1200 Collins Ave,

Mandan, ND 58554, USA

(701) 663-5373

Time Log and Certification for Non-Visit Working Time

By submitting this Time Log and Certification for Non-Visit Time (“Time Log”), I certify that I have carefully reviewed this Time Log and that I have accurately recorded all non-visit time worked. I hereby certify that I have accurately reported my non-visit time worked, that I have not reported more or less time than I actually worked, and that I have not rounded up or down any start or stop time. I have not been pressured, coerced, or directed by anyone to inaccurately report my non-visit time worked. I understand I must not certify the accuracy of this Time Log, and I agree to contact Dakota Home Care if the Time Log I submit is inaccurate. I acknowledge it is my responsibility to notify my supervisor of any issues/conditions that require me to work beyond regularly scheduled hours. If I work beyond my regularly scheduled hours, with or without approval, I understand I will be compensated for the additional, unscheduled time worked.

Dakota Home Care’s Travel Time Policy provides an explanation of compensable travel time, and all time spent traveling should be recorded in accordance with this policy.