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Time Sheet

Employee Numirer

Payroll Dept Email; payroll@healthcareaustralia.com.au Phone: 1300 667 391 Fax: 1300 732 318 Mail: PO Box 471, FullartonSA 5063 First Name

W A Nursing A g e n c y Healthcare Australia

Select Health Services Pty Ltd T/AWANA ACN: 086 744 327 Date shift started Day Month Year

Check with 'X'if QuickPay _ | required. Fee applies. Start day (check one box with 'X') Mon Tue Wed Ttiu Fri Sat ^ Sun o :

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Location/ward

I declare 1 worl<ed the above hours

I confirm that the above hours and meal breaks apply with no accidents, incidents or injury occurred during this time period.

Authoriser's name

Agency staff signature

Authoriser's signature

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BLOCK LETTERS PLEASE Employee Number

Email: payroli@heaithcareaustralia.com.au Phone: 1300 667 391 Fax: 1300 732 318 Mail: PO Box 471, Fuiiarton SA 6063 First Name

WA Nursing A g e n c y Healthcare Australia

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Check with X if QuickPay required. Fee applies.
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start time

Start day (check one box with'X') Mon Tue Wed Tfiu Fri Sat Sun

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Finish time

Sub total
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staff classification Write your increment number in the box

RN

EN RMId AIN CW PCA AT CSD IT Other

Finish time

Sub total

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Comments Check with 'X' if travel to be paid

Less meal break

Location/ward

Total hours worked

i declare I worked the above hour?

I confirm that the above hours and meal breaks apply with no accidents incidents or injury occuned during this time period.

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Start time

Finish time

Total in-charge hours

Authoriser's name

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Start time

Finish time

Total on-call hours

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• o--! 3 Authoriser's signature

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WA'0132352
Check with 'X if QuickPay required. Fee applies. Start day (check one box with 'X') Mon Tue Wed Thu Fri Sat Sun

Time Sheet
BLOCK LETTERS PLEASE Employee Number

Payroll Dept Email: payroll@healthcareaustralia,com,au Phone: 1300 667 391 Fax: 1300 732 318 Mail: PO Box 471, FullartonSA 5063 First Name •I

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WA Nursing A g e n c y Healthcare Australia

Select Health Services Pty Ltd T/AWANA ACN: 086 744 327 Date shift started Day Month Year

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start time

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Finish time Sub total

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Staff classification Write your increment number in the box Hospital/site RN EN RMid AIN CW PCA AT CSD IT Other

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Location/ward

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1 declare 1 wori<ed the above hours

1 confirm that the above hours and meal breaks apply with no accidents, incidents or injury occurred during this time period.

Authoriser's name

Agency staff signature

Authoriser's signature