Date	Time In	Time Out	Time In	Time Out	Daily Total Hours Worked
MON
TUE
WED
THURS
FRI
SAT
SUN

By signing this Time Log and Time Certification (”Time Log”), I certify that I have carefully review this Time Log and that I have accurately recorded all of my hours of work, including all start and stop times, and I hereby certify that my reported hours of work are accurate.

I certify that I have not reported more or less time than I actually worked and that I have not rounded up or down any start or stop. I will not sign this Time Log if it is not accurate and will report any inaccuracies.

I further certify that I have been provided with adequate sleeping facilities and generally enjoyed an uninterrupted night’s sleep. I recorded all interruptions in my sleep time due to wotk on this timesheet. If the interruptions were so frequent that I could not get at least 5 hours of sleep. I appropriately noted that on the timesheet and included the full 8-hour period in the Total Hours Worked. The five (5) hours of sleep need not be consecutive.

I have not been pressured, coerced or directed by anyone to work through any meal period without reporting it, inaccurately report any time worked or not report time that I have worked.

By signing this Time Log, I certify that I have carefully reviewed this Time Log and that the hours Caregiver reported on this Time Log, including all start and stop times are accurate.

By signing this Time Log, I certify that I have carefully reviewed this Time Log and that the hours Caregiver reported on this Time Log, including all start and stop times are accurate.