Spreadsheet: 107863d1305016768-autofill-sequence-of-master-timesheet
Sheet: Time-Sheet Form

 | Welsh Ambulance Services NHS Trust - All Staff Time Sheet
 | PIN No | 0000          Dummy User |  |  |  | NAME |  |  |  | Pay No: |  |  |  |  |  |  | Contract / Hours/Bank:
 | Station: |  |  |  |  |  |  |  | Month |  |  |  |  |  |  |  |  | Rota No. |  | n/a
 |  |  | Hours of Normal Duty or Non-Attendance |  |  |  |  | Additional | USH Sun/BH | USH Mon/Sat | NHSDW | Meal Breaks |  | Overtime (OT) / Time Off in Lieu (TOIL) |  |  |  |  |  |  |  |  |  | Resp All / Acting up hrs / Remarks / Promis Ref. No.
 | Day | Date | Shift Code | Shift Times |  | [NAME]. | Abs. Code | Basic | Higher | Lower | B/H | Avail | Dist | Stn Code | From | To | [NAME]. | T x 1 | T x 1.5 | B-Hol T x 2 | Over-run | PAY or TOIL | Stdby/ Oncall | Hrs | Remarks / Promis Ref. No.
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 | TOTALS
 | Totals |  |  | A/L Hrs Taken: |  |  |  | Add Basic | Sun/BH USH | Mon/Sat USH | NHSDW | Meal breaks |  |  |  |  |  | Total Toil Hrs Accumulated
 | Sickness Hours: |  |  |  |  |  |  | Res'bility | Higher | Lower | B/H | Avail | Dist |  |  |  |  |  | Tx1 | Tx1.5 | Tx2 | Over runs | On Call | Acting Up Hours
 |  |  |  | [NAME]: |  |  |  |  |  |  |  |  |  |  |  | O/T hours to be Paid:
 | Industrial Injury:
 |  |  |  | Other:
 | ABSENCE ROTA CODES
 | Rest Day |  |  | RD |  |  |  |  | Meals Away From Base |  |  |  |  |  |  |  |  |  |  |  |  | SICKNESS CODES
 | Annual Leave |  |  | AL |  |  |  |  | Date &Time |  |  | Amount |  | Location |  |  |  | Reason |  |  |  | [NAME] |  | CODES
 | [NAME] |  |  | LL |  |  |  |  |  |  |  | £ | p |  |  |  |  |  |  |  |  |  |  | Sickness Absence | Industrial
 | Time Off in Lieu (OT) |  |  | TOIL |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Injury
 | Authorised U/Paid |  |  | AU |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Anxiety/Stress/Depression |  | S10 | I10
 | Unauthorised U/Paid |  |  | UU |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Back Problems |  | S11 | I11
 | Compassionate |  |  | C |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other Musculoskeletal Problems |  | S12 | I12
 | Maternity/Paternity |  |  | M/P |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Cold, Cough, Flu- Influenza |  | S13 | I13
 | Training (specify) |  |  | T |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Asthma |  | S14 | I14
 | Uni / Education |  |  | UE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Chest & Respiratory Problems |  | S15 | [NAME]
 | Special Leave |  |  | SL |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Headache / Migraine |  | S16 | I16
 | Duty Change |  |  | DC |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Benign & Malignant, Cancers, Tumours |  | S17 | I17
 | Secondment |  |  | SM |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  | S18 | I18
 | Trade Union |  |  | TU |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Heart , Cardiac&Circulatory Problems |  | S19 | I19
 | Public Duties |  |  | PD |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Burns. Poisoning |  | S20 | I20
 | Stood Down |  |  | SD |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Ear, [NAME], Throat (ENT) |  | S21 | I21
 | Bank Holiday |  |  | BH |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Dental and Oral Problems |  | S22 | I22
 | Other (specify) |  |  | O |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Eye Problems |  | S23 | I23
 | For Sickness or Industrial Injury See Sickness Codes |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Endocrine/Glandular Problems |  | S24 | I24
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Gastrointestinal |  | S25 | I25
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Genitourinary&Gynaecological Disorders |  | S26 | I26
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Infections Diseases |  | [NAME] | I27
 | FOR LINE MANAGER USE ONLY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Injury , Fracture |  | S28 | [NAME]
 | Pay | Category |  | No. | Hours and [NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Nervous System Disorders |  | S29 | I29
 | Additional Basic |  |  |  | Tx1 | Tx1.5 | Tx2(BH) | Total |  |  |  |  |  |  |  |  |  |  |  |  |  | Pregnancy Related Disorders |  | S30 | I30
 | Overtime |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] |  | S31 | I31
 | Standby |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Substance Abuse |  | S32 | I32
 | On-Call |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other Known Causes |  | S98 | I98
 | Shift Over-runs
 | Mon - Sat USH
 | Sun / B.Hol USH
 | Sun/Bhol Enh.
 | TOIL Pay
 | Totals (to be entered onto summary sheet)
 |  |  |  |  |  |  |  |  | Authorised for Payment By:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | FOR LINE MANAGER USE ONLY
 | Spoilt Meals / Meals Away |  |  |  | No. |  | £ |  |  |  |  |  |  |  |  |  |  | Fill in if related to normal sickness only |  |  |  | Not Applicable
 | Available Meal Payment Total |  |  |  | No. |  | £ |  |  |  |  |  |  |  |  |  |  |  |  | Yes/No |  | Work Related (Industrial Injury)
 | Disturbed Meal Payment Total |  |  |  | No. |  | £ |  |  |  |  |  |  |  |  |  |  |  |  | Other/RTA |  | Third Party / Road Traffic Accident
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes/No |  | Disability Related
 | Acting Up to:- Grade/Pay |  |  |  | Band |  | £ | pa |  |  |  |  |  |  |  |  |  |  |  | Yes/No |  | Violence & Aggression Related
 | for period of |  |  |  | Hrs |  |  | hrs |  |  |  |  |  |  |  |  |  |  |  | Yes/No |  | Notifiable Disease
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Details hrs |  | Hours Lost
 | Responsibility Allow (£1.50 ph) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Details sessions |  | Session Lost
 | Certified for Payment by: - |  |  |  |  |  |  |  |  |  | NAME |  |  |  | Pay No:
 | I understand that the information that I have given on this form is correct and complete.  I understand that if I knowingly provide false information this may result in disciplinary action and I may be liable for prosecution and civil recovery proceedings.
 | I consent to the disclosure of information from this form to and by the Trust and the NHS Counter Fraud and Security Management Service for the purpose of verification of this claim and the investigation, prevention, detection and prosecution of fraud.
 | I am the authorised signatory for this employee.  I am signing below to confirm that the information that I am authorising is accurate and I approve payment.  I understand that if I knowingly authorise false information this may result in disciplinary action
 | and I may be liable for prosecution and civil recovery proceedings.  I consent to the disclosure of information from this form to and by the Trust and the NHS Counter Fraud and Security Management Service for the purpose of verification of this claim
 | and the investigation, prevention, detection and prosecution of fraud.