Employee Forms | Pro Structural Inc

Employee Time Record Notice

This form is required to be completed by any employee who would like to report an issue related to their recorded work time, such as off-the-clock work hours.

Employee #

First Name

Last Name

Date of Issue

Job #/Name

Name of Supervisor/Foreman

Your Position

Nature of the Issue (choose the best answer)

I was required to perform off-the-clock work

I was given insufficient time to perform preparatory or conclusory work

I was denied the opportunity to take a rest period

I was denied the opportunity to take a 30 minute meal period within the first 5 hours of work

Other (please describe below)

"Other" Description

Describe why you believe the issue occurred during your shift

I declare that the information I’ve provided is accurate & complete.

Your Signature

Your form has been submitted to the HR Department. Someone from the office will contact you within 1-2 business days.Call 951-303-3835 and ask for the HR Department if you have any questions.