Fatigue Management Plan

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Hazard Factors Assessment

• Is the individual expected to work extended working hours?

  Yes

  No

  N/A

• Is the individual or team working with High Risk Fatigue demands for the works? e..g. repetitive work, physically demanding or requiring high conccentration

  Yes

  No

  N/A

• Is the individual or team working in Fatigue critical task? e.g. plant operation with a high risk of injury or harm.

  Yes

  No

  N/A

• Is the individual or Team exposed to hazardous substances, atmospheric contaminants, noise, extreme temperatures or excessive vibration?

  Yes

  No

  N/A

• Has the individual or Team been provided with information or training on fatigue management

  Yes

  No

  N/A

• Has an adequate level of supervision been provided?

  Yes

  No

  N/A

• Is there a risk of lifestyle factors? sleep, general health, fitness for work.

  Yes

  No

  N/A

Fatigue Control Plan

• Modified working hours arrangements

  Not Required

  Required

• Change in Shift work or Rosters

  Not Required

  Required

• Breaks during work period

  Not Required

  Required

• Reduction in fatigue critical tasks

  Not Required

  Required

• Reduction in exposure to hazards

  Not Required

  Required

• Information and Training on fatigue management

  Not Required

  Required

• Increases in Supervision

  Not Required

  Required

• Changes in Lifestyle factors

  Not Required

  Required

• Health Assessment and Monitoring required

  Not Required

  Required

Approval

• Has the Individual or Team been approved to conduct work in accordance with company policies and the outlined fatigue management control strategy

  Yes

  No

  N/A