Washington supervised experience verification (DOH 670⁠-⁠036)

Washington has no separate board. The Department of Health verifies supervised experience, and it wants one form for each site and supervisor pair.

Form: DOH 670-036
Board: Washington State Department of Health (DOH)
Source checked: 16 September 2026

What this form is.

A verification of the hours you worked at one place, under one supervisor.
If you worked at two sites, or under two supervisors, you need more than one form.
It sits under the chapter that also sets the pacing rule: at least one hour of supervision for every 80 hours of clinical practice (WAC 246-809-020).

Who signs it

Your supervisor, by hand. Washington's forms have a handwritten signature line and we found no official statement that an electronic signature is accepted, so HourSign does not claim one.

Common mistakes.

Most are easy to catch while the work is fresh.

One form for two supervisors. Split them.
Forgetting the supervisor declaration you file with DOH before supervision starts. That is a separate thing, and it is between you, your supervisor and DOH.
Assuming the older DOH forms, the rules and the statute all agree. Our research found conflicts between them.

How HourSign fills it in.

HourSign prints one page per site and supervisor pair, with section one filled in, so you never have to split the hours by hand.
The split comes from the same place the dashboard gets it, so the page and your totals cannot disagree.
Where the statute, the rules and the forms conflict, HourSign shows a warning with the citation instead of picking a side for you.

HourSign's page is not the board's form. It carries the board's layout so the numbers can be copied across, or so the page can be stapled behind the board's own copy. Every page says so.

The Exports screen in HourSign: signed direct and supervision totals, and a Board forms panel offering the Washington DOH 670-036 verification as a PDF, with a reminder to check the board's current form before submitting. — Board forms sit on the Exports screen, ready to download. Demo account.

The official source.

Last checked 16 September 2026

Washington State Department of Health

Where we are not sure. We have not verified a direct link to the current DOH 670-036 PDF. Search the DOH forms and publications page for the number and check the revision date on the form.

Check the board first. Check the board's own site for the current version of this form before you file anything. Boards change forms without notice, and the board's copy always wins over ours.

Other board forms.

Your hours, already in the board's layout.

Log free, forever. Your first signed period is free too. Supervisors never pay.

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