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(All) - Call Off Form

This document provides instructions for healthcare workers to report any shifts they are called off from work. The form should be submitted to the staffing agency whenever a call off occurs so that payroll can be properly tracked. Any call off shifts reported on this form will be sent to the healthcare facility for approval before payment is issued, which may take up to a week. The form must be received by the following Monday to record the call off shift. Contact information is provided if there are any other questions.

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Patricia Marinas
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3K views1 page

(All) - Call Off Form

This document provides instructions for healthcare workers to report any shifts they are called off from work. The form should be submitted to the staffing agency whenever a call off occurs so that payroll can be properly tracked. Any call off shifts reported on this form will be sent to the healthcare facility for approval before payment is issued, which may take up to a week. The form must be received by the following Monday to record the call off shift. Contact information is provided if there are any other questions.

Uploaded by

Patricia Marinas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Call-Off Form

Employee:__________________________ Contract Dates:__________________________

Every facility has a different call off policy and most do not report call off shifts to Aya. This is why it is important that if
you are ever called off of a shift, you use this form to alert payroll. Please send the form to Aya whenever you add a new
call off shift. This will help us track your shifts to see if you have exceeded your facilities limit for call offs and are eligible
for pay for the call offs. All call off shifts reported to Aya will be sent to your facility for approval, therefore there is likely
to be a lag of a week in payment (if owed) for a call off shift. Please track all call offs on this same form and add as your
assignment continues. The form must be received the Monday after your call of shift. Feel free to contact us at 866-687-
7390 if you have any questions.

**Please Note: If you volunteer to go home it does not count as a call off**

Please email to timecards@ayahealthcare.com or fax to 1-866-350-2836.

Did you call in sick


Date of call off/ during this pay period
sent home Hours Hours Were you offered or volunteer to go Total hours called Manager
early Scheduled Worked another shift? home? off or shorted Initials

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