Stress & Fatigue Monitoring Form

Purpose of the form: This form is used by Fitness Professionals to monitor their own levels of stress and fatigue. This document may also be used in Workplace Health and Safety meetings to allow effective consultation with other staff and higher management.

Fatigue Risk Checklist

This checklist provides guidance to assist in identifying risks of fatigue. If the answer is yes to any of the questions, fatigue risks may need to be further assessed and control measures implemented.

Do you carry out work for long periods which is physically demanding?	YES		NO
Do you carry out work for long periods which is mentally demanding?	YES		NO
Does your work roster include shift work?	YES		NO
Do you have less than a 10 hour break between each shift? (for example, split shifts, quick shift changeovers)	YES		NO
Is work performed at low body clock times (between 2 am and 6 am)?	YES		NO

Self-Monitoring

The symptoms listed below may indicate signs of stress and fatigue. Of the list below, select any symptoms you've experienced within the past month. If any of these are selected, fatigue risks may need to be further assessed and control measures implemented.

Falling asleep at work			Feeling drowsy
Short-term memory problems			Headaches
Inability to concentrate			Dizziness
Reduced capacity to engage in effective interpersonal communication			Reduced hand-eye coordination
Impaired decision-making and judgement			Increased rates of unplanned absence
Other changes in behaviour, for example repeatedly arriving late for work			Need for extended sleep during days off work

Control Measures

Was a WHS meeting conducted to consult with your manager regarding your stress and fatigue management?

YES

NO

Based on the information gathered above, and in consultation with your manager, what control measure/s will be used to manage your stress and fatigue? If no risks were identified, include at least one (1) way you might continue to keep your stress and fatigue levels low.