Fatigue Self-Reporting Form

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BENEFITS

Worker fatigue can lead to safety incidents because exhausted workers may have slowed reaction times or exercise poor judgment. So it’s important to take steps to address fatigue if it’s an issue in your workplace. One way to manage fatigue is by requiring workers to report when they’re feeling exhausted on the job so you can identify when fatigue hazards exist and what factors contributed to the development of fatigue.

HOW TO USE THE TOOL

Adapt this self-reporting form for your company’s operations and fatigue risk management system, if it has one, and give it to all workers at risk of experiencing fatigue, explaining to them the importance of providing accurate information on this safety hazard. Although the form is designed for commercial drivers, it can be tailored to other jobs in which fatigue is an issue, such as shift workers.

OTHER RESOURCES:

North American Fatigue Management Program

Implement a Fatigue Risk Management System

Model Fatigue Management Policy

Spot the Safety Violation: Time for a Cat Nap?