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  • Certification of Number of Hours Physically Rendered 1

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    Christian Palarca
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    This document certifies the number of hours worked at multiple health facilities by a health care or non-health care worker. It includes fields for the worker's name and address, the names of the health facilities worked at, the worker's position and employment status at each facility, the place of assignment, and the number of hours physically worked at each facility at low, medium, or high levels. The totals for all facilities are calculated and the document is signed by both the worker and a certifying human resources or administrative officer at each facility.

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    Certification of Number of Hours Physically Rendered 1(1)

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    This document certifies the number of hours worked at multiple health facilities by a health care or non-health care worker. It includes fields for the worker's name and address, the names of the health facilities worked at, the worker's position and employment status at each facility, the place of assignment, and the number of hours physically worked at each facility at low, medium, or high levels. The totals for all facilities are calculated and the document is signed by both the worker and a certifying human resources or administrative officer at each facility.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    90 views1 page

    Certification of Number of Hours Physically Rendered 1

    Uploaded by

    Christian Palarca
    This document certifies the number of hours worked at multiple health facilities by a health care or non-health care worker. It includes fields for the worker's name and address, the names of the health facilities worked at, the worker's position and employment status at each facility, the place of assignment, and the number of hours physically worked at each facility at low, medium, or high levels. The totals for all facilities are calculated and the document is signed by both the worker and a certifying human resources or administrative officer at each facility.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    CERTIFICATION OF NUMBER OF HOURS PHYSICALLY RENDERED

    Health care worker (HCW)/Non-HCW Reporting to Multiple Health Facilities


    Period :

    Name:
    Present Address:

    Name of Health Position Employment Place of Number of Hours Certified correct by: (Human
    Facility** Title Status Assignment Physically Rendered Resource Management
    Officer/Administrative Officer)
    Low Medium High Name Signature
    Health Facility A
    Health Facility B
    Health Facility C
    Health Facility D
    TOTAL

    Name and signature of HCW/non-HCW

    **The health facility shall be duly licensed or designated by the DOH, CHD, Provincial/City/Municipal Health Offices and Local Government Health Offices, for COVID-
    19 response per R.A. No. 11712.

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