Forms Payroll Grievance Form Rimland maintains an efficient and caring staff and my son is very happy there. I am very happy with all that has been done for him. — Ramona Marshall, Parent Payroll Grievance Form Employee Name* Employee Email Address* Home Worked:* Shift: Reason for Grievance*If you are missing a shift worked, was your Therap documentation completed?* Yes No If you are missing a shift worked, why was there no Clock In/Clock Out reported?*Was this grievance previously reported? If so, to whom and on what date?*Request for Time Punch AdjustmentPAY PERIOD WEEK 1 SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY ENTER REVISED TIME(S) FOR SUNDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR MONDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR TUESDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR WEDNESDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR THURSDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR FRIDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR SATURDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM PAY PERIOD WEEK 2 SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY ENTER REVISED TIME(S) FOR SUNDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR MONDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR TUESDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR WEDNESDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR THURSDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR FRIDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM ENTER REVISED TIME(S) FOR SATURDAY Month Day Year Start Punch : AM PM Stop Punch : AM PM Signature*NameThis field is for validation purposes and should be left unchanged.