Time Clock Missed Punch Request Form

Employee Name:______

Date of missed punch:______Reason for missed punch:______

Type of missed punch (if more than one check all that apply): Initial clock-in of the day. Clock out for lunch. Clock in from lunch. Clock out / end of day. Other:______

Time of missed punch:______Explanations: ______*If the missed punch caused employee to miss the next punch, please list both times and explain.

Approval from the employee’s department head / supervisor shall be obtained prior to HR/Payroll editing Time Clock Punch. ______

Employee PRINT Name Employee Signature Department Date

______

Supervisor PRINT Name Supervisor Signature Date