TIMESHEET Sunny Days Great Lakes TimeSheet Form CAREGIVER'S NAME * CLIENT'S NAME * DATE OF SHIFT * Clock in Time * 121234567891011 : 00153045 AMPM Clock out Time * 121234567891011 : 00153045 AMPM Total Hours REASON FOR TIMESHEET * CHOOSE YOUR FIELD MANAGER * Cheyanne | [email protected]Cassie | [email protected]Dinah | [email protected]Jayde | [email protected]Jenny | [email protected]Judy | [email protected]Kristina | [email protected]Rebeka | [email protected]Tanya | [email protected]Unknown | [email protected] TASK PERFORMED DURING SHIFT (must select at least 2) Homemaker Services Provided * Meal Prep Dishes Clean Bathroom Make/Change Bed Trash Out OtherOther Personal Care Services Provided * Bathing Hair Care/Skin Care Toileting Assist with Dressing Emptied/Cleaned Commode or Urinal OtherOther I, hereby attest that this information is true, accurate and complete to the best of my knowledge. I understand that all signatures must be authentic and by the authorized signer to prevent fraud/forgery. I understand that any falsification, omission or concealment of information fact may subject me to administrative, civil or criminal liability * I agree Instructions: This is a legal document. Verify your assignment and care plan for accuracy. Check off all duties completed. If the client is hospitalized, visit the Emergency Room (ER), in an in-patient facility, on vacation, away from home, receiving other services, deceased or is unable to be serviced due to other reasons; per regulation as a mandated reporter, you are required to report immediately to your supervisor. Note: A Timesheet does not replace the regulated EVV method to submit attendance. This may cause a delay in compensation as a manual review is required. Caregiver's Signature * signature keyboard Clear Client's Signature * signature keyboard Clear Terms and Conditions: By submitting this form you agree to the terms of the Privacy Policy. * I agree Captcha Submit If you are human, leave this field blank.
