In the last 24 hours, how much sleep have you had?

In the last 48 hours, how much sleep have you had?

In the last 7 days, how many consecutive nights sleep have you had?

In the last 7 days, how many hours have you worked?

Over the last 7 days, how many days free from work have you had?A day free from work is a day away from the workplace where no work tasks were completed

Over the last 7 days, how many days have you been on call?

How long will your current shift be?

How long was your last rest period from work?A rest period from work is time away from the workplace where no work tasks were completed

In the last 7 days, how many night shifts have you completed?

What rest breaks have you taken during your current shift?

What working environment will you be exposed to?Consider environments that are controlled (ie office) or harsh environments such as extreme temperatures, high risk work, noisy, harsh conditions.

What type of physical work tasks will you be completing?Physicals tasks can include but are not limited to repetitive, physically demanding tasks.

What type of mental work tasks will you be completing?Mental tasks can include but are not limited to tasks that require concentration, decision making or detailed monitoring

TOTAL POINTSLow Risk - Fatigue Score up to and including 19 points - Implement Level 1 controlsMedium

RECOMMENDED CONTROLSLEVEL 1 - Monitor for progression.Scores in this zone are acceptable and present

INSERT RISK MANAGEMENT CONTROLS OR COMMENTS (if these have been implemented at assessment stage)

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