Shift Adjustment (Provincial Travel Nurse Team)

Staff must submit a separate form for shifts worked on separate units.

Staff can submit up to 14 days worth of shifts on one form so long as the shifts were scheduled on the same unit.

Please note all overtime gets paid out by default. We follow the Shared Health MNU 4-week blocks in calculating OT.

PTNT Shift Adjustment

"*" indicates required fields

Step 1 of 3

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Name*

First Last

Employee #*

Nursing classification*

Work email*

SDO / Region*

Facility / Site*

Specific unit*

I need to submit an adjustment for

(please choose all that apply)

Missed Break(s)

Overtime / Mandated shift(s)

Reassigned shift(s)

Responsibility pay(s)

Short call shift(s)

Triage pay(s)

EFT nurses

(please complete ONLY if you are an EFT nurse)

Bank

Pay out

MISSED BREAK(S)

Shift details (MB)

NOTE: Rest periods are paid. Meal breaks are unpaid.

Date of shift

Rest period 1

Rest period 2

Meal break 1

Meal break 2

To enter more than one missed break above, please use the to the right of the row of fields.

OVERTIME / MANDATED SHIFT(S)

Shift details (OMS)

Enter the date and times the additional OT / mandated hours were worked.
Enter all start and end times using the 24-hour clock (e.g. 07:30 or 19:30).

Date of shift?

Was OT mandated?

Start of OT

End of OT

Relief type & reason

To enter more than one overtime / mandated shift above, please use the to the right of the row of fields.

REASSIGNED SHIFT(S)

Shift details (RS)

Enter all start and end times using the 24-hour clock (e.g. 07:30 or 19:30).

Date of shift

Unit from

Unit to

Time from

Time to

To enter more than reassigned shift above, please use the to the right of the row of fields.

RESPONSIBILITY PAY(S)

Shift details (RP)

Enter all start and end times using the 24-hour clock (e.g. 07:30 or 19:30).

Date of shift

Time from

Time to

To enter more than one responsibility pay shift above, please use the to the right of the row of fields.

SHORT CALL SHIFT(S)

Shift details (SCS)

Enter all start and end times using the 24-hour clock (e.g. 07:30 or 19:30).

Date of shift

Time of shift

To enter more than one short call shift above, please use the to the right of the row of fields.

TRIAGE PAY(S)

Shift details (TP)

(applicable to facilities where ED / Urgent Care premium applies) Dauphin, Swan River, The Pas, Flin Flon, Thompson, Selkirk, Portage La Prairie, Neepawa, Boundary Trails and Bethesda
Enter all start and end times using the 24-hour clock (e.g. 07:30 or 19:30).

Date of shift

Time from

Time to

To enter more than one triage pay shift above, please use the to the right of the row of fields.

Shift Adjustment (Provincial Travel Nurse Team)

PTNT Shift Adjustment

MISSED BREAK(S)

OVERTIME / MANDATED SHIFT(S)

REASSIGNED SHIFT(S)

RESPONSIBILITY PAY(S)

SHORT CALL SHIFT(S)

TRIAGE PAY(S)

CONSENT