Form - Missed Clock In/Out Times - HomeCentris Healthcare % Form

Caregiver Name *

In which HomeCentris office do you work?

WARNING:

ALERT MARYLAND CAREGIVERS:  NEW AS OF 2/1/22:  As you were notified, the state of Maryland and HomeCentris policy requires caregivers to record their time accurately and on time.  For any missed punches or inaccurate punches in excess Maryland's allowable limit (four per month), the Company does not receive any compensation on your inaccurate punches.  Therefore, on a caregiver's inaccurate or missing punches in excess of four per month, HomeCentris shall adjust employees time to match the hours reimbursed by Maryland which may exclude hours on inaccurate or missing punches.
https://www.homecentris.com/frequent-clock-in-clock-out-mistakes/

What phone number did you dial to log your time?

ISAS: (855) 463-4727

MEDsys: (877) 895-5183

Date of Missed or Incorrect Punch *

Missed or Corrected "Time In":

:

Missed or Corrected "Time Out":

:

Reason for Missed or Incorrect Punch *

Forgot

Phone problem or poor cell coverage

Client emergency

Need more training

CAREGIVER SIGNATURE: By signing below, I certify the above information is correct and understand any missed punch may be counted as a mistake for the month. I understand that repeated missed punches may lead to disciplinary action, including termination. *

Clear

RESPONSIBLE PARTY SIGNATURE: By signing below, I certify the above information is correct. *

Clear

Please enter your missed time information below.