Missed Clock In/Out Form

Missed Clock In/Out Form

Proper usage of the WellSky PC app and telephony for timely clocking in and clocking out is an important part of the Care Professional role. This ensures not only that you are paid properly, but also that the status of all tasks are updated correctly. The WellSky PC app, as well as telephony used from the client's home phone gives you the protection of location services to verify that you are at your shift should any questions arise about care log times. If you are having continued difficulty with either process, please call 401-667-2923 for assistance.
Care Professional Name*

First NameLast Name
Email*
example@example.com
Reason for completing form (select all that apply)*

Missed clock inMissed clock outAdjustment needed (time, mileage)
Please explain why you were unable to clock in/out of your scheduled shift.
Would you like additional training on how to use the WellSky PC app?

YesNo
Shift Information
Client Name*

First NameLast Name
Date*

MonthDayYear
Date
Actual Time You Arrived at Shift*

Hour Minutes

AM/PM Option
Actual Time You Left Shift*

Hour Minutes

AM/PM Option
Mileage (in your car for or with the client during shift - not mileage to and from client home)
Expenses

COVID-19 Screening Questions - If you answer yes to any of the following questions, you must call the office.*

	Yes	No
Have you or a member of your household been experiencing any symptoms of COVID-19, including fever, cough, or shortness of breath?
Have you or any member of your household been out of the country in the last 14-18 days?
Have you or any member of your household had close contact with anyone who has been tested, diagnosed, or told by a medical professional that they may have COVID-19?
Have you or a member of your household been in close contact with anyone who has traveled overseas or to a high-risk area within the last 14-18 days?