Employee Daily Time & Mileage Log Sheet
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1DAILY TIME & MILEAGE LOG
Mission Hospice Services of San Diego, Inc.
Employee Name:
Discipline:
Date:
Commute Miles:
Page _____ of _____
Visit
Travel
Total Travel
Worked Time
Total Worked
Depart From
Destination
Purpose
Miles
#
Time
Time
In / Out
Time
Name of Patient, Facility, Physician or Business Address
Name of Patient, Facility, Physician or Business Address
of Trip
Must be Street & City
Must be Street & City
In / Out
Travel Time In
Travel Time
Time In
Worked Time
Name
MR#
Name
MR#
Travel Time Out
Time Out
Address
Address
Travel Time In
Travel Time
Time In
Worked Time
Name
MR#
Name
MR#
Travel Time Out
Time Out
Address
Address
Travel Time Out
Travel Time
Time In
Worked Time
Name
MR#
Name
MR#
Travel Time Out
Time Out
Address
Address
Travel Time In
Travel Time
Time In
Worked Time
Name
MR#
Name
MR#
Travel Time Out
Time Out
Address
Address
Travel Time In
Travel Time
Time In
Worked Time
Name
MR#
Name
MR#
Travel Time Out
Time Out
Address
Address
Travel Time In
Travel Time
Time In
Worked Time
Name
MR#
Name
MR#
Travel Time Out
Time Out
Address
Address
Travel Time In
Travel Time
Time In
Worked Time
Name
MR#
Name
MR#
Travel Time Out
Time Out
Address
Address
Travel Time In
Travel Time
Time In
Worked Time
Name
MR#
Name
MR#
Travel Time Out
Time Out
Address
Address
Total
Total Travel
Total Worked
Total
Visits
Hours
Hours
Miles
Time Conversion
KEY: Purpose of the Trip
FOR PAYROLL PURPOSES ONLY
MIN
5
10
15
20
25
30
35
40
45
50
55
60
CHA = Hospice Aide Visit
HC = Hospice Chaplain
Descriptions
Totals Mgt Approved
HUND
0.08
0.17
0.25
0.33
0.42
0.5
0.58
0.67
0.75
0.83
0.92
1.0
I = Inservice Time
LN = LVN Visit
Total Time Worked
O = Orientation
OH = Office Time (IDG)
Total Reimbursable Time
RN = RN Visit
SW = Social Work Visit
Total Overtime
V = Volunteer Visit
B = Bereavement Visit
Total Vacation Hours
S = Supervisory Visit
16 = Other (mgt apprv)
Total Sick Hours
Total Holiday Hours
Total Miles
____________________________________________________________
_________________________________________________________
Employee Signature & Designation
Date
Approval Signature
Date
Commute is defined as the number of miles from an employee’s home to the site location. This mileage is NEVER reimbursed unless it is an on-call visit for any discipline.
(REV: 2/29/12)
If the mileage to first business stop or last business stop is less than number of commute miles, enter zero. Any excess difference between commute and first stop of the day or commute and last stop of the day is reimbursable.
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Parent category: Miscellaneous