Event Expense, Time and Reimbursement Form Name*Email PhoneDo you have hours worked to report?* Yes No What the work performed Online or In-Person* Online In-Person Total Online Development and Presentation Time* : Hours Minutes Development Time must be pre-approved by the Education DirectorDid you drive more than 3.5 hours ONE WAY to work?* Yes No Did you drive more than 5 hours ONE WAY to work?* Yes No Event Name/Clinic Topic*Location*Date of 1st Day Worked* MM slash DD slash YYYY Start Time* : Hours Minutes AM PM AM/PM End Time : Hours Minutes AM PM AM/PM 10 Min Breaks*Did you take your required breaks according to the PSIA-AASI Western Employee Handbook? Yes No Why did you not take your 10 Minute Required Break?*My break was less then 10 minutesMy breaks were interruptedMy breaks were delayedLunch Break*Did you take your required full 30-minute lunch break before the end of your 4th hour and 59th minute of work? Yes No Why did you not take your 30 Minute Required Lunch Break?*My lunch break was less then 30 minutesMy lunch was interruptedMy lunch break was delayed and took place after the 5th hourPlease explain and provide the actual time of your lunch break*Did you work a 2nd day?* Yes No Date of 2nd Day Worked* MM slash DD slash YYYY Start Time* : Hours Minutes AM PM AM/PM End Time* : Hours Minutes AM PM AM/PM 10 Min Breaks*Did you take your required breaks according to the PSIA-AASI Western Employee Handbook? Yes No Why did you not take your 10 Minute Required Break?*My break was less then 10 minutesMy breaks were interruptedMy breaks were delayedLunch Break*Did you take your required full 30-minute lunch break before the end of your 4th hour and 59th minute of work? Yes No Why did you not take your 30 Minute Required Lunch Break?*My lunch break was less then 30 minutesMy lunch break was interruptedMy lunch break was delayed and took place after the 5th hourPlease explain and provide the actual time of your lunch break*Did you work a 3rd Day?* Yes No Date of 3rd Day Worked* MM slash DD slash YYYY Start Time* : Hours Minutes AM PM AM/PM End Time* : Hours Minutes AM PM AM/PM 10 Min Breaks*Did you take your required breaks according to the PSIA-AASI Western Employee Handbook? Yes No Why did you not take your 10 Minute Required Break?*My break was less then 10 minutesMy breaks were interruptedMy breaks were delayedLunch Break*Did you take your required full 30-minute lunch break before the end of your 4th hour and 59th minute of work? Yes No Why did you not take your 30 Minute Required Lunch Break?*My lunch break was less then 30 minutesMy lunch break was interruptedMy lunch break was delayed and took place after the 5th hourPlease explain and provide the actual time of your lunch break*Did you work a 4th day?* Yes No Date of 4th Day Worked* MM slash DD slash YYYY Start Time* : Hours Minutes AM PM AM/PM End Time* : Hours Minutes AM PM AM/PM 10 Min Breaks*Did you take your required breaks according to the PSIA-AASI Western Employee Handbook? Yes No Why did you not take your 10 Minute Required Break?*My break was less then 10 minutesMy breaks were interruptedMy breaks were delayedLunch Break*Did you take your required full 30-minute lunch break before the end of your 4th hour and 59th minute of work? Yes No Why did you not take your 30 Minute Required Lunch Break?*My lunch break was less then 30 minutesMy lunch break was interruptedMy lunch break was delayed and took place after the 5th hourPlease explain and provide the actual time of your lunch break*If you worked ANY overtime (over 8-hours in a day), please explain whyMiles DrivenOnly the owner of the vehicle driven is eligible to submit miles to be reimbursed. Miles should reflect the most direct route. Did you carpool?* Yes No Lodging Expenses?* Yes No Total Lodging ExpenseWe need a receipt for lodging to be reimbursed $60 per night double occupancy; $100 per night single occupancy. These amounts are all inclusive. If lodging is provided, reimbursement for lodging will not be approved. Receipt for LodgingMax. file size: 256 MB. Please refer to the Employee Handbook for amounts to be reimbursed and reimbursement policies. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgDo you need to add a second lodging receipt?* Yes No Receipt for LodgingMax. file size: 256 MB. Please refer to the Employee Handbook for amounts to be reimbursed and reimbursement policies. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgDo you need to add a third lodging receipt?* Yes No Receipt for LodgingMax. file size: 256 MB. Please refer to the Employee Handbook for amounts to be reimbursed and reimbursement policies. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgLift Ticket Expense?* Yes No Total Ticket ExpenseReceipt for Lift TicketsMax. file size: 256 MB. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgReceipt for Lift TicketsMax. file size: 256 MB. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgReceipt for Lift TicketsMax. file size: 256 MB. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgReceipt for Lift TicketsMax. file size: 256 MB. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgAny Other expenses?* Yes No Reminder: A Per Diem will be applied for each day worked to cover meals and incidental expenses incurred when at an in-person event. $ 70 per day for a full day or $ 35 per day for a half-day worked. Expenses?* Yes No Explanation and amount of additional expensesReceipts for Other ExpensesMax. file size: 256 MB. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgReceipts for Other ExpensesMax. file size: 256 MB. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgReceipts for Other ExpensesMax. file size: 256 MB. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgReceipts for Other ExpensesMax. file size: 256 MB. If you have trouble attaching your receipt please email a copy to landerson@thesnowpros.orgSignatureAll hours and expenses are expected to follow the rules and guidelines set in the Employee Handbook. Everything stated above is correct.
