BREAK & EXPENSE
Tracking Form
First and Last Name
*
Your shift's date & SCHEDULED start time:
*
Team Name?
*
Aqua
Blue
Silver
White
Radio Team
Comedy Team
Sports Central
Sports South
Other
LOGISTICS: Aqua
LOGISTICS: Blue
LOGISTICS: Silver
LOGISTICS: Sports (central)
LOGISTICS: Sports South
LOGISTICS: White
LOGISTICS: Comedy Team
LOGISTICS: Radio Team
LOGISTICS: Other
For LOGISTICS SHIFTS, scroll to the bottom.
••• BREAKS •••
Did you take all of your rest break(s) and meal break(s) today?
*
YES
NO
You indicated that you did not take all of your breaks for this shift. Please explain why:
*
••• MILEAGE •••
Did you ride in the team's van for today's entire shift?
Yes
No
Was your vehicle driven TO the first location and FROM the last location.
Yes, my vehicle was driven TO and FROM.
No, I was a passenger in someone else's vehicle.
TO / FROM MILEAGE: Was mileage reimbursement offered TO and FROM work in the shift's details on Humanity?
Yes
No
Input the amount of paid mileage offered TO and FROM the shift as specified in Humanity, ONLY if your vehicle was driven:
*Note to Team Leads: this is where you put any mileage that is not part of the Team's route mileage to the locations on your daily schedule.
ROUTE MILEAGE: Was your vehicle driven today after the first worksite to additional worksites during this shift's scheduled hours?
Yes, I drove my vehicle to multiple worksites during this shift.
No, there was only 1 worksite on this shift or I rode as a passenger.
If your vehicle was driven in between the team's FIRST and LAST worksites during the shift, input the total work-related mileage incurred in your vehicle.
REVISED: Do not include mileage to arrive at the first location nor mileage after you depart from the final location. (*This should include ONLY the mileage between locations that ALL of the team traveled to.)
If reimbursable mileage is not included on this form, it will not be reimbursed.
$ 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?
Yes
No
Expense Amount #1
do not include a dollar sign ($)
Reason for expense #1?
*
Take Photo of receipt #1
Attach receipt #1
Browse Files or Take Photo
Cancel
of
Expense Amount #2
do not include a dollar sign ($)
Reason for expense #2?
*
Take Photo of receipt #2
Attach receipt #2
Browse Files or Take Photo
Cancel
of
Expense Amount #3
do not include a dollar sign ($)
Reason for expense #3?
*
Take Photo of receipt #3
Attach receipt #3
Browse Files or Take Photo
Cancel
of
Expense Amount #4
do not include a dollar sign ($)
Reason for expense #4?
*
Take Photo of receipt #4
Attach receipt #4
Browse Files or Take Photo
Cancel
of
Were you the Team Lead on this shift?
Yes
No
Do you have any receipts for charges to a Remarq credit card?
Yes
No
Attach receipts
Browse Files or Take Photo
Cancel
of
Details, comments, or feedback regarding credit card expenses?
Do not input mileage nor expense amounts for reimbursement in this section.
Draw a clear signature!!!
No initials. No squiggles. It should look like your I.D.
Signature
*
Signature must be clear and match your I.D.
Internal notes on this entry
Submit
OLD First & Last name
First Name
Last Name
OLD - TO / FROM MILEAGE: Were you offered paid mileage to and from work in the shift's details on Humanity or otherwise?
*
YES
NO
*OLD How many uninterrupted 10-minute rest breaks did you take during this shift?
ROUTE MILEAGE: Did you drive your own vehicle today after the first worksite to additional worksites?
*
YES
NO
If you did not drive to multiple locations or if you rode with someone, select "NO"
OLD How many 30-minute meal breaks did you take during this shift?
OLD Your shift's date:
How many uninterrupted 10-minute rest breaks did you take during this shift?
0
1
2
3
How many uninterrupted 30-minute meal breaks did you take during this shift?
0
1
2
3
Are you sure you received ZERO 10-minute breaks on your shift? Your BREAK time(s) were indicated in your shift details and both you and your manager are responsible for you taking your break(s). If you received zero breaks, call Max immediately after you complete this form but BEFORE you clock out. 323-400-4228
Yes, I took ZERO 10-minute breaks.
Oops, I did get a 10-minute break(s) and will correct my response to the previous question.
Should be Empty: