WORKING TIME REGULATIONS MANAGEMENT
POLICY NUMBER: HR 35a
Title of Policy Work time regulations management
Application All Trust Services
1. Record keeping
2. Maximum weekly working time limits
3. On call
4. Sleep ins
5. Workers with more than one employer
6. Options to work over 48 hours per week
7. In work rest breaks
8. Daily rest periods
9. Weekly rest periods
10. Compensatory rest
11. Shift workers
12. Entitlement under other provisions
13. Night work
14. Health assessments
15. Annual leave
Carry over of leave
Part time/ temporary workers
Dates on which leave is taken
Pay in respect of periods of leave
16. Bank staff
Paid annual leave
17. Agency staff
18. Enforcement agencies
20. Career grade & Junior Doctors
Appendix A – example calculations – on
Appendix B – example calculation – night
Appendix C – AXOHSS health assessment
(1) for night workers
Appendix D – AXOHSS health assessment
(2) for night workers
Total number of pages 17
Date of development June 2003
Date of ratification/by September 2008
Review date July 2007
Replacing All previous work time regulations
management guidance policies
Lead Human Resource Shared Services
The Trust has reached agreement with the local Staff Side representatives
for the implementation of the Working Time Regulations under the Terms
of Trust Policy 35 and in accordance with agreements reached at National
level (Reference HSC 1998(204)) for all staff, including separate
arrangements for Medical and Dental staff .
The agreement which has been reached with local representatives of
Medical and Dental staff is attached as an appendix to the Trust policy.
The agreement has been drafted to include specific guidance on
implementation in respect of career grade Doctors, Dentists and Doctors
in training and consequently no further reference is made, or should be
inferred, to these staff in this document.
Whilst this document provides additional guidance for managers on the
application of the Trust policy, it is not exhaustive and managers may
require further advice on specific questions of interpretation or individual
employee issues that may arise, which can be obtained through the Trust
Human Resource Department.
1. RECORD KEEPING
1.1 Regulations require that the Trust (the employer) keeps adequate
records which would be available to the enforcing agencies (the
Health & Safety Executive and the Employment Tribunals) and
locally recognised Trade Unions to demonstrate compliance with
the limits on maximum working time, rest breaks, daily rest, weekly
rest periods and provisions for night work.
1.2 Generally, the Trust's current systems for recording such as
individual timesheets, salaries and wages records, staff rotas etc
will be sufficient for these purposes and the Occupational Health
assessment forms for night workers are required (see Appendices).
1.3 The Electronic Staff Record (ESR) once fully implemented will aid
with the monitoring and reporting all the requirements of the
Working Time Regulations,
1.4 It is necessary for local managers, or administrators acting under
their delegated authority, to ensure they are able to demonstrate
the employer’s compliance with the regulations. It will be fairly
apparent in the majority of cases whether a worker is close to
working in excess of the maximum weekly time limit, for example.
It will be sufficient for those workers who keep regular hours to be
able to notify the employer (the manager), should the hours worked
change, after which the hours worked by such workers could be
monitored more closely and adjusted if required.
1.5 All records taken in accordance with the Regulations and the Trust
Policy must be kept for a minimum period of two years.
1.6 Employees need to ensure that they declare on an annual basis any
secondary employment they may undertake to their manager.
Managers and employees have a responsibility to monitor this,
ensuring that the maximum 48 hours are not breached. Timesheets
include a section requesting declaration of hours worked for further
employers which employees have a duty to complete accurately and
managers to check and monitor.
2. MAXIMUM WEEKLY WORKING TIME LIMITS
2.1 Working time is defined as any time where an employee is working,
at his/her employer’s disposal and carrying out activities or duties.
To be classified as working time all three elements must be
satisfied. Working time will include time taken for training, civic and
public duties, health & safety and trade union activities.
2.2 In accordance with the Working Time Regulations and under the
Trust Policy, the maximum weekly working time limit is 48 hours per
week, averaged over a 17 week reference period. The calculation
of average weekly working time should not be affected by periods
where a worker is absent due to annual leave, sick leave and/or
maternity leave. If such leave occurs within a reference period, then
an equivalent number of days to the period of leave should be
added from the next reference period (see example calculations at
2.3 The Working Time Regulations allow that in exceptional
circumstances where staff are involved in the need for continuous
care related to the reception, treatment or care of patients, the
reference period may be extended by agreement with locally
recognised Trade Unions to a maximum of 26 weeks. The Trust
has not considered it necessary, however, to exercise this option
2.4 The weekly working time limit shall normally be calculated exclusive
of meal breaks, except where individuals are required to work
during meals. Where this occurs workers would be entitled to
3. ON CALL
3.1 Time when a worker is "on call" but otherwise free to pursue their
own activities is not considered to be working time.
3.2 Although a worker who is on call can be contractually paid for being
"on call", for the purposes of the Trust policy and the Regulations,
working time would not start until they receive a call to go to work.
Once the worker receives the call or the employer has contacted
them by some other means, working time commences from then
3.3 A distinction should be made between those workers who are "on
call" who need to respond immediately and those who are warned
in advance, (e.g. theatre nurses who may be advised that they will
be needed in a couple of hours). In the latter case, working time
would not start until the worker has left his/her residence.
4. SLEEP INS
4.1 Where staff are required to "sleep-in" on Trust premises for the
duration of a specified period, the regulations apply to ensure that
if the sleep is disturbed the appropriate rest or compensatory rest
arrangements are put in place.
It does not however constitute actual working time for the
purposes of the contract or under the minimum wage legislation
as sleeping-in arrangements, for which an appropriate allowance
is made, is not deemed to be substantial work which counts
towards the contractual and national minimum wage requirement.
5. WORKERS WITH MORE THAN ONE EMPLOYER
5.1 Some workers will have more than one employer. For example,
they may have a permanent contract and work separately on the
‘bank’ for the Trust or another employer. In such circumstances, it
is the responsibility of each employer to ensure that the worker
does not work over the maximum weekly time limit when their hours
for both employers are added up.
5.2 In cases where workers have more than one employer, all that is
required is that reasonable steps are taken to ensure workers are
not working beyond their statutory limit. This is easily done by an
employer including a special box on their time sheet asking whether
or not the person has another employer. Provided this question
has been asked, the Trust will carry out its legal obligations,
irrespective of whether or not the worker is willing to answer that
question. A revised time sheet has been developed for this
5.3 If the worker is engaged within the Trust on both a permanent and
a bank contract with two different managers or with an outside
agency, the obligation rests with the Trust as the sole employer to
ensure the worker does not exceed the maximum weekly working
time limit. In these circumstances, the arrangements must be
made between the managers concerned to make adjustments to
the overall period of time worked to ensure compliance with the
5.4 In the circumstances described above, each of the managers would
be responsible for ensuring they provide adequate rest breaks
according to the hours worked for them. Therefore, if the worker is
entitled to compensatory rest from working with manager A, then
manager A should ensure it is given. Manager B should not be
5.5 If managers are aware that individuals are in dual employment,
adequate steps should be taken to ensure patient care is not
affected as a result of the worker doing excess hours. Managers
should inform Employment Services so this can be recorded on the
6. OPTION TO WORK OVER 48 HOURS PER WEEK
6.1 Under the Working Time Regulations it is possible for a worker to
agree with their employer to work over the maximum weekly limit
should they wish.
6.2 With the exception of Career Grade Doctors and Doctors in
Training, the Trust does not however consider that working in
excess of 48 hours per week on average complies with the Health
& Safety principles of the regulations and has therefore determined
that the employer shall not enter into such arrangements other than
in exceptional circumstances.
6.3 With regard to Career Grade Doctors and Doctors in Training,
separate arrangements in respect of the option to work in excess of
48 hours per week were agreed at national level and are included
in their agreement which is attached as an appendix to the Trust
Working Time regulations policy.
7. IN WORK REST BREAKS
7.1 Where daily working time is more than six hours a worker is entitled
to a minimum uninterrupted break of 20 minutes away from their
workstation. The break must not be taken at the start or the end of
the working day.
7.2 Where a rest break is already provided in the contractual working
day, e.g. when a worker starts at 8.00am and has a lunch break at
1.00pm, they are not entitled to an additional 20 minute rest break
as they have already had a break under their contract.
7.3 The Working Time Regulations do not provide for work rest breaks
to be paid (although they do not exclude this) and where workers
are required to work during their rest period and are paid for doing
so, they will be entitled to receive compensatory rest. This could be
taken as time owing, for example, within a reasonable time period.
8. DAILY REST PERIODS
8.1 Each worker is entitled to a rest period of no less than 11
consecutive hours between each working day in each 24 hour
period, during which he/she works for his/her employer.
8.2 There should be very few, if any, circumstances where the Trust's
working patterns do not ensure compliance with this particular
regulation, other than, for example, where staff are rostered to work
a late shift followed by an early shift the next day. In normal
circumstances, staff have compensatory rest provided for within a
two week rostering period when this occurs and no further
adjustment will therefore be necessary (see Shift Workers below).
9. WEEKLY REST PERIODS
9.1 A week starts at midnight on Sunday.
9.2 Workers are entitled to an uninterrupted rest period of not less than
24 hours in each seven day period. This may be averaged over a
two week period i.e. a worker is entitled to two days rest over a
fortnight. These can be successive days.
9.3 Daily and weekly rest are separate entitlements which should be
taken consecutively e.g. one period of 35 hours consecutive rest
per seven day period. Where this is not possible, workers should
receive equivalent rest over a 14 day period, either as one 70 hour
period or two 35 hour periods. Weekly rest is also to be additional
to paid annual leave, which a worker may be entitled to under the
regulations. Again, these entitlements are provided for the majority
of Trust employees under current rostering arrangements and no
further adjustment will be necessary.
10. COMPENSATORY REST
10.1 Where a worker is required to work anytime which is supposed to
be rest time, e.g. daily or weekly rest periods, then the worker must
be permitted to take equivalent periods (the same number of hours
lost) of compensatory rest or, in exceptional cases, where providing
equivalent compensatory rest is not possible, they must be granted
rest in order to protect their Health & Safety.
10.2 In practice, exceptional circumstances will be rare, but should also
10.3 Generally, the Trust's current rostering arrangements ensure
compliance with this part of the regulations.
11. SHIFT WORKERS
11.1 When a shift worker changes shift, it may not be possible for them
to take their full rest entitlement before starting the new pattern of
work. The regulations stipulate that in these circumstances, daily
and weekly rest entitlement do not apply. However, it is the Trust's
view that wherever full daily and weekly rest periods cannot be
taken, local managers should make arrangements to allow
equivalent compensatory rest as soon as possible. Where
managers follow standard rostering guidelines within the Trust, they
will be compliant with the regulations as far as shift workers are
12. ENTITLEMENT UNDER OTHER PROVISIONS
12.1 Where a worker is entitled to a rest period, rest break or annual
leave in accordance with the regulations, as well as under a
separate provision, such as under his/her Contract of Employment,
e.g. a lunch break, he/she may not exercise the two rights
separately but may take advantage of whichever is the more
favourable. This means that in general terms, where staff are
provided with a half or one hour lunch break under their existing
Contract of Employment, or are allowed five weeks annual leave for
example, their entitlement under the Working Time Regulations
have been satisfied through their Contract of Employment.
13. NIGHT WORK
13.1 Night time is a period of at least seven hours which includes the
period from midnight to 5am and a night worker is someone who is
classed as working for at least 3 hours daily working time during
night time hours as a "normal course" of their employment.
13.2 This definition will include those staff involved in internal rotation.
13.3 The Trust is requiring that managers take all reasonable steps to
ensure the "normal" hours of their night workers do not exceed an
average of eight hours in 24 hours over a 17 week period. In
practice, this means that it is still possible to operate a 12 hour shift
13.4 For the purposes of the limit on night work, it is the night workers
normal hours of work which are relevant. Normal hours are those
which are regularly worked or fixed by the Contract of Employment.
The calculation is unaffected by absence from work, e.g. due to
sickness, as a workers normal hours of work remain the same
regardless of the actual hours worked (see sample calculation at
13.5 Local managers are responsible for ensuring that no night worker
who is doing work which involves heavy physical or mental strain,
e.g. described under the regulations as a special hazard, is not
actually working more than eight hours per night. The definition of
work which is of ‘heavy physical or mental strain’ should be
determined at a local level, following a risk assessment. In reality
there are very few situations within the Trust which would meet the
definition but where there is any doubt a risk assessment should be
14. HEALTH ASSESSMENTS
14.1 A night worker is entitled to a free health check at regular intervals.
The frequency of repeat assessments will often vary between
individuals according to factors such as the type of night work, it's
duration and the age and health of the individual worker. Repeat
assessments are not necessary where it is believed the original
assessment remains valid.
14.2 The Trust Occupational Health Department has made
arrangements for compliance with the requirements of the
Regulations for Health Assessments by the introduction of two
forms which are provided at Appendix C and D.
14.3 The first form is a straightforward fitness for work statement which
may be provided to night workers for completion and returned to
local managers where it will be stored in the individual's personnel
records. In accordance with the agreements reached with the Joint
Trade Union's completion of the form is voluntary.
14.4 The second form contains more detailed clinical information which
must remain confidential and should therefore not be seen by the
manager but should be returned directly to the Occupational Health
Department upon completion by the employee.
14.5 A night worker is entitled to be transferred, whenever possible, to
other suitable work which is not at night, where a registered
medical practitioner has advised the employer that the worker is
suffering from health problems connected with the fact that they
work at night. The option to transfer to suitable day work, with
appropriate pay and conditions of service, should therefore be
considered in such circumstances.
15. ANNUAL LEAVE
15.1 . All employees including "bank" workers, shall be entitled to a
statutory period of 4 weeks paid annual leave (pro rata for part-
time) to be taken at a time to be agreed with the employer. This
entitlement shall rise to 4.8 weeks (24 days if work 5 day week)
with effect from 1st October 2007 under the Working Time
(Amendment) Regulations 2007 and to 5.6 weeks (28 days if
work 5 day week) (pro.rata for part-time) from 1st April 2009.
15.2 Entitlement to annual leave under the regulations is not in addition
to existing contractual entitlements. Taking contractual paid leave
in a particular leave year therefore counts against the workers
entitlement under the Regulations. This means that those workers
with substantive full time contracts who work additionally for the
bank will not be entitled to further leave. Bank staff will only be
entitled to annual leave if they do not receive contractual annual
leave from any other Trust employment.
15.3 Leave may be taken in instalments but only in the leave year in
respect of which it is due and, under the regulations, may not be
replaced by a payment in lieu except where the workers
employment is terminated.
15.4 Where a worker begins part way through a leave year, he/she is
entitled to leave proportionate to that period of the leave year
remaining. If the period of leave includes a proportion of a week,
this should be calculated in days with any part days being treated
as whole days.
15.5 Qualifying period - The entitlement to paid annual leave begins on
the first day of employment. Employers can use an accrual system
whereby during the first year of employment the proportion of leave
which may be taken builds up over the year. Therefore the amount
of leave which may be taken builds up monthly in advance at the
rate of one-twelfth of the annual entitlement each month.
15.6 Public holidays - there is no statutory entitlement to bank and
public holidays. These are simply days where a worker may use
his paid leave under the terms of their Contract. As with other
contractual leave, this can be used to discharge an employer’s
responsibility for providing statutory leave under the regulations.
15.7 Carry over of leave - the regulations do not allow carry over of
statutory leave entitlement to a new annual leave year, although
they do leave scope for individual employers and workers to
negotiate more favourable terms. Under the Trust's current
arrangements, staff may carry a maximum of five days leave
forward with their local manager's agreement and as long as a
minimum of four weeks statutory leave is offered every year or 4.8
weeks (24 days if work 5 day week) from 1st October 2007, annual
leave over and above the four weeks (4.8 weeks /24 days from 1st
October 2007) may be carried forward subject to normal Trust
15.8 Where a workers employment is terminated during the course of
his/her leave year and where the proportion of leave taken is less
than the proportion of the leave year which has expired, then
he/she may be entitled to a payment in lieu of outstanding annual
15.9 Where a worker has taken more leave than that to which he/she is
entitled at the date of termination, the Trust may seek
compensation from the worker either by a reduction in final
payment or by undertaking additional work or otherwise.
15.10 Part time/temporary workers - will be entitled to annual leave
under the Working Time Regulations (or under their Contract of
Employment) pro-rata to full time.
15.11 Dates on which leave is taken:
a) A manager can require a worker to take all or any of the
leave to which he/she is entitled at specified times provided
that he/she is given prior notice. The notice period should be
at least twice the period of leave to be taken.
b) A worker is required to give notice to the manager when they
wish to take leave. The notice period should be at least
twice the period of leave to be taken. A manager may refuse
the worker permission to take leave requested. To do so,
they must notify the worker within the period equivalent to
the period of leave.
15.12 Any rights or obligations mentioned in the previous paragraph may
be varied or excluded where there is a relevant clause in the
Contract of Employment.
15.13 Payment in respect of periods of leave - the Trust has
determined that in accordance with the Working Time Regulations
and a worker will be entitled to paid annual leave for the statutory
annual leave period of four weeks or 4.8 weeks (24 days if working
a 5 day week) from 1st October 2007at a rate of a week's pay in
respect of each of leave. Trust annual leave entitlements are
inaccordance with the Agenda for Change Terms and Conditions
which exceed the statutory entitlement.
15.14 A week's pay is defined as the payment a worker would receive
during a normal working week. For some NHS staff, it will mean an
increase in the payments they receive for annual leave as a
consequence of the addition of the unsociable hours
enhancements they would receive if they were working during a
normal working week.
15.15 The Trust has determined that staff on permanent contracts shall
receive any additional payments to which they are entitled under
the Regulations in two lump sum payments per annum, one in June
and one in September, each of which will equate to the average
enhancements for two weeks annual leave, calculated over a 26
16. BANK STAFF
16.1 The Working Time Regulations are applied to "workers" and it has
been accepted by the Trust that bank staff are workers irrespective
of the complexities surrounding the nature of their employment
16.2 Paid annual leave:
a) Permanent staff who are working additional hours on the
bank will already be under a Contract of Employment which
entitles them to four or more weeks paid annual leave. As
these staff are already entitled to annual leave, the
requirement of the Regulations have been met and therefore
no additional leave will be accrued whilst working on the
b) Staff who work solely on the bank will accrue their annual
leave on a pro-rata basis. Payments for annual leave for
bank staff will be calculated quarterly and any payments for
annual leave will be based on the previous quarter's
calculations of average earnings.
Whilst bank staff conduct their work in unique circumstances, it is
imperative that the same record keeping practices are followed as
those for permanent staff. Local managers should ensure records
are kept of key hours worked on the nurse bank, any hours worked
for another employer, health assessments details in cases of night
workers and compensatory rest accrued (if applicable). In general
terms, the current systems of recording time worked for bank staff
will be sufficient for these purposes.
16.4 Dual employers:
As many of the Trust bank staff also have a substantive Contract
with the Trust and do extra shifts on the bank within their own
service or at another hospital service, it is important that each
employer/manager takes reasonable steps to establish:
a) Whether their staff are working for another employer, or
b) if they are working over the average of 48 hours.
This duty is easily discharged by the inclusion of a special box on
the bank staff time sheet. By asking these questions the Trust will
have discharged it's obligations under the legislation.
16.5 Where bank staff are employed in different services within the
Trust, each local manager for whom they undertake duties will be
responsible for ensuring that they provide adequate rest breaks
according to the hours worked for them.
17. AGENCY STAFF
17.1 Agency staff will be covered under the scope of the Regulation and
have a right to all the Health & Safety entitlements provided for.
However, the responsibility for these staff shall lie with the Agency
who is their employer.
17.2 Whilst the Trust contract's department shall be responsible for
ensuring that provisions under the Working Time Regulations are
adequately provided for in any contract to supply agency staff on a
Trust wide basis, this will be the responsibility of local managers
where they enter into contractual arrangements with agencies by
themselves. Although the Agency will be recognised as the
employer under the Regulations, it remains the responsibility of the
local manager to comply with requirements for ‘in work’ rest breaks.
18. ENFORCEMENT AGENCIES
18.1 The limits on weekly working time, night work and provisions for
health assessments for night workers, the pattern of work and
record keeping will be enforced under the Regulations by the
Health & Safety Executive (HSE) and local authority Environmental
Health Officers. The HSE is responsible for enforcing the working
time limits where they apply in hospitals. Local Authority Officers
are responsible for retailing, offices, hotels and catering, sports,
leisure and consumer services.
18.2 The right to daily rest, weekly rest, rest breaks and paid annual
leave will be enforced through the Employment Tribunals.
18.3 Workers whose entitlements are denied or who has suffered
detriment as a result of asserting their rights are entitled to make a
complaint to an Employment Tribunal. However, as a prior step, a
worker can seek trades union advice and try to settle any dispute
using the Trust's Grievance procedure.
19.1 The Regulations provide for various sectors of activity within the
work force to be excluded from certain parts of the Regulations.
19.2 The entitlement to certain provisions under the Regulations does
not arise in a range of other circumstances. However, the Trust
does not consider that these circumstances apply generally to NHS
workers and has therefore not exercised any options to exclude
workers from the Regulations.
20. CAREER GRADE & Junior Doctors
21.1 The Trust has reached agreement with Medical and Dental staff
representatives under the terms of the national arrangements for
Career Grade Doctors and Junior Doctors for the implementation of
the Working Time Regulations and which are attached as
Appendices to the Trust policy.
Example Calculations - Average Weekly Hours
The average weekly hours can be calculated using the equation:
Where: A is the total number of hours worked during the reference period.
B is the total number of hours worked, immediately after the reference
period, during the number of working days equal to the number of days
missed due to annual leave entitlement, sick leave and maternity leave;
C is the number of weeks in the reference period.
1. A worker has a standard working week of 40 hours and does overtime
of 12 hours a week for the first 10 weeks of the 17 week reference
period. He has no leave of any sort during the reference period.
The total hours worked is:
17 weeks of 40 hours and 10 weeks of 12 hours of overtime
(17 x 40) + (10 x 12) = 800
The average is calculated as follows:
800/17 = 47.1 hours per week
Therefore the average limit of 48 hours has been complied with.
2. A worker has a standard working week of 40 hours (8 hours a day) and
does overtime of 8 hours a week for the first 12 weeks of the 17 week
reference period. He also takes 8 days sick leave during the reference
Of the 17 week reference period 15 weeks and 2 days were worked
together with 12 weeks of 8 hours overtime. Therefore the total hours
worked for the 17 week reference period:
(15 x 40) + (2 x 8) + (12 x 8) = 712
To this must be added hours worked for the 8 days of his sick leave
during the reference period. Therefore the hours worked in the first 8
working days after the reference period is added to the total. If the
worker does no overtime this will be (8 x 8) = 64.
Therefore his average is: 712 + 64/17 = 45.6 hours per week.
The average limit has been complied with.
Example Calculation - Night Work
Average night hours can be calculated using the following equation:
A/B - C
Where: A is the number of hours during the applicable reference period which
are normal working hours for that worker.
B is the number of days during the applicable reference periods.
C is the number of hours of weekly rest to which a worker is entitled
under the Regulations (i.e. 24 hours for 7 days) divided by 24. (It should
be noted that this is not the total amount of hours that the worker is at
rest each week. Only the hours making up the weekly rest period that
the worker is entitled to under the Regulations are counted).
A night worker normally works 4 x 12 hour shifts each week. Therefore,
the total number of normal hours of work for a 17 week reference period
17 weeks of 4 shifts of 12 hours
17 x (4 x 12) = 816
There are 119 days in the reference period of 17 weekly rest periods of
24 hours to which the worker is entitled. Therefore, C is:
17 x 24/24 = 17
The calculation becomes the total of hours divided by the number of
days a worker would be required to work:
816/119 - 17
This equals an average of 8 hours in each 24 hour period.
Exeter Occupational Health and Safety Service (EXOHSS)
HEALTH ASSESSMENT (1) FOR NIGHT WORKERS
You have the right to a health assessment under the Working Time Regulations 1998. If
you tick YES to any of the questions below then arrangements may be made for you to
see the Occupational Health Nurse or Physician.
Name Date of Birth
Job Title NI No.
Trust/Compa Dept/Area of
Shift Pattern/Details of Internal Rotation (eg 4 on 4 off / 4wks days 2 wks
Do you suffer from any of the following? To preserve medical confidentiality you are not
obliged to identify which conditions / illnesses you have.
Heart Problems eg High Blood pressure / angina?
Psychiatric or Nervous problems?
Gastro-intestinal problems eg peptic ulcer?
Any medical condition requiring you to take medication on a strict
Any other health factors that might affect you fitness to work nights?
Please tick Yes No
Do you wish to talk to the Occupational Health Nurse about working nightshifts?
Please tick Yes No
I certify that I have answered the above questions to the best of my knowledge.
Please return this form to your manager. If you answered YES to any questions your
manager will forward this Health Questionnaire to EXOHSS who will send you a more
detailed questionnaire for direct return to EXOHSS. You will then be contacted personally
if you need an appointment. If you have any concerns please contact EXOHSS on 01392
Exeter Occupational Health and Safety Service (Tel: 01392 405062)
HEALTH ASSESSMENT (2) FOR NIGHT WORKERS
MEDICAL IN CONFIDENCE
In response to your recently completed screening questionnaire you are invited to
complete the more detailed questionnaire below:
The purpose of this health questionnaire is to assess your fitness for night work and to
advise you and your employer if any action is required (see notes overleaf).
Name Date of Birth
Job Title NI No.
Trust/Company Dept/Area of Work
Shift Pattern/Details of Internal Rotation
Please complete this form to the best of your knowledge and tick the appropriate boxes.
If you answer YES, please describe (on the back of this form) any difficulties you think you
have with night work.
Do you suffer from any of the following?
Diabetes? Yes No
If Yes does this require treatment with Insulin injections on a strict timetable? Yes No
Epilepsy / Blackouts? Yes No
Gastro – Intestinal problems? Yes No
Heart Disease or High Blood Pressure? Yes No
Psychiatric / Nervous problems? Yes No
Any medical condition requiring you to take medication on a strict timetable? Yes No
Any other health factors that may affect your fitness to do night work? Yes No
I certify that I have read the notes overleaf and that the answers to the above questions
are correct to the best of my knowledge. I understand that if I have withheld information,
this may adversely affect efforts to place me in suitable employment. I agree to this
assessment being followed up by an appointment with an Occupational Health Nurse or
Physician if necessary.