EVV Exception Form

EVV EXCEPTON FORM
This form is required for any instance in which you fail to clock in or out at your scheduled time. Please ensure that the form is completed immediately after the incident occurs.
EMPLOYEE INFORMATION:
Employee Full Name
Client Full Name
SHIFT DETAILS:
Scheduled shift date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Updated Instructions Please Read: What was your scheduled shift time? Every time listed in caresmartz is here. If you cannot find yours please choose other and enter the start time manually in the note box below.
Please select which exception applies:
Briefly explain the reason for the error. (Example I was late to my shift)
Employee Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
HR Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
HR USE ONLY:
Form Code:
Should be Empty:

SHIFT DETAILS: