Safe Ride Home Form: Submission #26

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Submission information

Submission Number: 26

Submission ID: 11611

Submission UUID: fc9e564f-cb96-4e49-8302-47d770288750

Submission URI: https://www.uottawa.ca/faculty-medicine/form/safe-ride-home-form

Created: Wed, 05/14/2025 - 12:56

Completed: Wed, 05/14/2025 - 12:57

Changed: Wed, 05/14/2025 - 12:57

Remote IP address: 162.158.126.101

Submitted by: Anonymous

Language: English

Is draft: No

Webform: Safe Ride Home Form

Student Number 8760593

First Name Austin

Last Name Gerhart

Date of service 2025-05-14

Your on-call shift’s start time 17:00

Your on-call shift’s end time 08:00

Proof of on call shift

Screenshot 2025-05-14 at 12.55.01 PM.png

Proof of payment

Uber Receipt May 14th.pdf

Proof of payment 2 {Empty}

Name of hospital where work was performed General

Home program Internal Medicine

Comment {Empty}