Weekly Timecard / Activity Daily Log Sheet (Page 3 of 3) in pdf

WEEKLY TIMECARD /

ACTIVITY DAILY LOG SHEET

Employee Name:

Client Full Name:

Work Week Ending Sunday:

/ 20_____

Client Authorized

Employee Telephony Log-In #:

Signature:

(Last 4 digits of social security number)

IMPORTANT FOR CLIENT:

By signing this form, client or client rep certifies



LATE

ON TIME

NOT RECEIVED

Office Use Only:

that hours shown are correct, work was done satisfactorily and all transactions and

services were completed fully and are considered final. Please review carefully.

Input Work Date:

Work Day:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Hrs.

Min.

Hrs.

Min.

Hrs.

Min.

Hrs.

Min.

Hrs.

Min.

Hrs.

Min.

Hrs.

Min.

Start Time:

Less Break Time or

Personal Time:

End Time:

Total Hours Worked:

Total Mileage (if any):

Total

Total Hours / Minutes Worked Written Out

Hours

Minutes

Mileage

Total Hours Worked

TIMECARD / ACTIVITY DAILY LOG SHEET / PAYROLL INSTRUCTIONS

 In order to process your check, timecards Must be filled out completely

 Deliver your timecard to your local SYNERGY Homecare office

and accurately

immediately upon completion of the assignment or at the end of your work

 Use a ballpoint pen – your writing must penetrate through all copies

week, whichever is sooner. Should you choose to mail your timecard, mail it

 The pay period is Monday through Sunday. Indicate the Sunday week

from a post office or mailbox that has daily pickup. Be sure the timecard

ending date in the upper left hand corner of your timecard i.e.: if you work

will arrive in the SYNERGY HomeCare office no later than Wednesday

08/11/03 – 08/17/03, the week ending date is 08/17/03.

following the week ended Sunday.

 The timecard must have your signature as well as the client’s signature.

 If you do not have a blank timecard please go to:

Timecards without signature will not be processed.

and print one yourself.

 White Copy – Office, Yellow Copy – Client, Pink Copy – Keep for your

 Originals submitted without client or client rep signature will be sent back

records.

to you to allow you to get the appropriate signature.

 Payroll deadline is Wednesday. If your timecards are not received by

 Timecards submitted after 10 days from the applicable pay date, will not

this time, your check will be processed the following pay period. Payroll

be processed and you will not be paid for the work on those timesheets.

 Payroll errors that are past 10 days from the applicable pay date may not

will only “back pay” late timecards up to ten (10) days past the deadline. If

you notice an error on your pay check you have seven (7) business days to

be corrected.

 If you have an address, name or filing statues change, please call pay roll

notify the office of the error. Payroll errors that are addressed will be

corrected on the following pay period. Do not hold your timecards week to

ASAP. If your check is lost, stolen or you have not received it within a week

week.

of the date issued, please call payroll. There is a ten (10) calendar day period

 Synergy’s Arbitration Policy is in effect for any employee that actively

from the date the check is issued before a stop payment transpires and a new

works. This Arbitration Policy was presented to all employees in 2016.

check is issued.

Activity Daily Log Instructions

 All entries must be made in blue or black ink and must penetrate through

 Mark with an “X” to indicate a duty was performed.

 If a client refuses to have a duty performed, record an “R” in the

all copies. Give your client the YELLOW copy. Keep the PINK copy.

 Do not write in shaded areas.

Appropriate box.

 You are responsible to perform all assigned duties.

 Report any significant changes in client condition to your SYNERGY

 Do not perform any duties requested outside the scope of duties.

office immediately.

Terms and Conditions

Timesheets are due the Wednesday following the week of work. Timecards must be received within ten (10) days from pay period date or you will not receive wages for hours

listed on the timecard that is 10 days late. Timecards can be mailed or turned into your local SYNERGY HomeCare office, but to be paid, all originals must be received within

ten (10) days from pay period end date. Once assigned a client and you accept set client, you will be required to complete a full weekly assignment. If you fail to complete a full

week assignment without contacting your SYNERGY HomeCare office with reason and documentation why you cannot complete the full week’s assignment, SYNERGY

HomeCare will consider that your voluntary resignation and you will be taken off all assignments. Each weekly assignment must be worked in full--no exceptions will be made.

IMPORTANT FOR EMPLOYEE: By executing this form, employee agrees to

Employee Signature:

terms and conditions on employee copy of this form and Employee Policy and

Procedures. Employee certifies this form is true, complete and accurate.

X ________________________________________

Employee may be terminated for providing false information. Client/client rep

signature is required. Late timesheets will result in delayed payment of wages.

Employees:

has work documents & links to key work sites.

White Page: Turn into Office

Yellow Page: Give to Client/Client Rep

Pink Page: Employee Copy