Free template

Supervision hours log template

By Albert Wong, PhD, Clinical Psychologist

Every pre-licensure clinician eventually faces the same form: prove your hours. The clinicians who sail through are the ones who logged contemporaneously, with supervisor signatures collected as they went — not the ones reconstructing two years of Tuesdays from an old calendar. This is a clean, printable log built for that discipline: a daily table, activity codes you can map to your board's categories, weekly summaries, running totals, and an attestation block your supervisor signs while they still work down the hall.

The template

Plain text — paste into any EHR or document

SUPERVISED CLINICAL HOURS LOG

Supervisee: ______________________________  Registration/permit # (if any): __________
Supervisor: ______________________________  License type and #: ____________________
Site / setting: __________________________  Period covered: __________ to __________

DAILY LOG
+------------+------------------------------+---------+---------+------------+
| Date       | Activity (code below)        | Direct  | Other   | Supervisor |
|            |                              | hours   | hours   | initials   |
+------------+------------------------------+---------+---------+------------+
|            |                              |         |         |            |
+------------+------------------------------+---------+---------+------------+
|            |                              |         |         |            |
+------------+------------------------------+---------+---------+------------+
|            |                              |         |         |            |
+------------+------------------------------+---------+---------+------------+
|            |                              |         |         |            |
+------------+------------------------------+---------+---------+------------+
|            |                              |         |         |            |
+------------+------------------------------+---------+---------+------------+
|            |                              |         |         |            |
+------------+------------------------------+---------+---------+------------+
|            |                              |         |         |            |
+------------+------------------------------+---------+---------+------------+

ACTIVITY CODES
IND   Individual therapy               GRP   Group therapy
FAM   Couples / family therapy         ASM   Assessment / testing
INT   Intake / evaluation              DOC   Documentation / charting
TRN   Training / didactics             CON   Case consultation
SUP-I Individual supervision received  SUP-G Group supervision received

WEEKLY SUMMARY
Week of __________ :  Direct client contact ______  Supervision received ______
                      Other supervised experience ______  Week total ______

PERIOD TOTALS
Direct client contact hours ............ ______
Individual supervision hours ........... ______
Group supervision hours ................ ______
Other supervised experience hours ...... ______
TOTAL, this period ..................... ______
Running total to date .................. ______

SUPERVISOR ATTESTATION
I supervised the experience recorded above and attest that these entries are accurate
to the best of my knowledge.

Supervisor signature: ____________________________   Date: ______________

Supervisee signature: ____________________________   Date: ______________

How to use it

First, download your board's actual requirements and rename the activity codes to match its categories — boards differ on what counts and in what ratios.
Log daily or, at worst, weekly. Precision decays fast: a week later you are estimating, a month later you are guessing.
Collect supervisor initials at your regular supervision meeting, and a signed attestation every period — before staff transitions, not after.
Keep a scanned copy of every signed page somewhere that survives leaving the training site.
The table prints best in a monospaced font (or paste it into a spreadsheet and let the columns do the work).

Common questions

What counts as "direct" client contact hours?

Generally, time spent face to face (or on video, where your board allows it) providing clinical services — therapy, intakes, assessment. Documentation, treatment planning, consultation, and trainings are supervised experience but usually count in a different bucket, often with caps. The exact definitions and ratios are set by your licensing board, so mirror your board’s categories in the activity codes rather than inventing your own.

Will my board accept this log format?

Use this as your working log, not your submission form. Most boards publish their own required forms for verifying hours at application time, and some also require specific weekly logs. The painful scenario this template prevents is arriving at application day with vague records — a contemporaneous log with supervisor sign-offs makes filling in any official form a transcription job instead of an archaeology project.

How often should my supervisor sign?

As frequently as your board requires, and no less than the rhythm that keeps the log honest — weekly initialing with a full attestation each month or each review period is a common pattern. Signatures collected in real time are easy; reconstructing a year of hours for a supervisor who has since moved on is one of the classic pre-licensure disasters.

What happens to my hours if my supervisor leaves?

Hours already logged and attested stay valid — which is exactly why you get signatures as you go. Before a supervisor departs, have them sign a final attestation covering everything they supervised, and keep their license number and contact information. Then start a fresh log section with the new supervisor.

How long should I keep the log?

Indefinitely. You will need it to apply for licensure, but hours can matter again years later — licensing in a second state, credentialing questions, or a board that asks for verification of long-ago experience. A scanned copy of every signed page, stored somewhere you will still have access to after leaving the training site, costs nothing and ends every future argument.

Related tools

In a group practice, supervision also runs through the chart — Practice Harbor, an EHR built by a psychologist, includes supervisor co-signing of notes, so the clinical side of the paper trail keeps itself.

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Licensing requirements — categories, minimums, supervision ratios, and required forms — are set by your board and profession, and they change. This log organizes your record; your board's current rules define what counts.