Single Clock Correction Form

Single Clock Correction Form

Employees: If you failed to clock in/out or your time needs a correction, please complete this form before the payroll period ends. Use a separate form for each date. Enter the ACTUAL time you arrived or left, NOT your scheduled time.
Time Clock Information
Name

First NameLast Name
Emp Nr.
Date of Shift

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Please only complete the times that are missing from your report. There is no need to fill in times that were clocked and that pulled through to the report that was received.
Clock In Time

Hour Minutes
Clock Out Time

Hour Minutes
Break Clock Out Time (where applicable)

Hour Minutes
Break Clock In Time (where applicable)

Hour Minutes
Reason for Correction
Details need to be given where possible
Supervisor Approval: I certify that the information reported above reflects the accurate correction and that the employee actually worked the corrected hours.
Supervisor

First NameLast Name
Supervisor Email
example@example.com
Supervisor Signature
Should be Empty:

Time Clock Information