Enclosure (3) to COMDINST 1750.4D
U.S. DEPARTMENT OF
OMBUDSMAN SERVICE HOURS
DATE:
HOMELAND SECURITY
U.S. COAST GUARD
CG- 6076 (3-04)
Name: __________________________
Command: ____________________________
Month:___________
Year:___________ Total hours this month: __________________
Date
Time In Time
Total
Date
Time
Time
Total
Out
Hours
In
Out
Hours
Totals Hours:
___________
Totals Hours:
___________
Ombudsman Printed Name:
Date:
Ombudsman Signature:
Command Representative Printed Name:
Date:
Command Representative Signature
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