Free 47507.FH11 - Indiana

REPORT OF CHILD PROTECTION OVERTIME
State Form 47507 (4-96) / PYL 2625

I want to claim overtime for _____________________________ hours on _____________________________________
(date)

when I worked from _________________________
Describe below why this time meets the qualifications of the following paragraph.

a.m.

p.m. to _______________________

a.m.

p.m.

A normally exempt staff member maybe compensated for time spent physically responding to a child abuse or neglect complaint and / or when engaged in telephone communications with emergency abuse and neglect complaints outside normal office hours. Time spent waiting to be engaged to perform such services (time spent on call, in stand-by status, or carrying a beeper) does not constitute compensable hours of work.
Name or number of case (child and parent) Police Department:

Date signed Date signed

Signature of employee Signature of supervisor