Printable hospital template
Hospital petty cash payment voucher
Document an authorised small hospital expense, its supporting evidence and the cash handed over, with a separate record for any money returned.
- Written by
- RizCare
- Published
- Last reviewed
RizCare's suggested worksheet. Adapt to your hospital. https://riz.care/library/templates/clinic-petty-cash-voucher
For the petty cash custodian and expense approver.
A staff member buys printer paper and brings back a receipt. The petty cash record needs to show who authorised the purchase, how much cash left the box and what happened to the change. Writing only stationery leaves the custodian to reconstruct the transaction later.
Use a voucher reference that belongs to the petty cash record. Patient refunds and changes to patient bills should follow their own authorised procedures.
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: ______________
| Voucher / date | Purpose / approval | Cash issued (naira) | Evidence / expense | Change / closure |
|---|---|---|---|---|
| Blank entry | ||||
| Blank entry | ||||
| Blank entry | ||||
| Blank entry | ||||
| Blank entry |
Keep completed copies with the staff authorised to use them.
How to use it
Agree the expense before paying
Describe the item and its hospital purpose in ordinary words. Record the requested amount, the approver and the date of approval. Follow the hospital's spending limits and separation of responsibilities. If an urgent expense needs retrospective review under local policy, mark that status plainly; do not add an approval signature on somebody else's behalf.
Follow the cash to its evidence
The custodian records the actual amount handed over and the recipient acknowledges it. Attach or reference the supplier's evidence when available. If cash was advanced, record the later evidence and any returned change separately. A request for 5,000 naira and a final purchase of 4,200 naira leave 800 naira to account for.
Close the voucher
Check that the expense plus returned cash equals the advance, allowing only separately authorised differences. Link the completed voucher to the petty cashbook entry. The general bookkeeping manual listed below is background reading; your hospital decides its approval limits and what evidence is acceptable. Refer missing evidence to the approver rather than making a substitute receipt.
What each field means
- Purpose
- Name what was bought and why the hospital needed it. Keep patient information out of a general expense voucher.
- Cash and change
- Record money issued and money physically returned as separate amounts with their dates. An expected return is not cash already in the box.
- Evidence and closure
- Give the receipt or supporting-document reference and the reviewer name. Leave the voucher open while the advance or evidence is unresolved.
Completed fictional example
The fictional purchase accounts for the entire advance. It does not set a spending limit for your hospital.
| Voucher / date | Purpose / approval | Cash issued (naira) | Evidence / expense | Change / closure |
|---|---|---|---|---|
| PC-018 / 9 September | Printer paper / Owner A | 5,000 | Receipt S-41 / 4,200 | 800 returned; checked Staff B |
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.