ATTENDANCE MONITORING SHEET

RETAINER PHYSICIANS
NAME OF PHYSICIAN _____________________________________________________ COMPANY NAME ________________________________________________
MOBILE NUMBER _____________________________________________________ COMPANY SITE _________________________________________________
PERIOD COVERED _______________________________________________________
DATE ACTUAL ATTENDANCE TOTAL EXTENDED HOURS TOTAL HOURS
Encircle the date of duty
SCHEDULE REASON FOR EXTENSION
IN OUT HOURS IN OUT RENDERED

1 16
2 17
3 18
4 19
5 20
6 21
7 22
8 23
9 24
10 25
11 26
12 27
13 28
14 29
15 30
31
NOTE: CUT-OFF PERIOD IS EVERY 15 th & LAST DAY OF THE MONTH. SUBMIT ATTENDANCE MONITORING SHEET WITHIN 3 DAYS AFTER CUT-OFF TO PREVENT PROCESSING DELAYS.
THERE SHOULD BE A VALID REASON STATED FOR EXTENSION BEYOND DUTY HOURS.

__________________________________________ __________________________________________ __________________________________________

Prepared by Validated by Verified and approved by
PHYSICIAN GUARD or HR OPERATIONS OFFICERS IN CHARGE
Signature over printed name Signature over printed name Signatures over printed names

Form Control Template: QMS / October 23, 2019 / FC-CM-0.006/ Rev.00