Template

VISY Fatigue Risk Assessment Tool

by Natalie Swoboda, from the Community

20+

Use this VISY Fatigue Risk Assessment Tool to evaluate fatigue risk before performing work. Capture rest hours, recent shifts, night work and on-call time, planned shift length, breaks and environmental conditions. Assess physical and mental task demands, calculate a total score, and apply the appropriate control level: Level 1 monitoring, Level 2 task rotation and buddy checks, or Level 3 stopping safety-critical tasks and arranging rest or transport.

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Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Fatigue Risk Report
Report used for fatigue risk, duty extension or rest facility use
by Paul Kirby, from the Community
Downloads: 100+
Get
Template
Fatigue Management Extended Hours Approval Form
Use this fatigue management approval form to evaluate worker fitness and authorize shifts exceeding 14 hours. The checklist guides supervisors through fatigue risk assessment, signs of physical, emotional, and cognitive fatigue, sleep and work history, and required breaks. Capture reasons for extended hours, review alternatives, classify risk level, and record supervisor and department approvals. Reinforces minimum 10 hours off site and a maximum 16 hour shift limit; adapt to your site policies.
by Caleb Trease, from the Community
Downloads: 10+
Get
Template
Fatigue Management Travel Home Form for Kinross
This Fatigue Management Travel Home form supports supervisors in evaluating an employee’s condition after a fatigue event and arranging safe transport. Capture job role, department, crew and shift details, reasons for sending the employee home, distance to home, fatigue risk level, and fitness to drive. Record alternatives to self-driving, planned transport, pit stops, and responsibilities. Include HR notifications, approvals, and both employee and supervisor signatures, and confirm required rest before returning to work.
by Caleb Trease, from the Community
Downloads: 10+
Get
Template
Fatigue Management Assessment and Event Form
This Fatigue Management Assessment and Event Form helps supervisors and operators proactively assess fatigue risk and manage post-event responses in mining operations. It captures site, department, shift, and rotation details; travel and commute factors; observation type and behaviors; suspected medical conditions; and potential substance impairment indicators. The form includes DSS video review, alert meter game and Prism results, work hours, breaks, and sleep history. It guides selection of controls based on a total fatigue score, from continuing duties with hydration to mandatory rest or removal from safety‑sensitive tasks, and travel-home planning. HR notifications, documentation of reasons, transport alternatives, and required 10-hour rest are supported. Follow-up reassessments and hydration guidance help verify readiness to return to work, with signatures and comments recorded.
by Caleb Trease, from the Community
Downloads: 0
Get

Fatigue Risk Report

Report used for fatigue risk, duty extension or rest facility use

by Paul Kirby, from the Community

100+

Get

Template

Fatigue Management Extended Hours Approval Form

Use this fatigue management approval form to evaluate worker fitness and authorize shifts exceeding 14 hours. The checklist guides supervisors through fatigue risk assessment, signs of physical, emotional, and cognitive fatigue, sleep and work history, and required breaks. Capture reasons for extended hours, review alternatives, classify risk level, and record supervisor and department approvals. Reinforces minimum 10 hours off site and a maximum 16 hour shift limit; adapt to your site policies.

by Caleb Trease, from the Community

10+

Get

Template

Fatigue Management Travel Home Form for Kinross

This Fatigue Management Travel Home form supports supervisors in evaluating an employee’s condition after a fatigue event and arranging safe transport. Capture job role, department, crew and shift details, reasons for sending the employee home, distance to home, fatigue risk level, and fitness to drive. Record alternatives to self-driving, planned transport, pit stops, and responsibilities. Include HR notifications, approvals, and both employee and supervisor signatures, and confirm required rest before returning to work.

by Caleb Trease, from the Community

10+

Get

Template

Fatigue Management Assessment and Event Form

This Fatigue Management Assessment and Event Form helps supervisors and operators proactively assess fatigue risk and manage post-event responses in mining operations. It captures site, department, shift, and rotation details; travel and commute factors; observation type and behaviors; suspected medical conditions; and potential substance impairment indicators. The form includes DSS video review, alert meter game and Prism results, work hours, breaks, and sleep history. It guides selection of controls based on a total fatigue score, from continuing duties with hydration to mandatory rest or removal from safety‑sensitive tasks, and travel-home planning. HR notifications, documentation of reasons, transport alternatives, and required 10-hour rest are supported. Follow-up reassessments and hydration guidance help verify readiness to return to work, with signatures and comments recorded.

by Caleb Trease, from the Community

Get

VISY Fatigue Risk Assessment Tool

About author

You might also like

Fatigue Risk Report

Fatigue Management Extended Hours Approval Form

Fatigue Management Travel Home Form for Kinross

Fatigue Management Assessment and Event Form

You might also like

Fatigue Risk Report

Fatigue Management Extended Hours Approval Form

Fatigue Management Travel Home Form for Kinross

Fatigue Management Assessment and Event Form