EVV Timesheet Correction Form
Instructions: This form must be completed in full and submitted to the Agency Director or Payroll Department within the same pay period when possible. All corrections required employee and supervisor signatures to comply with EVV and payroll audit requirements.
Name
*
First Name
Last Name
Date of Shift
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client Name
*
First Name
Last Name
Reason for Correction
*
Missed clock-in
Missed clock-out
Incorrect time entered
Other (explain)
If "Other", please explain reason for correction:
Correct Time Entry
*
Total Hours Worked:
*
Explanation of Error:
*
Did you take your required meal periods and rest breaks?
*
Yes
No
If "No", please explain which meal periods and rest breaks you missed:
Employee Signature
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Supervisor/Administrator Review
Reviewed by:
Date Reviewed:
Approved Correction?
Comments:
For Payroll Use Only
Adjustment Entered By:
Date Entered:
Notes:
Should be Empty: