Missed Clock In/Out Form
Proper usage of the WellSky PC app and telephony for timely clocking in and clocking out is an important part of the Care Professional role. This ensures not only that you are paid properly, but also that the status of all tasks are updated correctly. The WellSky PC app, as well as telephony used from the client's home phone gives you the protection of location services to verify that you are at your shift should any questions arise about care log times. If you are having continued difficulty with either process, please call 401-667-2923 for assistance.
Care Professional Name
*
First Name
Last Name
Email
*
example@example.com
Reason for completing form (select all that apply)
*
Missed clock in
Missed clock out
Adjustment needed (time, mileage)
Please explain why you were unable to clock in/out of your scheduled shift.
Would you like additional training on how to use the WellSky PC app?
Yes
No
Shift Information
Client Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Actual Time You Arrived at Shift
*
Hour Minutes
AM
PM
AM/PM Option
Actual Time You Left Shift
*
Hour Minutes
AM
PM
AM/PM Option
Mileage (in your car for or with the client during shift - not mileage to and from client home)
Expenses
COVID-19 Screening Questions - If you answer yes to any of the following questions, you must call the office.
*
Rows
Yes
No
Have you or a member of your household been experiencing any symptoms of COVID-19, including fever, cough, or shortness of breath?
Have you or any member of your household been out of the country in the last 14-18 days?
Have you or any member of your household had close contact with anyone who has been tested, diagnosed, or told by a medical professional that they may have COVID-19?
Have you or a member of your household been in close contact with anyone who has traveled overseas or to a high-risk area within the last 14-18 days?
Did you update your tasks for this shift?
*
Yes
No
***** This is a required field for Payroll and Insurance. ***** Please describe what tasks you completed during your shift today. "N/A" for missed clock ins only.
*
I would like to speak with a member of the client care team about this clients change in condition?
*
Yes
No
I certify that the above information is true and accurate.
*
Home Instead
100 Jefferson Blvd. Suite 310 Warwick, RI 02888
401-214-2470
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