Template

Fatigue Management Travel Home Form for Kinross

by Caleb Trease, from the Community

10+

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.

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Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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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 Management Travel Home Form Kinross
Use this fatigue management travel home form to evaluate risk and plan safe transport for employees following a fatigue event. The checklist captures site, role, work area, crew and rotation details, records department such as Ore Process, Mine, Mill, Fixed or Mobile Maintenance, and documents miles to home and fatigue risk level. It prompts for driving ability, pit stops, alternatives to self driving, and the agreed transport plan. HR notification and approval are captured, along with employee and supervisor signatures and a reminder of a minimum 10 hour rest before return.
by Caleb Trease, from the Community
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Template
Kinross Fatigue Management Reassessment Form
This Kinross fatigue management reassessment form is used after a fatigue event to confirm a worker’s condition before returning to duty. It captures site and shift details, rotation day, department and crew, and prompts employees to describe how they feel, what recovery actions they took during rest, and whether an extra break helped. If a second event occurs, it directs the user to contact HR and complete a travel home form. Employee and supervisor signatures document the decision and next steps.
by Caleb Trease, from the Community
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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
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Template
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.
by Caleb Trease, from the Community
Downloads: 10+
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Fatigue Management Travel Home Form for Kinross

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Fatigue Management Travel Home Form Kinross

Kinross Fatigue Management Reassessment Form

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Fatigue Management Travel Home Form Kinross

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