Printable hospital template
Hospital cash bank-deposit handover record
Track hospital cash released for a bank deposit, its custody acknowledgements and the bank evidence checked when the deposit is completed.
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- RizCare
- Published
- Last reviewed
RizCare's suggested worksheet. Adapt to your hospital. https://riz.care/library/templates/clinic-bank-deposit-handover
For the cash custodian and authorised deposit reviewer.
Cash leaves the hospital for a bank deposit, but the bank credit appears later. The cashier's release and the bank's confirmation are different points in that journey. Record both so a shift change does not leave the amount unexplained.
Use the hospital's existing arrangements for safe custody and deposits. This form records responsibility and evidence; it provides no transport or cash-security instructions.
Print this page or save it as a PDF from your browser. The print layout contains only the blank worksheet and its completion note. Fill it in within your hospital.
Practice: ____________________ Prepared by: ____________________ Date: ______________
| Release / count | Amount (naira) | Custody accepted | Bank evidence / check | Difference / owner |
|---|---|---|---|---|
| Blank entry | ||||
| Blank entry | ||||
| Blank entry | ||||
| Blank entry | ||||
| Blank entry |
Keep completed copies with the staff authorised to use them.
How to use it
Release a counted amount
Reference the completed denomination count and closing record. Record the amount released, the date and time, and the authorised person accepting custody. Check the intended hospital account through the approved procedure. Use a protected account reference on this sheet instead of copying full account details into every handover.
Keep the deposit pending until checked
The person making the deposit returns the bank evidence through the hospital's agreed channel. The reviewer checks the receiving account, amount and date against the release record and the bank's evidence. Record when the check happened. A deposit slip awaiting verification should remain marked for follow-up rather than being treated as a checked bank credit.
Resolve the difference without changing the release
If less or more is credited than expected, record the amount observed and the enquiry owner. Keep the original release and custody acknowledgements intact. Refer any bank query through the authorised account holder. Moving collections from hospital cash into the hospital bank account must not produce a second patient receipt or make the same income appear twice.
What each field means
- Release reference
- Link the cash count and the handover, including the actual release time. This allows the reviewer to distinguish two deposits on the same day.
- Acceptance
- The receiving person acknowledges the cash they counted and accepted. An intended assignee who has not received the cash cannot close this part.
- Bank evidence
- Record the protected evidence reference and reviewer. Do not attach an entire bank statement where a limited reference will retrieve the relevant credit.
Completed fictional example
This invented deposit follows existing collections into a bank account. It does not add 40,000 naira of new patient payments.
| Release / count | Amount (naira) | Custody accepted | Bank evidence / check | Difference / owner |
|---|---|---|---|---|
| DEP-09 / COUNT-16 | 40,000 | Staff B, 10:20 | BNK-08 checked by Manager A | 0 / closed |
Related resources
Sources and review
The worksheet design and examples are RizCare's recommendations. The sources below support the background discussion; they do not endorse this form.
- Bookkeeping and financial management training manual (FAO-hosted Liberia forestry training resource). Read 9 September 2026.