DAILY TIME RECORD                                                        DAILY TIME RECORD
-----o0o-----                                                            -----o0o-----
                              (Name)                                                                   (Name)
For the month of: _______________________                                For the month of: ______________________
               A.M.                    P.M.                                             A.M.                    P.M.
Day                                                               Min    Day                                                               Min-
          IN          OUT         IN          OUT      Hours                       IN          OUT         IN          OUT      Hours
                                                                  utes                                                                     utes
1                                                                        1
2                                                                        2
3                                                                        3
4                                                                        4
5                                                                        5
6                                                                        6
7                                                                        7
8                                                                        8
9                                                                        9
10                                                                       10
11                                                                       11
12                                                                       12
13                                                                       13
14                                                                       14
15                                                                       15
16                                                                       16
17                                                                       17
18                                                                       18
19                                                                       19
20                                                                       20
21                                                                       21
22                                                                       22
23                                                                       23
24                                                                       24
25                                                                       25
26                                                                       26
27                                                                       27
28                                                                       28
29                                                                       29
30                                                                       30
31                                                                       31
                                              Total                                                                    Total
I certify on my honor that the above is a true and correct report of     I certify on my honor that the above is a true and correct report of
the hours of work performed, record of which was made daily at the       the hours of work performed, record of which was made daily at the
time of in and out.                                                      time of in and out
VERIFIED as to the prescribed working hours:                             VERIFIED as to the prescribed working hours:
                             In Charge                                                                In Charge