EVV/Sick Time Adjustment Form

EVV/Sick Time Adjustment Form
When issues arise that prevent the EVV App from being used, an adjustment to the shift or a manual time entry will need to be made using this form. You may also use this form to request Sick Pay Hours.

Employees will need to fill out the information below and a member from our admin team will need to review and approve the form.
Employee Name*

First NameLast Name
Employee ID*
Employee ID (You can find on your Pay Stub)
Phone Number*

Area CodePhone Number
Employee Email*
example@example.com
Reason for Time Adjustment or Manual Time Entry*
Select a reason for requesting this Time Adjustment or Manual Time Entry
Explain the reason selected above in more detail:*
Client Name*

First NameLast Name

Rows	Date M-D-Yr	Start Time	End Time	Total Hours
Enter shift details