DAILY WORK REPORT (DOT-12)



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|Form DOT-12 (Rev. 11/98) |

| |A C C O U N T I N G I N F O R M A T I O N |

| |1 |2 |3 |4 |

| |RECEIVING ORG. |     |     |     |     |

|      |AUTH./ E.D. NO |      |      |      |      |

| |ACTIVITY CODE |    |    |    |    |

|     |“N” OR “P” |  |  |  |  |

| |ROUTE NUMBER |      |      |      |      |

| | |BEG. MILE POST |      |      |      |      |

|      |      |END. MILE POST |      |      |      |      |

|MAINT: UNITS ACCOMPLISHED / WORK ORDER NO. |      |      |      |      |

|MAINT: UNITS OF MEASURE / TYPE OF WORK |      |      |      |      |

|EMPLOYEE |SOCIAL |WAGE |H O U R S R E P O R T E D |

|NAME |SECURITY |CODE |1 |2 |3 |4 |

|      |      |     |      |      |      |      |

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|      |      |     |      |      |      |      |

| TOTAL HOURS REPORTED |      |      |      |      |

|EQUIPMENT | |END. METER |H O U R S O R M I L E S R E P O R T E D |

|DESCRIPTION |E.D. NO. |& STATUS |1 |2 |3 |4 | |

|      |      |      |   |      |      |      |      |

|      |      |      |  |      |      |      |      |

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|      |      |      |  |      |      |      |      |

| |TOTAL HOURS/MILES REPORTED |      |      |      |      |

|INVENTORY |ORG. |CLASSIFICATION |I N V E N T O R Y U S A G E B Y U N I T S |

|DESCRIPTION |LOC. |CLASS - TYPE - SUB. |1 |2 |3 |4 |

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|      |      |      |      |      |      |      |

| | TOTAL UNITS REPORTED |      |      |      |      |

Prepared By: Approved By: Entered Into System By:

_______________________________ ______________________________ _______________________________

COMMENTS

Document workday issues, such as: unauthorized absences, work rule violations and disciplinary action, work related injuries, supplemental reporting of work hours unreported within a week, etc. The preparer must sign and date the information.

     

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WEST VIRGINIA

DEPARTMENT OF TRANSPORTATION

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DAILY WORK REPORT

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