DEPARTMENT OF HEALTH & HUMAN SERVICES
DEPARTMENT OF HEALTH & HUMAN SERVICES
REQUEST TO ACCRUE OVERTIME OR COMPENSATORY TIME
(Approved forms to be retained at Division Administrator’s Office)
EMPLOYEE’S NAME: ____________________________________CLASS TITLE: ___________________________
DIVISION: ___________________ AGENCY/OFFICE: BUDGET ACCT:
PAY PERIOD NO. BEGIN DATE: END DATE:
| |COMP TIME |FROM: | |TO: | | | |
|OT |TOTAL HOURS | | | | |* REASON |DETAILED EXPLANATION (i.e. provide CW |
|TOTAL HOURS | |Date |Time |Date |Time |CODE |report/case number if applicable, name of employee who |
| | | | | | | |called in sick, covering vacancy etc.) |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
Employee’s Signature: Date:
Authorized Supervisor’s/Manager’s Signature: Date:
Division Administrator’s Signature: Date:
Director’s Signature: Date:
OVERTIME REASON CODES
1. Accidents 17. Coverage - Vacant Positions
2. Accounting Fiscal Issues 18. Emergencies
3. Administration 19. Investigations
4. Administrative Support 20. Meetings
5. Backlog Reduction 21. Office Support Activities
6. Budget Preparation/Response 22. Personnel Issues
7. Client Meetings 23. Program/Project Deadlines
8. Client Services 24. Site/Equipment Repair
9. Conferences 25. Special Events
10. Court 26. Staff Meetings
11. Coverage – Annual Leave/Military Leave 27. Training
12. Coverage – 24-Hour Facility - Use for staff brought in to 28. Training New Personnel
maintain required staffing ratios 29. Travel
13. Coverage – Holidays/Weekends 30. Workload
14. Coverage – Injuries 31. Workshops
15. Coverage – Sick Leave 32.. Unfulfilled Shift Trade
16. Coverage – Training 59. DHHS Defined – Shift Call Off – Use
when coverage is needed because of unanticipated
absences
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