Name
*
First Name
Last Name
Weekending Date
*
/
Day
/
Month
Year
Date
Company
*
Monday Hours
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Monday Break Time
Please Select
0 - No Break
0.5 - Half Hour
1 - Hour
Monday Total Hours
Tuesday Hours
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Tuesday Break Time
Please Select
0 - No Break
0.5 - Half Hour
1 - Hour
Tuesday Total Hours
Wednesday Hours
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Wednesday Break Time
Please Select
0 - No Break
0.5 - Half Hour
1 - Hour
Wednesday Total Hours
Thursday Hours
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Thursday Break Time
Please Select
0 - No Break
0.5 - Half Hour
1 - Hour
Thursday Total Hours
Friday Hours
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Friday Break Time
Please Select
0 - No Break
0.5 - Half Hour
1 - Hour
Friday Total Hours
Saturday Hours
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Saturday Break Time
Please Select
0 - No Break
0.5 - Half Hour
1 - Hour
Saturday Total Hours
Sunday Hours
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Sunday Break Time
Please Select
0 - No Break
0.5 - Half Hour
1 - Hour
Sunday Total Hours
Total Weekly Hours
Additional Notes / Comments ?
Drivers Must take a 30 minute break prior to completion of a 5 1/2 hour working period. Drivers must have a 10 hour break after the completion of a 13 hour maximum working period. Drivers must have a 24 hour break upon completion of a 70 hour cumulative working period.
*
I CERTIFY THAT THE HOURS ABOVE ARE CORRECT AND THAT THE WORK HAS BEEN COMPLETED TO A SATISFACTORY STANDARD
Please read over the health and safety policy
*
I have read and agree with the Heath and safety policy
Please let us know about any health and safety concerns from the previous week
Signature
*
Please verify that you are human
*
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