TX HHS Form 4117. Supported Employment/Employment Assistance Service Delivery Log

The TX HHS Form 4117, Supported Employment/Employment Assistance Service Delivery Log, is a tool used to track and record the services provided by employees or job trainers in supported employment settings. This form helps solve the problem of monitoring and documenting the progress of individuals with disabilities who are receiving employment assistance.

The log requires information such as individual name, local case number, date of services, service details including start and end times, employee name, signature, code, and comments. Important sections include the "Service" column where employees can record specific activities or tasks provided to individuals, and the "Comments" section for noting any special events or occurrences.

This form is typically used in situations where employment adaptations, supervision, and training are necessary due to an individual's disability. Common scenarios of use may include assisting with career advancement, developing assets, transportation needs, job training, consulting, or participating in service planning team meetings. The log can be used by employees, job trainers, or case managers to document services provided and track progress towards self-sufficiency through work.