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: *
Chose a facility or facility type
Facility / Hospital Worked *
Savoy Medical floor worked: *

ER ICU Rehab MedSurg
OGHS floor worked: *

ER ICU PCU / 3rd floor Ortho / 4th floor MedSurg / 5th floor Rehab / South campus Post partum (L&D)
LTAC location worked: *

Lafayette - Louisiana Ext Care Opelousas - St Landry Ext Care New Iberia - Iberia Ext Care Eunice - Eunice Ext Care
Psych location worked: *

Vermilion Behavioral Optima Specialty (Vermilion South) New Beginnings
Nursing Home worked: *

Lake Charles Care Center The Ellington / Rayne Guest Home Maison De Lafayette
Shift worked:

Day Shift (AM - PM) Evening Shift (PM - PM) Night Shift (PM - AM)
Date of shift worked *

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

: Hour Minutes
Until
: Hour Minutes
Total Hours Worked (minus lunch break)
Lunch Break? *

YES NO
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
Nurses Direct Employee Name *

First Name Last Name
Nurses Direct Employee position: *

RN LPN CNA
Charge Nurse (RN ONLY) *

YES NO
Nurse Direct employee signature *

Clear
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