Docstoc

MISSED REST BREAK AND OR MEAL PERIOD FORM

Document Sample
MISSED REST BREAK AND OR MEAL PERIOD FORM Powered By Docstoc
					             MISSED REST BREAK AND/OR MEAL PERIOD FORM


Printed Name:____________________________________________________________

Department:______________________________________________________________

Date:___________________________________________________________________

Total Hours Worked on this date:_____________________________________________

Missed Rest Break and/or Meal Period on this date:



Please explain why you were unable to take the required break(s)/meal period (if more
than one break(s)/meal period missed, explain each one):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
___________________________________________________________________

I certify that I missed the above referenced break(s)/meal period on this date for the
reasons stated above, and that all information on this form is true and correct.


Signed:______________________________________________Date:_______________

                                    Employer Use Only

Missed breaks/meal periods are acknowledged and action has been taken to ensure the
employee is able to take applicable breaks in the future.

Supervisor:____________________________________________Date:______________

   Form must be turned submitted to Supervisor the day of the missed break and
   submitted to Payroll in accordance with the timecard deadline schedule for the
                               applicable pay period.

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:83
posted:9/8/2010
language:English
pages:1
Jun Wang Jun Wang Dr
About Some of Those documents come from internet for research purpose,if you have the copyrights of one of them,tell me by mail vixychina@gmail.com.Thank you!