Fatigue Risk Assessment – A M Water Services Forms

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Pre-shift fatigue assessment when an individual is asked to work beyond standard hour limits. Authorises (or refuses) the exceedance.

Document Reference	HS_FM_18 — Working Hours / Fatigue Risk Assessment
Issue Number	2
Issue Date	12 May 2026
Next Review	12 May 2027
Controlled By	Sean Ashton (HSQE Consultant, Onyx Operations)
Approved By	Aaron Mason, Managing Director
Status	Paper version (HS_FM_18, Issue 1) retired on digital go-live.

Name of employee(Required)

Location(Required)

Date of proposed shift(Required)

Shift (e.g. 'Night 21:00-06:00')(Required)

Type of exceedance (tick all that apply)

+13 consecutive shifts

+72 hours per week

+12 hours per shift

Less than 12 hours rest between shifts

Amount of exceedance (additional hours or shifts)(Required)

For each factor: assess the risk and note mitigations in place. Required where exceedance is proposed.

Quality of rest periods

Sufficient rest before working the exceedance? Recovery time between shifts adequate (travel home, wind-down, sleep)?

Work pattern

Successive nights / earlies prior to this shift? Cumulative fatigue risk?

Type of shift

Night shifts and early starts before 07:00 carry highest fatigue risk.

Nature of work and work involvement

Mentally demanding? Long periods of concentration? Natural breaks?

Individual factors

New to role? Persistently working overtime? Health concerns?

What is the reason for the exceedance?(Required)

Extreme weather conditions

Equipment failure

Accident / serious incident

Shortage of staff

Other (specify in notes)

If shortage of staff — reason (record one only)

Alternative options considered

Relief by an alternative member of staff, close location / cancel work, reduce manning, relief by supervisor / on-call manager, other.

Authorisation decision(Required)

Authorised — exceedance permitted with stated mitigations

Refused — alternative arrangement required

Additional information / mitigations agreed

Authoriser name + role(Required)

Authoriser signature(Required)

Authoriser email (for confirmation)