How to use:

This online tool will produce a document which you will need to complete, print and be countersigned prior to submission to our office.

  1. Complete all the required information in the form below.
  2. Click on the large blue button at the bottom of the page to download and open your PDF.
  3. Print the completed timesheet and sign where indicated.
  4. Ensure your timesheet is countersigned and submitted to our accounts department.
Full Name *
Grade & Specialism *
Place of Work *
Department *
Booking Reference (If Known)

Pulse Temps Only

Agenda for Change (AFC) Job Profile
AFC Banding
Spinal Point
Day Date Start Time
Finish Time
Length of
Meal Break
Monday (next day) 0
Tuesday (next day) 0
Wednesday (next day) 0
Thursday (next day) 0
Friday (next day) 0
Saturday (next day) 0
Sunday (next day) 0

I have entered times that confirm I have worked overnight.
(Please tick this box)

Candidate Declaration:
I declare that the information I have given on this form is correct and complete and that I have not claimed elsewhere for the hours/shifts detailed on this timesheet. I understand that if I knowingly provide false information this may result in disciplinary action and I may be liable to prosecution and civil recovery proceedings. I consent to the disclosure of information from this form to and by the NHS body and the NHS CFSMS for the purpose of verification of this claim and the investigation, prevention, detection and prosecution of fraud.

I also confirm that I have been given an Induction on the first day of my placement and have received a valid ID badge prior to the beginning of my assignment.

Should you have difficulties downloading the document, you will need to install / update your PDF Reader Software (Adobe Reader, Foxit Reader or SumatraPDF). Firefox users should update to the latest version to use the built-in PDF Viewer.