Non-Public Agency  Service Provider Sign In/Out Sheet
Los Angeles Unified School District: Rio Vista Elementary School
*Lunch Breaks-Defined as times that do not include student supervision and last thirty (30) minutes or more i.e. lunch.
**Note-Rest and meal/lunch breaks cannot be combined.
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Agency Name:
Service Provider's Name: First,Last:
Date:
MM
/
DD
/
YYYY
Time In:
Time
:
Lunch Break:
Time Out:
Time
:
Submit
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