Time Sheet - Keystone Passionate Care

2000 Linglestown Rd, Suite 101
Harrisburg, PA 17110

Phone: 717-298-3555

Time Sheet

Time sheet

Pay Period (Dates)

MM slash DD slash YYYY

Thru

MM slash DD slash YYYY
Monday
MM slash DD slash YYYY

Shift One

Time in
:
Time Out
:

Shift Two

Time in
:
Time Out
:
Tuesday
MM slash DD slash YYYY

Shift One

Time in
:
Time Out
:

Shift Two

Time in
:
Time Out
:
Wednesday
MM slash DD slash YYYY

Shift One

Time in
:
Time Out
:

Shift Two

Time in
:
Time Out
:
Thursday
MM slash DD slash YYYY

Shift One

Time in
:
Time Out
:

Shift Two

Time in
:
Time Out
:
Friday
MM slash DD slash YYYY

Shift One

Time in
:
Time Out
:

Shift Two

Time in
:
Time Out
:
Saturday
MM slash DD slash YYYY

Shift One

Time in
:
Time Out
:

Shift Two

Time in
:
Time Out
:
Sunday
MM slash DD slash YYYY

Shift One

Time in
:
Time Out
:

Shift Two

Time in
:
Time Out
:

Activity Record

Directions: This is a legal document. Check the assignment/care plan. Check each activity that is completed. Indicate “R” if an assigned activity is refused by the consumer. Indicate “H” for hospitalizations. Consumer changes, including hospitalizations should be called in to the Case Manager, IMMEDIATELY. 717-298-3555 Ex. 2

Activity record
Activity
Day
Status
 

Consumer Note: By your signature, you certify that hours shown are correct, and work was completed satisfactorily for the days and time documented:

EMPLOYEE NOTE: By your signature, you certify that the hours recorded for the above dates are true and accurate and are properly verified by the client.

MM slash DD slash YYYY