Please email/hand in your timesheet by Monday 5PM or post to arrive Monday

Timesheet Ref No: ISON000383

Email: Timesheets@isonna.co.uk

Post: 128 Highstreet, Edgware, Middlesex, HA8 9NP

Payroll Enquires: 020 8952 0351 Option 5 for Finance

PLEASE COMPLETE ALL FIELDS FULLY IN BLOCK LETTERS, USING A BLACK BALLPOINT PEN AND 24-HOUR CLOCK OR YOUR PAYMENT MAY BE DELAYED

First Name

Surname

Trust/Ward/Unit

Job Title

Ison ID No

Note to candidate: Please can you ensure that you ask the authorising signatory to complete the shift appraisal

Client Shift Appraisal (client use only)

1=unsatisfactory 2=poor 3=satisfactory 4=good 5=excellent N/A=Not Applicable

Punctuality

Clinical Skills

Team Working

Organization Skills

Management Skills

Accountability

Concerns?

Yes/No

Willing to have candidate return?

Yes/No

Induction complete? (1st timers only)

Yes/No

You may report any case of fraud, in confidence, to the NHS Fraud and Corruption Reporting Line on 0800 0284060.

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Day

Date

Start

Break

Finish

Total Hours
(excluding breaks)

Band

Shift Reference

Daily Authorised Client Initials

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

TOTAL HOURS (excluding break)

Candidate declaration: I declare that the information I have given on this timesheet is correct and complete and I have not claimed elsewhere for the hours/shift details on this timesheet. I understand that if I knowingly provide false information this may result in disciplinary action, and I am liable for persecution and civil recovery proceedings. I consent to disclosure of information from this timesheet to and by any Ison authorised body for the purpose of verification of this claim and the investigation prevention detection and prosecution of fraud.

Name:

Signature:

Speciality:

Date:

Candidate authoriser: I am an authorised signature for my ward/department/NHS body or other relevant organisation I’m signing to confirm that the job profile title and band of the candid it and the hours/shift that I am authorising is accurate and I approve payment. I understand that if I knowingly provide false information this may result in disciplinary action and I may be liable to persecution and civil recovery proceedings. I consent to the disclosure of information from this form to and by any Ison authorised body for the purpose of verification of this claim and the investigation prevention detection and prosecution of fraud I understand and agree to Ison’s current terms of business. Note to client if you have any concerns you wish to raise, please email them to support@isonna.co.uk

Name:

Signature:

Speciality:

Date: