Date of Observation
Total Hours Observed
Name of Office
Office Address
Phone #
Name of Hygienist
License #
Hygienist Signature
Date
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Blinn College
Blinn College Dental Hygiene Program
Observation Log
Observation of Registered Dental Hygienist Only
Student’s Name
Blinn ID #
* Observation must occur between the following dates: Feb. 1, 2026 – Jan. 31, 2027
Date of Observation
Total Hours Observed
Name of Office
Office Address
Phone #
Name of Hygienist
License #
Hygienist Signature
Date
Date of Observation
Total Hours Observed
Name of Office
Office Address
Phone #
Name of Hygienist
License #
Hygienist Signature
Date
Date of Observation
Total Hours Observed
Name of Office
Office Address
Phone #
Name of Hygienist
License #
Hygienist Signature
Date