Weekly Timesheet
Employee Name
First Name
Last Name
Consumer Name
First Name
Last Name
Week Begin Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Week End Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Enter the total number of hours you have worked each day. If you worked more than one shift for the day, please put check-in and check-out time for your second shift in the box titled '2nd Shift'
Rows
Date
Check-in time
Check-out time
2nd Shift
Total Hours
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Total Weekly Hours
Check all that apply:
Worked with more than one consumer this week
Consumer had appointments this week
Made contact with supervisor(s) this week
Made contact with emergency personnel this week
Completed Incident/Behavior report this week
Fax all documentation regarding appointment(s) to (501)213-0574 and fill out a Consumer Health Report
Notes:
Direct Support Professional
My signature indicates that services were provided during the hours outlined on this time document, and I reported all illnesses, behaviors, activies, events, and injuries that occurred during this assignment.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Direct Care Supervisor
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Documentation that is illegible or lacks sufficient detail will be rejected. You may submit timesheets via fax, email (PDF format only), or deliver originals to the main office. Pictures of documents will not be accepted. You must complete each day's documentation during the last hour of your shift. Your weekly timesheet must be submitted no later than 10:00 a.m. on Thursday each week. Failure to submit documentation on time will result in a delay of your hours being submitted to payroll, which will result in a delay of payment.
Continue
Continue
Should be Empty: