Employee Resources

Time Off Request Form

Please fill out the following form for the day(s) you’d like to request off. Request forms are due 1 month prior to time needed off and all forms will be reviewed at a first-come first-served basis. We will try our best to accommodate your requests.

Time Adjustment Request

Employee Name

Supervisor Name

Work Day of Time Adjustment Request

Work Date of Time Adjustment Request

CORRECT Clock In/Clock Out Times SHOULD be

Clock In

Clock Out

Reason for/Explanation of Time Adjustment Request

New employee; unable to utilize Telephony

Forgot to clock in using Telephony

Forgot to clock out using Telephony

Worked after clocking out using Telephony

Worked after clocking in using Telephony

Interrupted sleep time

Duplicate clock in or out (i.e., inadvertently clocked in or out twice)

Telephony malfunction

Other

If other, explain:

Mileage (if applicable)

Time Log And Certification For Non-Visit Working Time

By submitting this Time Log and Certification for Non-Visit Time (“Time Log”), I certify that I have carefully reviewed this Time Log and that I have accurately recorded all non-visit time worked. I hereby certify that I have accurately reported my non-visit time worked, that I have not reported more or less time than I actually worked, and that I have not rounded up or down any start or stop time. I have not been pressured, coerced, or directed by anyone to inaccurately report my non-visit time worked. I understand I must certify the accuracy of this Time Log, and I agree to contact Dakota Home Care if the Time Log I submit is inaccurate. I acknowledge it is my responsibility to notify my supervisor of any issues/conditions that require me to work beyond regularly scheduled hours. If I work beyond my regularly scheduled hours, with or without approval, I understand I will be compensated for the additional, unscheduled time worked.

Employee Name

Date

Start Time

End Time

Total Time

Client Name (if applicable)

Description

Dakota Home Care’s Travel Time Policy provides an explanation of compensable travel time, and all time spent traveling should be recorded in accordance with this policy.

Employee Handbook

All employees are encouraged to review and refer to our Dakota Home Care Employee Handbook frequently.

Dakota Home Care Employee Handbook (password protected)

Time Off Request Form​

Time Adjustment Request

Time Log And Certification For Non-Visit Working Time

Employee Handbook

Time Off Request Form