Attachment 7 Time and Attendance Sheet Sample.pdf
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Attachment 7 Time and Attendance Sheet Sample Wheelchair Seating – NWIVAHCS – Omaha Division
Contract #
RECORD OF ARRIVAL AND DEPARTURE TIME
OCTOBER 2022
DATE
PRINT NAME
(Last – First – Initial)
SIGNATURE
ARRIVAL
TIME
LUNCH
OUT
LUNCH
IN
DEPARTURE
TIME
HOURS
WORKED
TOTAL HOURS WORKED
I certify this time and attendance sheet to be accurate:
___________________________________________________ Date: ________________ COR/Manager, Physical Medicine and Rehab Services
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