Santa Clara County
Missed Meal Period Review
First Name
*
Last Name
*
Employee Number
*
email
*
Company email
Date of Shift
*
mm/dd/yyyy
Scheduled Unit ID
*
Shift/Unit Assigned
Length of Scheduled Shift
*
8 Hour
10 Hour
12 Hour
Number of Missed Meal Periods
*
1
2
Reason for Missed Break
*
*
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