Template

Fatigue Management Extended Hours Approval Form

by Caleb Trease, from the Community

10+

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.

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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.

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by Caleb Trease, from the Community
Downloads: 0
Get

Fatigue Management Plan

Internal Assessment and Control Plan for Extended Working Hours

by SafetyCulture

400+

Get

Template

Fatigue Management Plan for HVNL Compliance

This Fatigue Management Plan helps teams assess hazard factors such as extended hours, high risk tasks, environmental hazards, training and supervision, and lifestyle risks. It guides the creation of controls including modified hours, roster changes, breaks, reducing fatigue critical tasks and exposure, training, increased supervision, lifestyle changes, and health assessment and monitoring. A formal approval step authorizes work in line with company policy. Designed for heavy vehicle operations under the Heavy Vehicle National Law, it supports transport operators, depots, and drivers working extended shifts to manage fatigue and maintain safety.

by Mick Woods, from the Community

Get

Template

Fatigue Management strategy Declaration

To be completed by personnel working over fatigue hours or traveling over safe fatigue hours

by William Coleman, from the Community

50+

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

Fatigue Management Extended Hours Approval Form

About author

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Fatigue Management Plan

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