Employee Weekly Activity Report
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Date Work Started Date Work Ended Number of Hours Worked (on average) PER DAY Starting Hourly Pay Current or Ending Pay Supervisor s Name Supervisor s Telephone Number (Include area code) PER WEEK Check each block below that is true for this work: I stopped working within 6 months, or I reduced my work hours and earnings within 6 months, or within 6 months I had to change the type of work I was doing (i.e.. Date Work Started Date Work Ended Number of Hours Worked (on average) PER DAY Starting Hourly Pay Current or Ending Pay Supervisor s Name Supervisor s Telephone Number (Include area code) PER WEEK Check each block below that is true for this work: I stopped working within 6 months, or I reduced my work hours and earnings within 6 months, or within 6 months I had to change the type of work I was doing (i.e.. Date Work Started Date Work Ended Number of Hours Worked (on average) PER DAY Starting Hourly Pay Current or Ending Pay Supervisor s Name Supervisor s Telephone Number (Include area code) PER WEEK Check each block below that is true for this work: I stopped working within 6 months, or I reduced my work hours and earnings within 6 months, or within 6 months I had to change the type of work I was doing (i.e.. Date Work Started Date Work Ended Number of Hours Worked (on average) PER DAY Starting Hourly Pay Current or Ending Pay Supervisor s Name Supervisor s Telephone Number (Include area code) PER WEEK Check each block below that is true for this work: I stopped working within 6 months, or I reduced my work hours and earnings within 6 months, or within 6 months I had to change the type of work I was doing (i.e..
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