Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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To be performed immediately before the start of any trip from home if direct to a job site,or before each work day at mango 4 depot and on any occasion during the work day
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E : Add c and d together
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F: Have you taken any substance in the last 24hrs that may affect your fitness for work in any way?
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Fitness for work and/or fatigue points
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For every hour that 'A' is less than 6 hrs - Give yourself 2 points ( per hour)
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For every hour that 'B' is less than 12hrs - Give yourself 1 point ( per hour )
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For every hour that 'E' is larger 'B' give yourself 1 point ( per hour )
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If 'F' equals 'Yes' then give yourself 10 points. If 'no' then score zero points
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Transfer your 'G' score here
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Add all of the above points and input here
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Control matrix for fatigue score 0 points = proceed to work / 1-9 points = implement local fatigue management / 10-12 points = Do Not commence Work
