Kilometre Reimbursement Form

Does ShiftCare instructions state you are to use your own car for the below trip/s? If not, do not submit this form as mileage will not be reimbursed.

YesNo

Did you attempt to book a company car for your shift/s through Skedda?*

YesNo

Was there a company car available at the time of the shift? NB: If there was a company car available at the time of the shift, mileage is not payable.*

YesNo

If your travel was outside of Mildura, did you contact management so a company car could be made available? Clients travelling outside Mildura take priority for company cars. If you do not contact management, mileage reimbursement may not be payable, as it is your responsibility to arrange a company car with management for travel outside the Mildura area.*

YesNo

Employee Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

State date:*

Date

End Date*

Date

Total Mileage to be reimbursed*

Trips*

	Date	Client	Where did you go?	Odometer Start	Odometer End	Total KM	Start & End time of shift
1
2
3
4
5
6
7
8
9
10

Kindly add photos of odometer

Have you updated the mileage in ShiftCare for the relevant shift(s)? Mileage is unable to be reimbursed unless ShiftCare has mileage in the corresponding shift.*

YesNo

Reminder:

Under the SCHADS Award, you may use your own car and claim mileage only if a company car is not available. If a company car is available and you choose to use your own vehicle, mileage will not be paid.

For travel outside Mildura (including Koorlong, Irymple, Merbein, Red Cliffs, Wentworth and surrounding areas), you must contact management to arrange a company car. If you don’t, mileage reimbursement may not be payable.

I confirm this mileage claim is true and correct. I confirm I checked if there was not a company car available at the time of my shift/s in Skedda. I have added the kilometres travelled in the mileage section in ShiftCare. If this has not been done, this form is unable to be processed. I understand travel to & from in home shifts (ie personal care etc) within Mildura will not be reimbursed. I understand incomplete forms will be returned for completion. *

Submit by Monday 9am to be reimbursed in the next pay run.