Time and Expense Entry Form
When you have completed a job (including writing-up and/or dictating the report) enter the time and expense information on this form. If areas do not apply, leave that area blank.
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Your Information
Name:
Account Information
LMC Control #:
Account:
Date of Survey:
Expense information
Expense Item
Amount incurred
Mileage
(When using own vehicle mileage is reimbursed at $0.345 per mile from office location to account location.)
Parking / tolls
(Cost of parking, road, bridge and tunnel tolls, and any other misc. vehicle expense excluding gas)
Airfare
(Prorate among other accounts if more then one risk is surveyed)
Transportation
(Any transportation other then own vehicle: i.e.; taxi, subway, airport shuttle, etc.)
Car Rental
(Prorate among other accounts if more then one risk is surveyed. Include cost of gas)
Lodging
(Prorate among other accounts if more then one risk is surveyed)
Per diem
($30 per day if overnight visit, or travel over 150 miles one way in one day)
Phone
(Enter cost of any phone calls associated with this account)
Photos
(Enter number of photos taken)
Building Eval. Fee
(Fee for accessing online evaluation program: $40)
Other
Explain
Other
Explain
Time Allocations
Service code
Hours
Travel Time
(Actual time to and from account using office as starting point)
Site Survey
(Actual time at risk location)
Service Call
(Actual time at risk location. This would be a recurring visit to the same risk)
Day Rate
(If hours at risk exceed four hours charge 0.5 day rate. An all day visit would be 1.0)
Report Writing
(Time writing own report)
Report Dictating
(Time dictating report)
Consultation
(Consulting on a account with underwriter or with any other person other then insured)
Phone Survey
(Consulting with insured over the phone)
Research
(Time spent researching background about or for risk)
Resurvey
(Updating of a previously surveyed risk)
Recommendation Check
(Check for recommendation compliance)
Proposal Writing
(Writing proposal for new service or new business)
Personal Lines 1
(Flat fee simple PL evaluation: $75)
Personal Lines 2
(Flat fee moderate PL evaluation: $125)
Personal Lines 3
(Complex PL Evaluation: enter hours spent)
Flood Map
(Flat fee: $30)
Full Map Set
(Flat fee: $50)
Industrial Hygiene
(Enter number of hours for IH or Ergonomics survey)
Transcription costs
(Enter number of hours for transcription service)
Other
(Enter Units)
Describe
Comments and Additional Information