Time Adjustment Form Details
Employee number:
Employee name:
Adjustment for missed breaks
Date:
Start time:
End time:
Total hrs:
Break time:
Adjusted hrs:
Reason this pay was missed
**Signature/Approval - Please make sure to sign and print your name before turning in this form.
Employee:
Joe Schaeppi
01/15/2024
Manager:
Joe Schaeppi
01/15/2024