Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
FATIGUE SURVEY
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Do you regularly lose one or two hours' sleep when working shifts?
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Is the quality of sleep you get generally poor - e.g., frequently interrupted (by noise or bright light)?
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Do you sometimes have to work on safety-critical tasks at a 'low point' in the day, e.g., early hours of the morning; mid to late afternoon or after a meal?
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Do you regularly work long shifts - e.g., over 12 hours?
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Do you have enough breaks during the shift?
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Are the breaks long enough?
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Are rest periods between shifts long enough to recover from the previous shift (at least 12 hours)?
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Can you rest properly (or even nap) during breaks?
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Do you feel generally drowsy a lot of the time?
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When changing from night shifts to day shifts, do you feel 'rough' for the first few days?
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Are you noticeably absent-minded or forgetful at work or do you find it hard to concentrate?
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Do you sometimes feel that you just can't move; or don't want to?
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Do you suffer from a lot of heartburn, indigestion or a generally upset stomach?
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Do you find it difficult to get a good undisturbed sleep between shifts?
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At work, do you often find it hard to concentrate, make clear decisions or take in and act on information?
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Have more than occasional lapses of attention or memory?
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Find your reaction times are slow (for example, responding to an alarm or a threat that builds up in your workplace)?
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Make lots of errors?
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Occasionally fall asleep at work - momentarily or for several minutes.
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Find that you are often irritable?
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Do you have the opportunity and facilities to rest properly (or even nap) during breaks?