TIMESHEET PULSE Nursing PLEASE FAX TO 0333 577 3117

Name: Rechade Seecahid Specialty

Client / Hospital Ward/Workplace
Please complete 1 timesheet per week. You must use a new timesheet for each new client. Please complete your hours using the 24-hour clock.If you have any queries about how to complete this timesheet speak to your PULSE Nursing consultant.

STANDARD HOURS WORKED Week Ending (Sunday)

Date Reference Number Band Start Break
minutes Finish Total excluding
breaks Client Signature
Mon
Tue
Wed
Thu
Fri
Sat
Sun
PLEASE MARK TIMES CLEARLY AS 24-HOUR CLOCK. BREAKS ARE UNPAID. Total Hours
TO BE READ BY ALL PULSE ASSOCIATES
ON CALL HOURS Week Ending (Sunday) I declare that the information I have given on this form is correct and complete and that I have not claimed
elsewhere for the hours/shifts detailed on this timesheet. I understand that if I knowingly provide false
Date Reference Number Band Start Break
minutes Finish Total excluding
breaks Client Signature information this may result in disciplinary action and I may be liable to prosecution and civil recovery
proceedings. I consent to the disclosure of information from this form to and by the NHS body and the NHS CFSMS
Mon for the purpose of verification of this claim and the investigation, prevention, detection and prosecution of fraud.

Tue TO BE READ BY ALL PULSE NHS CLIENTS

Wed I am an authorised signatory for my ward/department/NHS body. I am signing to confirm that both the grade of
Agency Worker and the hours/shift that I am authorising are accurate and I approve payment. I understand that if
Thu I knowingly provide false information this may result in disciplinary action and I may be liable to prosecution and
civil recovery proceedings. I consent to the disclosure of information from this form to and by the NHS body and
Fri the NHS CFSMS in England (or NHS CFS in Scotland) for the purpose of verification of this claim and the
investigation, prevention, detection and prosecution of fraud.
Sat
For your information - Any questionable timesheet must be immediately brought to the attention of the
Sun Local Counter Fraud Specialist (within England) or you may report any case of fraud, in confidence, to the
NHS Fraud and Corruption Reporting Line on 0800 028 4060 (within England) or 0800 015 1628 (within
PLEASE MARK TIMES CLEARLY AS 24-HOUR CLOCK. BREAKS ARE UNPAID. Total Hours Scotland)
AUTHORISATION: We confirm that the hours and grade/band shown on this timesheet have been I confirm I have worked the above hours. I also confirm I have read the Counter
worked to our satisfaction and that this will form the basis of an invoice which will be paid on Fraud Declaration on this timesheet
receipt. We agree to be bound by the terms and conditions of business.

INVALID WITHOUT THIS SIGNATURE

Authorised Client Signature: Date: Associate Name:

Rechade Seecahid
Print Name: Position: Associate Signature:

Turnford Place, Great Cambridge Road, Turnford, Hertfordshire, EN10 6NH