Octirose Time and Activity Form

1

Terms and Conditions* This field is required.This form must be submitted before/by 11:59pm at the end of every Monday. If you submit your Time and Activity Form after 11:59PM on Mondays and/or have errors that delay Payroll from processing during their normal processing times, You agree that you have been informed that you will receive that week's pay on your following Pay check after the Time and Activity Form has been Approved.

2

UNDERSTAND

1. Not submitting your time sheet because you assume payroll knows what you work, will result in that time being paid out on the next Pay Date, After you have submitted your Approved Time and Activity(TAA) Form.

2. Submitting a Late TAA Form, will result in that time being paid out on the next Pay Date.

3. Submitting an Incorrect TAA form and not having it corrected before the end of Monday at 11:59PM, will result in that time being paid out on the next Pay Date.

4. Submitting your TAA form before your shift is completed will result in an Automatic Disapproval of that Form

3

Employee Email* This field is required.

example@example.com

Confirm Email

4

Did you work Monday* This field is required.

YESNO

5

Monday Date* This field is required.

Monday Date

6

Monday Time* This field is required.What time did you Clock-In Monday?

Monday Clock-In Hour

Monday Clock-In Minutes

Until

Monday Clock-Out Hour

Monday Clock-Out Minute

7

Did you work a Second Shift Monday* This field is required.

YESNO

8

Monday Second Shift Time* This field is required.What time did you Clock-In Monday for your Second Shift?

Monday Clock-In Hour

Monday Clock-In Minutes

Until

Monday Clock-Out Hour

Monday Clock-Out Minute

9

Monday Work Hours Total* This field is required.How many hours did you work on Monday?

Monday Work Hours Total

10

Monday Mileage TotalHow many miles did you drive for the Client during work hours?

Monday Mileage Total

11

Monday Activity Description* This field is required.Describe what was performed and/or experienced on Monday’s work shift with the client.

Description of Work Day

12

Did you work Tuesday* This field is required.

YESNO

13

Tuesday Date* This field is required.

Tuesday Date

14

Tuesday Time* This field is required.What time did you Clock-In Tuesday?

Tuesday Clock-In Hour

Tuesday Clock-In Minutes

Until

Tuesday Clock-Out Hour

Tuesday Clock-Out Minute

15

Did you work a Second Shift Tuesday* This field is required.

YESNO

16

Tuesday Second Shift Time* This field is required.What time did you Clock-In Tuesday for your Second Shift?

Tuesday Clock-In Hour

Tuesday Clock-In Minutes

Until

Tuesday Clock-Out Hour

Tuesday Clock-Out Minute

17

Tuesday Work Hours Total* This field is required.How many hours did you work on Tuesday?

Tuesday Work Hours Total

18

Tuesday Mileage TotalHow many miles did you drive for the Client during work hours?

Tuesday Mileage Total

19

Tuesday Activity Description* This field is required.Describe what was performed and/or experienced on Tuesday’s work shift with the client.

Description of Work Day

20

Did you work Wednesday* This field is required.

YESNO

21

Wednesday Date* This field is required.

Wednesday Date

22

Wednesday Time* This field is required.What time did you Clock-In Wednesday?

Wednesday Clock-In Hour

Wednesday Clock-In Minutes

Until

Wednesday Clock-Out Hour

Wednesday Clock-Out Minute

23

Did you work a Second Shift Wednesday* This field is required.

YESNO

24

Wednesday Second Shift Time* This field is required.What time did you Clock-In Wednesday for your Second Shift?

Wednesday Clock-In Hour

Wednesday Clock-In Minutes

Until

Wednesday Clock-Out Hour

Wednesday Clock-Out Minute

25

Wednesday Work Hours Total* This field is required.How many hours did you work on Wednesday?

Wednesday Work Hours Total

26

Wednesday Mileage TotalHow many miles did you drive for the Client during work hours?

Wednesday Mileage Total

27

Wednesday Activity Description* This field is required.Describe what was performed and/or experienced on Wednesday’s work shift with the client.

Description of Work Day

28

Did you work Thursday* This field is required.

YESNO

29

Thursday Date* This field is required.

Thursday Date

30

Thursday Time* This field is required.What time did you Clock-In Thursday?

Thursday Clock-In Hour

Thursday Clock-In Minutes

Until

Thursday Clock-Out Hour

Thursday Clock-Out Minute

31

Did you work a Second Shift Thursday* This field is required.

YESNO

32

Thursday Second Shift Time* This field is required.What time did you Clock-In Thursday for your Second Shift?

Thursday Clock-In Hour

Thursday Clock-In Minutes

Until

Thursday Clock-Out Hour

Thursday Clock-Out Minute

33

Thursday Work Hours Total* This field is required.How many hours did you work on Thursday?

Thursday Work Hours Total

34

Thursday Mileage TotalHow many miles did you drive for the Client during work hours?

Thursday Mileage Total

35

Thursday Activity Description* This field is required.Describe what was performed and/or experienced on Thursday’s work shift with the client.

Description of Work Day

36

Did you work Friday* This field is required.

YESNO

37

Friday Date* This field is required.

Friday Date

38

Friday Time* This field is required.What time did you Clock-In Friday?

Friday Clock-In Hour

Friday Clock-In Minutes

Until

Friday Clock-Out Hour

Friday Clock-Out Minute

39

Did you work a Second Shift Friday* This field is required.

YESNO

40

Friday Second Shift Time* This field is required.What time did you Clock-In Friday for your Second Shift?

Friday Clock-In Hour

Friday Clock-In Minutes

Until

Friday Clock-Out Hour

Friday Clock-Out Minute

41

Friday Work Hours Total* This field is required.How many hours did you work on Friday?

Friday Work Hours Total

42

Friday Mileage TotalHow many miles did you drive for the Client during work hours?

Friday Mileage Total

43

Friday Activity Description* This field is required.Describe what was performed and/or experienced on Friday’s work shift with the client.

Description of Work Day

44

Did you work Saturday* This field is required.

YESNO

45

Saturday Date* This field is required.

Saturday Date

46

Saturday Time* This field is required.What time did you Clock-In Saturday?

Saturday Clock-In Hour

Saturday Clock-In Minutes

Until

Saturday Clock-Out Hour

Saturday Clock-Out Minute

47

Did you work a Second Shift Saturday* This field is required.

YESNO

48

Saturday Second Shift Time* This field is required.What time did you Clock-In Saturday for your Second Shift?

Saturday Clock-In Hour

Saturday Clock-In Minutes

Until

Saturday Clock-Out Hour

Saturday Clock-Out Minute

49

Saturday Work Hours Total* This field is required.How many hours did you work on Saturday?

Saturday Work Hours Total

50

Saturday Mileage TotalHow many miles did you drive for the Client during work hours?

Saturday Mileage Total

51

Saturday Activity Description* This field is required.Describe what was performed and/or experienced on Saturday’s work shift with the client.

Description of Work Day

52

Did you work Sunday* This field is required.

YESNO

53

Sunday Date* This field is required.

Sunday Date

54

Sunday Time* This field is required.What time did you Clock-In Sunday?

Sunday Clock-In Hour

Sunday Clock-In Minutes

Until

Sunday Clock-Out Hour

Sunday Clock-Out Minute

55

Did you work a Second Shift Sunday* This field is required.

YESNO

56

Sunday Second Shift Time* This field is required.What time did you Clock-In Sunday?

Sunday Clock-In Hour

Sunday Clock-In Minutes

Until

Sunday Clock-Out Hour

Sunday Clock-Out Minute

57

Sunday Work Hours Total* This field is required.How many hours did you work on Sunday?

Sunday Work Hours Total

58

Sunday Mileage TotalHow many miles did you drive for the Client during work hours?

Sunday Mileage Total

59

Sunday Activity Description* This field is required.Describe what was performed and/or experienced on Sunday’s work shift with the client.

Description of Work Day

60

Total Work Week Hours * This field is required.This is the total hours you’ve worked this week.

Work Hours Total

61

Total Work Week Mileage* This field is required.This is the total miles you’ve driven on the clock for the client this week.

Work Mileage Total

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Employee Name* This field is required.Please enter your Name.

First Name

Last Name

63

Employee Signature* This field is required.Please sign your name.

64

Client Name* This field is required.Please enter your Client’s Name.

First Name

Last Name

65

Client Signature* This field is required.Please have your Client sign their name.

66

Submission DateThis value should not be visible to the user and is used to help name the file.

Submission Date

Hour

Minutes