OPTIMASTAFFINGSOLUTIONSTIMESHEET

Pleaseemailalltimesheetstotimesheets@optimastaffingsolutions.co.uk.TimesheetsMUSTbereceivedbyMIDDAYonMONDAYforpaymenttobemadeonFriday.

Pleasecompletefullyasincompleteorincorrecttimesheetsmayresultindelayinpayment.YOURNAME

HOSPITAL/HOME

WARD/UNIT

ROLE RMNRGNHCABAND:

WEEKENDING(SUNDAY):………………………………………………………………………………………………………………….DAY DATE START

TIMEBREAK FINISH

TIMEHOURSWORKED(excludingbreaks)

WARD/UNIT BOOKINGREF

AUTHORISEDSIGNATURE

MON

TUE

WED

THU

FRI

SAT

SUN

TOTALHOURSWORKEDINTHEWEEK

CLIENTAUTHORISATION CANDIDATESDECLARATION

Iamanauthorisedsignatoryofaboveclient.Iamsigningtoconfirmthattheagencyworkerhasworkedthehoursspecified.Iconfirmthatthehoursareaccurate and I approvepayment. I understand that if I knowingly providefalseinformation,thismayresultindisciplinaryactionandImaybeliabletoprosecution and civil recovery proceedings. I consent to the disclosure ofinformationfromthisformtoandusebyanyauthorisedbodyforthepurposeofverificationofthisclaimandtheinvestigation,prevention,detectionandprosecutionoffraud.IunderstandandtoOptima’scurrentBusinessTermsofBusinessSignature

Name

Position

Date

I declare that the information I haveprovidedon this form is correct andcompleteandthatIhavenotclaimedelsewhereforthehours/shiftsdetailedonthistimesheet.IunderstandthatifIknowinglyprovidefalseinformation,thismayresultindisciplinaryactionandImaybeliabletoprosecutionandcivil recoveryproceedings. I consent to thedisclosureof information fromthisformtoandusebyanyauthorisedbodyforthepurposeofverificationofthisclaimandtheinvestigation,prevention,detectionandprosecutionoffraud.IunderstandandtoOptima’scurrentBusinessTermsofBusinessSignature

Name

Position

Date

CLINICAL&CHARACTERASSESSMENTAssessmentCriteria Excellent Good Satisfactory UnsatisfactoryDemonstratesClinicalCompetenceforrole Conduct/Behaviour/Attitude/Teamwork Timekeeping/Punctuality Communicationskillsdemonstrated Appearance/dressingcode OverallPerformanceonshift Assessedby:Name:Signature:Role/Position:

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