Spreadsheet: 763406d1642158530-linking-excel-sheets-time-sheet-ceredigion-master
Sheet: BACK

 | Absence Rota Codes
 | Rest Day |  |  |  |  | RD |  |  |  |  | Meals Away From Base |  |  |  |  |  |  |  |  |  |  |  |  |  | SICKNESS CODES
 | Annual Leave |  |  |  |  | AL |  |  |  |  |  | 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 |  |  | 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 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Bengin/malignant tumours cancers |  |  | S17 | I17
 | Secondment |  |  |  |  | SM |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Blood disorders |  |  | S18 | I18
 | Trade Union |  |  |  |  | TU |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Heart/cardiac/circulatory problems |  |  | S19 | I19
 | Public Duties |  |  |  |  | PD |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Burns/poisoning/frostbite.hypothermia |  |  | S20 | I20
 | Stood Down |  |  |  |  | SD |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Ear/nose/throat (ENT) |  |  | S21 | I21
 | Bank Holiday |  |  |  |  | BH |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Dental/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 problems |  |  | S25 | I25
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Genitourinary/gynaecological disorder |  |  | S26 | I26
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Infectious diseases |  |  | [NAME] | I27
 | FOR LINE MANAGER USE ONLY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Injury/fracture |  |  | S28 | [NAME]
 | Pay |  |  | No. |  | Hours and [NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Nervous system disorders |  |  | S29 | I29
 | Category |  |  |  | Tx1 |  | Tx1.5 | Tx2(BH) | Total |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Pregnancy related disorders |  |  | S30 | I30
 | Overtime |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Skin disorders |  |  | S31 | I31
 | Standby |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Substances abuse |  |  | S32 | I32
 | On-Call |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other known causes |  |  | S98 | I98
 | Shift Over-runs
 | Total
 | Mon - Sat USH
 | Sun / B.Hol USH
 | Sun/Bhol Enh.
 | TOIL Pay
 | Totals (to be entered onto summary sheet)
 |  |  |  |  |  |  |  |  |  |  | Total
 |  |  |  |  |  |  |  |  |  |  | Authorised for Payment By:
 | Spoilt Meals |  |  |  |  | No.
 | Meals away from Base |  |  |  |  | No. |  |  |  |  |  |  |  |  |  | Fill in if related to normal sickness only |  |  |  |  |  |  |  |  | Not Applcable
 | Available Meal Payment Total |  |  |  |  | No. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes/No |  |  | Work Related (Industrial injury)
 | Responsibility Allow (£1.50 ph) |  |  |  |  | No. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Other/RTA |  |  | Third Party / Road Traffic Accident
 | Acting Up to:- Grade/Pay |  |  |  |  | Band |  | £ | pa |  |  |  |  |  |  |  |  |  |  |  |  | Yes/No |  |  | Disability Related
 | for period of |  |  |  |  | Hrs |  |  | hrs |  |  |  |  |  |  |  |  |  |  |  |  | Yes/No |  |  | Violence & Aggression Related
 |  |  |  |  |  |  |  |  |  |  | NAME |  |  |  | PAY NO |  |  |  |  |  |  | Yes/No |  |  | Notifiable Diseases
 | Shift Change within 24 hrs |  |  |  |  | No. |  | £ |  |  |  |  |  |  |  |  |  |  |  |  |  | Details hrs |  |  | Hours Lost
 | Certified for Payment by: - |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Details sessions |  |  |  |  | Session Lost
 |  | Name and Job Title |  |  |  |  |  |  |  |  | Employee Name |  |  |  |  |  |  |  | Employee Signature |  |  |  |  |  |  |  | Date
 |  | OFFICE USE
 |  | Signature |  |  |  | Date |  |  |  |  | Manager name |  |  |  |  |  |  |  | Manager Signature |  |  |  |  |  |  |  | Date
 |  | OFFICE USE |  |  |  | OFFICE USE
 | 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.