Moonlighting Request
NOTE: Housestaff are required
to notify the program director of all moonlighting
hours.
Name: PGY:
Rotation:
Moonlighting
Information
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:
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