Information

  • Document No.

  • Conducted on

  • Prepared by

Details of exceedance

  • Location

  • Date/Time

  • Shift

  • Name of individual incurring the exceedance

  • Employer

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?

Mitigation

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

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

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

  • Mitigation measures implemented:

  • Decision

  • Requested by

  • Authorised by

  • Line managers signature (if incurred out of hours)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.