UNDERTIME AND HALFDAY FORM
SBU-BRANCH: DESIGNATION: DATE FILED:
NAME OF EMPLOYEE: EMPLOYMENT STATUS: DATE HIRED:
DATE OF UT/HD: TIME: NAME OF RELIEVER: ___________________
______________________________ IN: _________________
(MM/DD/YYYY) OUT: _______________ DESIGNATION: ______________________
REASONS/JUSTIFICATION:
DOCTOR/NURSE REMARKS:
NOTE: This form must be accomplished and submitted to Admin Department.
REQUESTED BY: APPROVED BY: RECEIVED BY:
Employee's Signature - Date Immediate Head Admin Dept.
*Undertime rendering less than eight hours but more than four hours work or;
*Halfday; rendering an exact four hours work either at first or last working hours.
CC.Dept./Guard MG/Admin/Admin File 09/2015