Timesheet Report

WEEK ENDING (SUNDAY)

Month*

Day*

Year*

CUSTOMER INFORMATION

JOB NUMBER JOB SITE LOCATION

REPORT ALL INJURIES TO YOUR SKILLED STAFFING BRANCH OFFICE IMMEDIATELY SKILLED STAFFING IS A DRUG – FREE WORKPLACE TIME WORKED IS FOR ONE WEEK ONLY. START WITH MONDAY AND END ON MIDNIGHT SUNDAY. ENTIRE TIME NEAREST QUARTER HOUR (.00; .25; .50; .75) ONLY. IF NO HOURS ARE WORKED, LEFT EMPTY IN THE DAY’S COLUMN.

SKILLED STAFFING EMPLOYEE

MON

TUE

WED

THU

FRI

SAT

SUN

TOTALS REGULAR—OVERTIME

GRAND TOTAL

CUSTOMER APPROVAL The hours as shown are correct. By signing this Customer Approval we acknowledge that we are bound by the terms of the conditions of assignment as stated on the reverse hereof and certify that the listed employees have satisfactorily performed service for the hours shown. Additionally, I am not aware of any work-related injuries or accidents which may have occurred during this pay period involving any of the above named employees except as noted at the bottom of this form.

I Agree