TIMESHEET

TIMESHEET DEADLINE - MONDAY 1600 - FAX: 01277 848 687

Client name and address:
Postcode:
Department: Position:
Start Date: End date:
Day

Date

Start Time

End Time

Break Start

Break Finish

Total Hours

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total hours worked in words:

Total hours worked numerically:

EXPENSES CLAIM
Mileage (please provide amount and details of journey):
Public transport (please provide amount and details of journey):
NO EXPENSES WILL BE PAID UNLESS CORRECT RECEIPTS HAVE BEEN PRESENTED WITH YOUR TIMESHEET

KEY COUNTER FRAUD MEASURES - PLEASE READ!

All entries must be made in black ink and block capitals

No correction fluid must be used on the timesheet
Any timesheet which is incomplete or illegible will result in the
form being returned to you and a delay in payment
Any corrections or alterations made on the timesheet by the agency
worker must be initialled by the authorised signatory

Before the timesheet is submitted for authorisation, any

uncompleted boxes must be crossed through
Times of hours worked should be entered in the twenty-four hour \
format only
Total hours worked should be written in long hand in addition to
numerically

COUNTER FRAUD DECLARATION TO BE SIGNED BY AGENCY WORKER

Full Name:

Position:

Signature: Date:
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 for prosecution and civil recovery proceedings. I
consent to the disclosure of information from this form to and by the NHS body and the NHS Counter Fraud and Security Management Service for the purpose of
verification of this claim and the investigation, prevention, detection and prosecution of fraud. I understand that a copy of your Terms of Engagement is available on
request.
COUNTER FRAUD DECLARATION TO BE SIGNED BY AN AUTHORISED SIGNATORY WITHIN THE NHS BODY OR OTHER PARTICIPATING AUTHORITY

Full Name:

Position:

Signature: Date:
I am an authorised signatory for my ward/department/NHS body. I am signing below to confirm that both the grade of agency worker and the hours/shift that I am
authorising are accurate and I approve payment. I understand that if I knowingly authorise false information this may result in disciplinary action and I may be liable
for prosecution and civil recovery proceedings. I consent to the disclosure of information from this form to and by the NHS body and the NHS Counter Fraud and
Security Management Service for the purpose of verification of this claim and the investigation, detection and prosecution of fraud. I understand a copy of your Terms
of Business is available on request.
T: 01277 212 797
F: 01277 246 850
E: accounts@promedical.co.uk
W: www.promedical.co.uk

ProMedical Personnel Ltd,

Compliance Department, Regent House,
Hubert Road, Brentwood
CM14 4JE

PMP-VS001 APRIL 2012

ProMedical