Fatigue Management Tool

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

General information

• This Audit Tool is developed to assist the Supervisor in addressing fatigue management and record keeping.

• Shift

  A

  B

  C

• Time of day

  Day

  Night

• Department

  Production

  Engineering

  Construction

  Admin

Employee/s Interviewed

Employee

• Name & Surname

• Coy nr

• How many hours of sleep did you have in the last 24hrs?

  >6hrs (low risk)

  <6hrs(high risk)

• How many hours sleep did you have in the last 48hrs?

  >12hrs (low risk)

  <12hrs (high risk)

• Did you have adequate rest?

  Yes

  No

• How is your well being?

  Good

  Bad

• Are you Using any medication?

  Yes

  No

• Are you fit for work today?

  Yes

  No
• Add location
  Address

• Signature of employee

  Sign