Fatigue Management Re-assessment Form

Use this follow-up form to reassess employee fatigue after a reported event in mining operations. Capture date, preparer, employee, shift, and days into rotation; select department such as Ore Process, Mine, Mill, Fixed or Mobile Maintenance; record number of re-assessments for the shift; document how the worker feels, what rest and revival actions were taken, whether the extra break helped, and readiness to return. Includes employee and supervisor signatures and guidance to contact HR and complete travel home if this is a second event.