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Healthscope JMO Unrostered Overtime Form
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Claims for unrostered overtime are to be submitted as soon as possible after the hours have been worked. They should not be submitted any later than four weeks after the overtime was worked.
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Employee NameMedical Administration Office use onlyDate received
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Employee Number (mandatory!)
Validated by
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“I confirm that these claims are a true and accurate reflection of work performed and that, where required, pre-approval was sought prior to working the overtime”Comments
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Date
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Signature*
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*If submitting via email, your email is considered acceptance of this acknowledgement - no signature required.
*Please don't put the shift start time
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Date of Unrostered OvertimeShift Worked e.g. D8.5Which Department do you belong to?Patient Full NamePatient MRNReason for OTAdditional information for Reason (required for reasons 7, 8 and 9)Overtime Start time (24 hour)*Should match shift end time in rosterOvertime end time (24 hour)Hours claimed (in minutes)Office Use
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14/3/2025SurgeryFlynn Kinsey1321429 Other - Provide further detailRecall3
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16/3/2025Surgery
Evgenia Savvoudi
2788839 Other - Provide further detailRecall3
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16/3/2025Surgery9 Other - Provide further detailRecall3
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20/3/2025Surgery9 Other - Provide further detailRecakk3
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*For missed meal break, meal allowance or callback claims, follow the relevant process.
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When all fields complete, email completed excel sheet to nbhjmo.OTclaims@healthscope.com.au
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When adding additional rows to the document, please ensure that you keep the same formatting
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