ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQAR
1
Unrestricted HoursRestricted HoursSupervisor 1 HoursSupervisor 2 HoursObservations with Client:0
2
⊲ observation and data collection ⊲ training staff and caregivers on behavior-analytic programs or content ⊲ conducting assessments related to the need for behavioral intervention ⊲ meeting with clients about behavior-analytic programming and services ⊲ conducting behavior-analytic assessments (e.g., functional analyses, stimulus preference assessments) ⊲ data graphing and analysis ⊲ researching the literature relevant to a current client’s programming ⊲ writing and revising behavior-analytic programsRestricted Activities: There is a restriction on the overall amount of hours you may spend delivering therapeutic and instructional procedures during fieldwork. This restriction is designed to ensure that trainees have sufficient time to acquire the other skills necessary for practice as a BCBA. Restricted activities may comprise no more than 40% of the total fieldwork hours—this requirement does not need to be met during each supervisory period. Please note that this restriction does not necessarily refer to all time spent working with clients.Setting:Setting:Must be at least 1
3
4
OVERALL PERCENTAGE of HOURS SUPERVISED:#DIV/0!
5
DateStart TimeEnd Time# HoursDateStart TimeEnd Time# HoursDateStart TimeEnd Time# HoursGroup?Observed With Client?DateStart TimeEnd Time# HoursGroup?Observed With Client?Supervised Fieldwork (5%)Documentation Checklist
6
0:00:000:00:000:00:000:00:00Concentrated Supervised Fieldwork (10%)this tracker includes all fieldwork and supervision I completed this month
7
0:00:000:00:000:00:000:00:00
8
0:00:000:00:000:00:000:00:00Total Supervisions:0Monthly Fieldwork Verification Form (M-FVF) completed and signed
9
0:00:000:00:000:00:000:00:00Supervised Fieldwork (4 req.)
10
0:00:000:00:000:00:000:00:00Concentrated Supervised Fieldwork (6 req.)Final Fieldwork Verification Form (F-FVF) completed and signed (if applicable)
11
0:00:000:00:000:00:000:00:00
12
0:00:000:00:000:00:000:00:00Percent Unrestricted: #DIV/0!
13
0:00:000:00:000:00:000:00:00Percent Restricted: #DIV/0!
14
0:00:000:00:000:00:000:00:00Unrestricted must be at least 60%, and restricted can be no more than 40%
15
0:00:000:00:000:00:000:00:00
16
0:00:000:00:000:00:000:00:00
17
0:00:000:00:000:00:000:00:00Percent of Supervision that was held in a group: #DIV/0!
18
0:00:000:00:000:00:000:00:00
19
0:00:000:00:000:00:000:00:00
20
0:00:000:00:000:00:000:00:00Can be no more than half
21
0:00:000:00:000:00:000:00:00
22
0:00:000:00:000:00:000:00:00Supervisior 1
23
0:00:000:00:000:00:000:00:00Name:
24
0:00:000:00:000:00:000:00:00Certification #:
25
0:00:000:00:000:00:000:00:00an active BCBA who has been certified for at least one year
26
0:00:000:00:000:00:000:00:00
27
0:00:000:00:000:00:000:00:00an active BCBA who has been certified for less than one year and is receiving consultation on a monthly basis from a qualified consulting supervisor
28
0:00:000:00:000:00:000:00:00
29
0:00:000:00:000:00:000:00:00
30
0:00:000:00:000:00:000:00:00a licensed or registered psychologist certified by the American Board of Professional Psychology in Behavioral and Cognitive Psychology who was tested in applied behavior analysis
31
0:00:000:00:000:00:000:00:00
32
0:00:000:00:000:00:000:00:00
33
0:00:000:00:000:00:000:00:00an authorized Verified Course Sequence Instructor
34
0:00:000:00:000:00:000:00:00
35
0:00:000:00:000:00:000:00:00Supervisior 2
36
0:00:000:00:000:00:000:00:00Name:
37
Total Hours:0:00:00Total Hours:0:00:00Total Hours0:00:000:00:00Total Hours0:00:000:00:00Certification #:
38
Total Supervisions:000Total Supervisions:000an active BCBA who has been certified for at least one year
39
40
an active BCBA who has been certified for less than one year and is receiving consultation on a monthly basis from a qualified consulting supervisor
41
42
43
a licensed or registered psychologist certified by the American Board of Professional Psychology in Behavioral and Cognitive Psychology who was tested in applied behavior analysis
44
45
46
an authorized Verified Course Sequence Instructor
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100