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FATIGUE SURVEY

  • Do you regularly lose one or two hours' sleep when working shifts?

  • Is the quality of sleep you get generally poor - e.g., frequently interrupted (by noise or bright light)?

  • 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?

  • Do you regularly work long shifts - e.g., over 12 hours?

  • Do you have enough breaks during the shift?

  • Are the breaks long enough?

  • Are rest periods between shifts long enough to recover from the previous shift (at least 12 hours)?

  • Can you rest properly (or even nap) during breaks?

  • Do you feel generally drowsy a lot of the time?

  • When changing from night shifts to day shifts, do you feel 'rough' for the first few days?

  • Are you noticeably absent-minded or forgetful at work or do you find it hard to concentrate?

  • Do you sometimes feel that you just can't move; or don't want to?

  • Do you suffer from a lot of heartburn, indigestion or a generally upset stomach?

  • Do you find it difficult to get a good undisturbed sleep between shifts?

  • At work, do you often find it hard to concentrate, make clear decisions or take in and act on information?

  • Have more than occasional lapses of attention or memory?

  • Find your reaction times are slow (for example, responding to an alarm or a threat that builds up in your workplace)?

  • Make lots of errors?

  • Occasionally fall asleep at work - momentarily or for several minutes.

  • Find that you are often irritable?

  • Do you have the opportunity and facilities to rest properly (or even nap) during breaks?

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.