NOTE: Housestaff are required to notify the program director of all moonlighting hours.

Name: PGY:

Rotation:

Approval to moonlight is requested for the following:

Month/Year: Hours Per Month:

Location:

• Any hours a resident works for compensation at the sponsoring institution or any of the sponsor's primary clinical sites must be considered part of the 80-hour weekly limit on duty hours.
• Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

Confirmation

I have read the program policies on moonlighting and duty hours and affirm that the above request will not violate these policies.

Agree: