EMS Schedule Change Form

Name

Date

Name / Scheduled Shift / New Shift*

Type Both Crew Members Initials*

Reminder

Note* By submitting this form, It is understood by staff that this shift exchange will not incur more than 4 hours of overtime.

Note* No 48hr shifts will be approved without supervisor or director approval.

Note* If this change is less than 24hrs you must have supervisor or director approval.

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