DAILY WORK REPORT (DOT-12) - West Virginia
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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
Date:
Home Org:
D O C U M E N T C O N T R O L
Type:
Number:
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