Nursing Home Petty Cash Reconciliation Form
Nursing Home Petty Cash Reconciliation Form
Complete this form at the end of each month to reconcile the petty cash fund. Ensure that all receipts are attached and that the expenses are documented and authorized. If discrepancies arise, please report them to the finance department immediately.
|
Date |
Reconciliation Period |
|---|---|
1. Petty Cash Information
|
Custodian Name |
Location |
|---|---|
2. Cash on Hand
|
Denomination |
Quantity |
Total |
|---|---|---|
|
$100 |
$ |
|
|
$50 |
$ |
|
|
$20 |
$ |
|
|
$10 |
$ |
|
|
$5 |
$ |
|
|
$1 |
$ |
|
|
Coins |
$ |
|
|
Total Cash on Hand |
$ |
3. Cash Recorded
|
Beginning Balance |
Amount |
|---|---|
|
Add: Receipts |
$ |
|
Total |
$ |
|
Less: Disbursements |
$ |
|
Ending Balance (should match Total Cash on Hand) |
$ |
4. Disbursements
|
Receipt Number |
Date |
Amount |
Purpose/Notes |
|---|---|---|---|
|
$ |
|||
|
$ |
|||
|
$ |
5. Discrepancies
|
Amount |
Description |
|---|---|
6. Verification
|
Completed By: |
|
|
Date: |
|
|
Approved by: |
|
|
Date: |
7. Notes
Please ensure this form is filled out completely and accurately before submission. Attach all relevant receipts and documents for review.
