Downloading a Form to Your Computer

Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

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Effective Date: 



Updated: 1/1994


  • To register clients who come to the office without an appointment and want to see a worker.
  • To document the number of clients interviewed during the month who did not have an appointment.
  • To assign case maintenance activities.
  • To provide a record of client-reported changes (optional).


When to Prepare

The clerical staff prepare and maintain this form each day.

Number of Copies

The clerical staff prepare one copy of the form each day. As many forms as necessary may be used each day.


Staff keep the logs in a notebook or file folder. At the end of the month, staff remove all forms from the notebook and file them with the appointment schedules for that month.

Form Retention

The requirements are listed in the Manager's Guide for Eligibility Programs .


Date — Enter the date the log is prepared.

Time of Arrival— Enter the time the client comes into the office.

Time Seen — Enter the time the worker interviews the client.

Client Name — Enter the client's or case name.

Request — Describe the reason the client wants to see a worker.

Worker's Initials — The worker enters his initials at the time he interviews the client.