Understanding Your Responsibilities: Elected & Appointed Officials

Record of Activities Template

Officials are required to complete a three-month record of activities (ROA) within 150 days of the start of the term. We have created a fillable template to help you track your activities and hours worked.

  1. Click to download the ROA Template (you must have Microsoft Word* on your computer to use the template).
  2. Follow the browser prompts to open or save the Word document.
  3. After opening the Word document, select “Enable Content” in the security warning banner at the top.
  4. A security warning box may also appear asking if you want to make this file a Trusted Document — if so, click “Yes.”
  5. If you haven’t done so already, go to File and Save As to save the template on your desktop or to a folder on your computer.
  6. Fill out the top of the form with your information.
  7. Use a new row for each activity (you must include the start and end times for each activity). Note: the maximum number of rows is 84.
  8. Before printing your ROA, be sure to click the “Update Total” button.

Please read the Your Record of Activities page for additional information and the Work-Related and Non-Work-Related Activities page for examples of activities to include on the ROA. If you have questions about using the template, our sample ROA may help, or you can email the Pension Integrity Bureau.

When the ROA is complete, print, sign and date it. Then, submit it to the secretary or clerk of the governing board within 30 days of completion.

*Versions of Word older than Word 2003 may have a limit on the number of rows you can add.


(Rev. 11/19)