Overtime Claim Form

To fill in this PDF: Download this Form to your computer, open it in Adobe Acrobat, then click “Fill & Sign”

Employee Name Employee ID Entity

Employee Comments Employee Signature & Date

Date Worked Time Start Time Finish Meal Break Duration Total Hours Worked Meal Allowance? Paid or Time in Lieu (TIL)?
#
eg: 01 Jan 2023 eg: 09:00AM eg: 5:00PM eg: 30 MINS eg: 7HRS 30MINS [MGR to complete] [MGR to complete]

1 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

2 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

3 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

4 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

5 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

6 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

7 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

8 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

9 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

10 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

11 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

12 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

13 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

14 ☐ ☐ Paid OR ☐ Time in Lieu (TIL)

Manager Approval
Declaration “I certify that the information included herein is correct”

Manager Name & Pos. Title Manager Signature & Date

Manager Comments Charge Code

(if different to default)

Send the completed form to dtppayroll@transport.vic.gov.au

Overtime Form Page 1

Last Updated: 22 May 2023