Exceedance Form

• Document No.

• Conducted on

  Date

• Prepared by

Details of exceedance

• Location

• Date/Time

  Date

• Shift

• Name of individual incurring the exceedance

• Employer

  Select Network Rail TES2000 Other

  • Network Rail
  • TES2000
  • Other

Type of Exceedance

• + 13 consecutive shifts

• + 72 hours per week

• + 12 hours per shift

• Less than 12 hours rest between shifts

The amount of exceedance

• Where the working time limit is defined in terms of number of hours/shifts, each shift or hour over the limit will be continued on a separate exceedance

• Number of additional hours?

• Number of additional shifts?

Exceptional Circustances

• Extreme weather conditions

• Equipment failure

• Accident or serious incident

• Shortage of staff (e.g. Sudden illness) which would cause significant operational disruption?

• Other -please specify

Risk assessment

• Are the working conditions extreme? If yes consider changing the scope of the work or providing personal needs breaks

  Yes

  No

• Is the driving time from completion of shift to home >45 minutes? If yes consider offering driving assistance or using lodgings followings exceedance

  Yes

  No

• Do you feel fit to continue working? If no arrange for the individual to go home or discuss putting on lighter duties if agreeable

  Yes

  No

• Mitigation measures implemented:

• Decision

  Agreed

  Declined

• Requested by

  Sign

• Authorised by

  Sign

• Line managers signature (if incurred out of hours)

  Sign