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Form preview Your world timesheet form Yourworldhealthcare. com Ward / Department Nursing HCA Midwifery Timesheet Fax 0207 220 6657 Email nursing ywtimesheets. Gsi. gov.uk. Willingness to follow hospital procedure Punctuality and reliability Appearance Would you be prepared to have this healthcare worker back in the Ward/Dept. I consent to the disclosure of information from this form to and by the NHS body and NHS Protect 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. Level 5 Broadgate Tower 20 Primrose Street London EC2A 2EW Registered Company Number 7935722 Band / Grade Name of Trust / Hospital Tel 0207 220 0811 www. Any questionable timesheet must be immediately brought to the attention of the Local Counter Fraud Specialist within England or you may report any case of fraud in confidence to the NHS Fraud and Corruption Line on or email nhsfraud nhsprotect. I consent to the disclosure of information from this form to and by the NHS body and NHS Protect NHS CFSMS for the purpose of verification of this claim and the investigation Print Name Position Declaration I confirm I have worked the above hours. Com max 5 MB Timesheets must be received on Sunday by Fax Post or Email Scans only NOT Photographs Date DD/MM/YY Start Time Finish Break Hours Worked Booking Reference Number Authorised Signature Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total Hours Please Use 24 hour clock Clinical/Character Assessment Please complete G Good Is able to provide a full range of care to patients and their family Ability to organise work within guidelines and professional boundaries Demonstrates clinical competence Uses initiative and experience to make the right decisions Mantains legible and accurate records Please email feedback to feedback ywrgroup.com To be completed by Head of Department/Authorised Signatory TO BE READ BY ALL CLIENTS I am an authorised signatory for my ward/department/NHS body. Consultant Name Insert Consultant Name Here Candidate Name Reporting to Job Title Your World Nursing Ltd. I also declare that any laundry costs I have claimed have been incurred by me wholly exclusively and necessarily in the been worked to our satisfaction and that this will form the basis of an invoice which will be paid on receipt.

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