1. So Cal HH Break and Expense form

BREAK & EXPENSE FORM

This form must be completed immediately at the end of each shift and prior to clocking out.
First and Last Name
Your shift's date & scheduled START TIME (Not the onsite time):
Team Name?
For LOGISTICS SHIFTS, scroll to the bottom.
••• BREAKS •••
Did you take all required rest break(s) and meal break(s) based on your continuous work time today? (If a break was required, it must be taken.)
You indicated that you did not take all required breaks. Please explain, including any additional work performed before or after this shift and whether it was continuous.
••• MILEAGE •••
Did you operate or ride in a company vehicle at any time today?
TO/FROM MILEAGE: Did you drive your personal vehicle for any reimbursable travel used TO arrive at the first team worksite and/or depart FROM the final team worksite during this shift?
TO / FROM MILEAGE: Was mileage reimbursement offered TO and FROM work in the shift's details on Humanity?
Input the amount of paid mileage offered TO and FROM the shift as specified in Humanity, ONLY if your vehicle was driven:
ROUTE MILEAGE: Did you drive your own vehicle between team worksites during this shift?
If your vehicle was driven between the team worksites scheduled for this shift, input the total work-related mileage incurred in your vehicle.
Include only mileage you personally drove directly between team worksites scheduled for the shift. (Do not include any mileage driven to arrive at your first worksite of the day or after departing from your last worksite of the day, regardless of individual attendance."
Reimburseable mileage must be submitted in the mileage section of this form. Mileage that is omitted or improperly reported may be delayed until corrected and properly documented.
Mileage is calculated using the standard Google Maps route for the shift; personal odometer readings are not used.
$ AMOUNT DUE for Grand Total Miles (Route + TO/FROM)
Based on current IRS mileage rate.
Details, comments, or feedback pertaining only to breaks, mileage, or expenses.
This is ONLY for comments related to breaks, expenses, or mileage and not for anything related to your clock in nor clock out..
••• EXPENSES •••

(Only if pre-approved)
Do you have any pre-approved expenses you paid for personally that need to be reimbursed to you?
Expense Amount #1
do not include a dollar sign ($)
Reason for expense #1?
Take Photo of receipt #1
Attach receipt #1

Browse Files or Take Photo

Cancelof
Expense Amount #2
do not include a dollar sign ($)
Reason for expense #2?
Take Photo of receipt #2
Attach receipt #2

Browse Files or Take Photo

Cancelof
Expense Amount #3
do not include a dollar sign ($)
Reason for expense #3?
Take Photo of receipt #3
Attach receipt #3

Browse Files or Take Photo

Cancelof
Expense Amount #4
do not include a dollar sign ($)
Reason for expense #4?
Take Photo of receipt #4
Attach receipt #4

Browse Files or Take Photo

Cancelof
Were you the Team Lead on this shift?
Do you have any receipts for charges to a Remarq credit card?
Attach receipts

Browse Files or Take Photo

Cancelof
Details, comments, or feedback regarding credit card expenses?
Do not input mileage nor expense amounts for reimbursement in this section.
Signature must be clear and match your I.D.

I certify that the information provided in this form is complete and accurate, including all reported time, breaks, expenses, and mileage.
Signature must be clear and match your I.D.

I certify that the information provided in this form is complete and accurate, including all reported time, breaks, expenses, and mileage.
Signature
Internal notes on this entry

••• BREAKS •••

••• MILEAGE •••

Reimburseable mileage must be submitted in the mileage section of this form. Mileage that is omitted or improperly reported may be delayed until corrected and properly documented.

••• EXPENSES •••

Signature must be clear and match your I.D.

BREAK & EXPENSE