Training Special Provision Monthly On-the-Job Training Report Sheet of
Contractor: (Name and Address)	INSTRUCTIONS: This report must be submitted each month directly to the Highway Civil Rights Office. Send a copy to the Project Manager for inclusion in the monthly progress estimate and also keep a copy for your records. Note: The Remarks column is to be used for reporting when a trainee completes training, terminates employment or is replaced by another trainee.
SUBMIT TO: NDOT.HCRO-OJT@nebraska.gov NDOT Highway Civil Rights Office 1500 Nebraska Parkway • P.O. Box 94759 • Lincoln, NE 68509-4759	Month and Year:	Project No.:	Control No.:
NDOT Project Manager:
TRAINEE NAME AND LAST FOUR DIGITS OF SSN (one Trainee per line)	WORK CLASSIFICATION	WAGE RATE PAID	TOTAL HOURS TRAINED THIS MONTH	REMARKS
Contractor’s Representative: (Signature and Title)	Date:	NDOT External Civil Rights Office: (Signature and Title)	Date: