Reminder:

Please complete and submit this timesheet for moonlighting shifts in PICU, OSU NICU and J4 NICU only. For shifts in ED, A2, C4 and H8 please report your hours directly to the department.

Moonlighting Timesheet

NOTICE: This timesheet must be submitted within 24 hours of completing your shift to ensure that the moonlighting pay will appear on your next paycheck.

Resident Name: *

Date of Moonlighting shift: *

Hours of Moonlighting shift: *

If other, please use this space to explain why the standard shifts or times do not apply. Please include the location worked, the start time of your moonlighting shift, the end time of your moonlighting shift, and the reason(s) why these hours apply:

By clicking "Submit" below, you are electronically signing that you agree to the below statement.

I attest that I have already worked in this location as a moonlighting resident, during these hours. If this timesheet is not submitted within 24 hours of completing my moonlighting shift, I understand that moonlighting pay may be delayed until after my next paycheck.

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000