Street
Brookfield
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Date of Visit
-
Month
-
Day
Year
Date
Time of Visit
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
ShopRite Store
Commerce
Shippan
Norwalk
Derby
Shelton
Fairfield
Danbury
Brookfield
Newfield
Hope Street
Officer on Duty
Manager on Duty
Comments
Photo
Photo Description
Photo
Photo Description
Photo
Photo Description
Field Supervisor Signature
Submit
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