To be completed by Campus/Department FEDERAL PROGRAMS DEPARTMENT ONLY Plan4Learning CIP/DIP Federal Programs Department G - Goal Quality Control Worksheet FUND # P - Performance Objective SUPPLEMENTAL PAYROLL DATE S - Strategy REVIEWED: FPD STAFF:

Items in yellow must be completed by the Campus/Department and submitted to Federal Programs.

Campus/Department: Contact Person: Scheduled Pay Date: Contact #: Week Period:

QUALITY CONTROL – SUPPLEMENTAL PAYROLL Campus/Department Federal Programs Department (form subject to change without notice) Submit for Submit for Required Support Documents Received Missing Revisions Requisition Payment 1. Quality Control Worksheet Report of Supplemental Pay Report form printed on Green 2. Legal-sized Paper 3. Ensure all fields are completed 4. Ensure correct budget code for each employee Original Principal/Authorized Administrator Signature and 5. date of signature 6. Plan4Learning CIP/DIP GPS indicated on QCW 7. Calculate number of units to the minute, NO ROUNDING In Description Field: a. Clear description of duties performed 8. b. Indicate Plan4Learning GPS that coincides with the duties/description indicated Additional items for Campus/Department Program Review: a. Campus/Department Program Review form 9. b. Professional Learning Statement (PLS) form c. Teacher sign in/out d. Agenda Additional items for Certified Retired Teachers: 10. a. Tutoring Lesson Plan form(s) Additional items for Tutoring: a. Tutoring Lesson Plan form(s) 11. b. Student’s original signatures and student’s completed time in/out Additional items for Part-Time Employee: 12. a. Employee sign in/out b. Daily schedule with job duties Additional items For Long Term Substitutes: 13. a. Attach Substitute Certification form(s) Additional items for Qualified Employees who attended PD beyond their contract hours: 14. a. Agenda b. Professional Learning Statement (PLS) form c. Sign in/out sheet for PD or Certificate of Attendance Additional items for Qualified Employees who worked beyond their contract hours (other than PD): 15.  Employee sign in/out sheet  Daily Schedule with job duties (must align with Federal compliance guidelines)

Revised 06-20-17 FEDERAL PROGRAMS DEPARTMENT ONLY REQ# FUND # Federal Programs Department DATE Quality Control Worksheet REVIEWED: SUPPLEMENTAL PAYROLL FPD STAFF: FOR FEDERAL PROGRAMS DEPARMENT USE ONLY: Date Initial Note(s)

Revised 06-20-17