Nurses Direct E-Time Slip

NURSES DIRECT LLC
** 109 South College Rd ** Lafayette, LA 70503

Office # 337-289-5393 - Fax # 337-769-9069
Facility / Hospital / Location: *
Chose a facility or facility type
Location / City *
Client Name *
Shift worked: *
Type of shift worked
Savoy Medical floor worked: *

ER ICU Rehab MedSurg Psych
Acadia General Hospital floor worked: *

ER ICU MedSurg Orientation
OGHS floor worked: *

ER (Main campus) ER (South campus) ICU PCU / 3rd floor Ortho / 4th floor MedSurg / 5th floor or South Campus Rehab / South campus Post partum (L&D) Orientation / Training / Education
LHC LTAC location worked: *

Lafayette - Louisiana Ext Care Opelousas - St Landry Ext Care New Iberia - Iberia Ext Care Crowley - Acadia Ext Care
AMG location worked: *

Lafayette Physical Rehab - Lafayette Lafayette AMG Zachary AMG Covington AMG Houma AMG
Acadia Vermilion Location: *

Main Campus South Campus
Date of shift worked *

Month Day Year
Date when shift STARTED
Time worked (Clocked in and out) *

: Hour Minutes AM/PM Option
Until
until : Hour Minutes AM/PM Option
Lunch Break? *

YES NO
Total Hours Worked (WITH meal break)
Total Hours Worked (WITHOUT meal break)
Reason for NO LUNCH/MEAL break (VALID reason must be documented) *

Short staffed / No relief Extremely busy Short shift / Sent home early Schedule error / sent home Shift cancelled less than 2 hours prior to shift beginning
Nurses Direct Employee Name *

First Name Last Name
Nurses Direct Employee position: *

RN LPN CNA
Charge Nurse (RN ONLY) *

YES NO
Employee Personal Email: *
example@example.com
Nurse Direct employee signature *

Clear
*

Shift times approved and signed by authorized individual NO ONE AVAILABLE TO SIGN/APPROVE OF SHIFT TIMES
Facility employee approval name: *

First Name Last Name
Facility approval employee position: *

RN LPN
Facility employee approval signature *

Clear
Should be Empty:

NURSES DIRECT LLC

** 109 South College Rd ** Lafayette, LA 70503

109 South College Rd Lafayette, LA 70503