sensible staffing timesheet

 

 

 

 

 

 

Working hours:

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Date Booking Ref Start Time Finish Time Break Overtime Worked

Hours

On Call

Hours

Combined

Hours

Total Hours

Daily Authorised Signature for Worked Hours

SENSIBLESTAFFING Timesheet

Agency Worker

Signature:

x Date:

Agency Worker declaration: I declare that the information I have given on this form is correct and complete and that I have not claimed elsewhere for the

hours/shifts detailed on this timesheet. I understand that if I knowingly provide false information this may result in disciplinary action and I may be liable

to prosecution and civil recovery proceedings. I consent to the disclosure of information from this form to and by the NHS body and the NHS CFSMS for the

purpose of veri­cation of this claim and the investigation, prevention, detection and prosecution of fraud. I declare that I am ­t to work & that I will

promptly inform the Company if this does or is likely to change. I have received an induction and orientation by the Client for this assignment, including

details of any onsite health & safety requirements and I have access to personal protective equipment. I con­rm that I have not worked for this Client via

another employment business within the previous twelve calendar weeks and that I am responsible for monitoring my hours of work in relation to the

Working Time Regulations. I have read, understood and agree to the Terms of Engagement supplied to me by the Company.

Agency Worker Details:

Forename(s):

Surname:

Grade:

Speciality: Placement Code:

Client Name:

Client Site:

Client Dept:

experts in healthcare recruitment

Weekly Hours Authorised by the Client: CLIENT SECTION ONLY

Placement assessment. Please as

appropriate.

Clinical skills in line with needs of position

Relationships with patients & sta­

Timekeeping

Managing workload

Reliability

Communication skills

Supervisory skills

Organisational ability

Sickness/absence record

Overall clinical & professionals performance

N/A Unsatisfactory Borderline Satisfactory Good Excellent

Client declaration: I am an authorised signatory for my ward/department/Company/NHS body. I am signing to con­rm that the

Job Title and Band (where applicable) of the Agency Worker and the hours/shift that I am authorising are accurate and I

approve payment. I understand that if I knowingly provide false information this may result in disciplinary action and I

may be liable to prosecution and civil recovery proceedings. I consent to the disclosure of information from this form to and

by the NHS body and the NHS CFSMS in England for the purpose of veri­cation of this claim and the investigation, prevention,

detection and prosecution of fraud. I acknowledge that the standard terms of business or other terms of business as stated on

the Con­rmation of Booking have been made available to me and are accepted and that an introduction fee may be chargeable

should a transfer of the Agency Worker either to direct/permanent employment or engagement by a third party occur.

NHS Fraud & Corruption Line: Any questionable timesheet must be immediately brought to the attention of the Local Counter

Fraud Specialist or you must report any case of fraud in con­dence to the NHS Fraud and Corruption Reporting Line on 0800

028 4060 (within England) or 0800 015 1628 (within Scotland).

Print Name:

Client Signature: x

Position:

Date:

On completion, please fax to: 0208 364 9966 or email to: timesheets@sensible-sta‑ng.com Page 1 of 1

 

 

 

 

Download Free