Time Adjustment  
Time adjustment forms can be used for adjustment to your regular clock in, breaks, or clock out. Too many adjustments will result in disciplinary action. Additionally the time adjustment can be used to submit your Paid Sick leave notice for Unforeseeable Sick Leave. For foreseeable sick leave please complete the Employee Notice for Use of Sick Leave form. For more information please review the Sick Leave Policy in the 2024 Employee Handbook. 
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Name (First & Last) *
Date of Time Adjustment Needed *
MM
/
DD
/
YYYY
Clock IN Time *
Time
:
Clock OUT time *
Time
:
How Long was your Break? ex: "15 mins" *
Reason for Time Correction? *
Who can verify your time change, if in question: *
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