Overtime Request Form

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					                              OVERTIME REQUEST FORM
                                PART ONE - REQUEST


Overtime requested by: ____________________________________________________


Project to be performed (provide short description):
________________________________________________________________________
________________________________________________________________________


Estimated number of employees to perform overtime: ____________________________


Estimated time period for project: ____________________________________________


Estimated number of hours: _________________________________________________


Estimated cost: __________________________________________________________


Estimated cost if a contractor was used instead of overtime (if applicable) – attach any
bids requested from vendors as verification: ____________________________________


Index for overtime to be charged : ____________________________________________


Explanation of why the project is not being performed during regular working
hours/shift:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


Approval of Overtime Request

   Department Head: _________________________________            Date: _____________

   Vice President/Chief: _______________________________          Date: _____________
                                      PART TWO – REVIEW

              (Optional form to be completed only if required by VP/Chief)

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    1. “Part Two – Review” of the Overtime Request Form must be completed by
       the requestor of the overtime after the project has concluded.
    2. Attach a copy of “Part One – Request” of the original Overtime Request
       Form for reference.
    3. Attach copies of overtime sheets applicable to this project. Originals
       must be sent to the Payroll Department.
    4. Submit paperwork from (1), (2) and (3) above to the Office of the
       Vice President/Chief.

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Employees that performed overtime:                                        Number of Hours:

_________________________________________                                  ______________________
_________________________________________                                  ______________________
_________________________________________                                  ______________________
_________________________________________                                  ______________________
_________________________________________                                  ______________________
_________________________________________                                  ______________________
_________________________________________                                  ______________________


Dates that work was performed:
________________________________________________________________________
________________________________________________________________________


Actual overtime cost (estimated):_____________________________________________



Explanation of any overrun costs:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

08-07