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  • Main Form Dca Bbs37a 638 Associate Clinical Social Worker Asw Weekly Log of Experience Hours California

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    Tham Dang
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    This weekly log tracks experience hours for an Associate Clinical Social Worker (ASW). It includes spaces to record hours spent in various clinical activities each week under the supervision of a named supervisor in a specific work setting. The log separates hours into categories like individual/group psychotherapy, diagnosis/assessment, supervision, and other clinical/professional activities. The maximum total hours allowed per week is noted. At the end of each week, the supervisor must sign verifying the reported hours.

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    This weekly log tracks experience hours for an Associate Clinical Social Worker (ASW). It includes spaces to record hours spent in various clinical activities each week under the supervision of a named supervisor in a specific work setting. The log separates hours into categories like individual/group psychotherapy, diagnosis/assessment, supervision, and other clinical/professional activities. The maximum total hours allowed per week is noted. At the end of each week, the supervisor must sign verifying the reported hours.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    51 views1 page

    Main Form Dca Bbs37a 638 Associate Clinical Social Worker Asw Weekly Log of Experience Hours California

    Uploaded by

    Tham Dang
    This weekly log tracks experience hours for an Associate Clinical Social Worker (ASW). It includes spaces to record hours spent in various clinical activities each week under the supervision of a named supervisor in a specific work setting. The log separates hours into categories like individual/group psychotherapy, diagnosis/assessment, supervision, and other clinical/professional activities. The maximum total hours allowed per week is noted. At the end of each week, the supervisor must sign verifying the reported hours.

    Copyright:

    © All Rights Reserved
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    of 1

    ASSOCIATE CLINICAL SOCIAL WORKER (ASW)

    WEEKLY LOG OF
    EXPERIENCE HOURS
    Use a separate log for each supervisor and for each work setting.
    Do not submit to the Board unless specifically requested.
    Name of Associate: Last First Middle

    Supervisor Name Name of Work Setting

    Address of Work Setting

    BBS File No. (if known): _______________ ASW Number: _______________

    seminars, training sessions or


    Psychotherapy or Counseling
    Diagnosis, Assessment, and
    Supervision, Individual or Triadic

    Client-centered advocacy,

    Maximum 40 hours/week
    consultation, evaluation,

    conferences, and direct

    Total Hours Per Week


    research, workshops,
    Clinical Psychosocial

    Treatment, including
    Individual or Group

    Individual or Group

    supervisor contact

    Supervisor Signature
    Psychotherapy*

    YEAR:
    Supervision, Group

    (A + B = C)
    __________
    B.

    C.
    A.

    A1.

    Week of:
    Week of:
    Week of:
    Week of:
    Week of:
    Week of:
    Week of:
    Week of:
    Week of:
    Week of:

    Total Hours:

    * Line A1 is a sub-category of line “A.” This line tells you how much of “A” was Individual or Group
    Psychotherapy. When totaling weekly hours do not include the subcategory - use the formula in box “C”.

    DCA BBS 37A-638 (Revised 08/2022) State of California

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