Self-Diagnosis Check List for Assessment of
Worker’s Accumulated Fatigue
This check list was made as a tool for workers to self-check the accumulation of fatigue
in order to prevent health impairment due to overwork
June, 2004
Ministry of Health, Labour and Welfare
|
Self-Diagnosis Check List for Assessment of Worker's Accumulated Fatigue |
Enter date ______ year ______ month ______ day |
| |
This check list is for assessment of the worker’s accumulated fatigue based on subjective symptoms and work conditions.
|
1. Please tick the most suitable box for each question concerning symptoms you have been aware of in the past month.
|
1. Irritable |  Hardly Ever(0)
| Sometimes(1) | Often(3) |
2. Anxiety | Hardly Ever(0) | Sometimes(1) | Often(3) |
3. Restless | Hardly Ever(0) | Sometimes(1) | Often(3) |
4. Depressed | Hardly Ever(0) | Sometimes(1) | Often(3) |
5. Cannot Sleep | Hardly Ever(0) | Sometimes(1) | Often(3) |
6. Feel Ill | Hardly Ever(0) | Sometimes(1) | Often(3) |
7. Lack of Concentration | Hardly Ever(0) | Sometimes(1) | Often(3) |
8. Often Make Mistakes | Hardly Ever(0) | Sometimes(1) | Often(3) |
9. Feel Very Sleepy During Work | Hardly Ever(0) | Sometimes(1) | Often(3) |
10. Unmotivated | Hardly Ever(0) | Sometimes(1) | Often(3) |
11. Exhausted
(excluding after exercise) | Hardly Ever(0) | Sometimes(1) | Often(3) |
12. Feel Tired when Waking Up
in the Morning
| Hardly Ever(0) | Sometimes(1) | Often(3) |
13. Get Tired More Easily than Before | Hardly Ever(0) | Sometimes(1) | Often(3) |
|
Assessment of Subjective Symptoms: Please total the numbers in the brackets for each question. |
Total: ________ Points |
I | 0-4 Points | II | 5-10 Points | III | 11-20 Points | IV | 21 Points or More |
|
|
| 2. Please tick the most suitable box for each question concerning work conditions in the past month. |
1. Overtime Work in the Past Month | None/Reasonable(0) | Often(1) | Very Often(3) |
2. Irregular Work
(Schedule Change, Unexpected Work)
| Few(0) | Often (1) | — |
3. Burdens Accompanying Business Trips
(Frequency/Actual Working Hours/International Time Difference) |
None or Few(0) | Heavy(1) | — |
4. Burdens Accompanying Night Work (*1) | None or Few(0) | Heavy(1) | Very Heavy(3) |
5. Break /Nap Time and Facilities | Adequate(0) | Inadequate(1) | — |
6. Work Related Mental Burdens | Few(0) | Heavy(1) | Very Heavy(3) |
7. Work Related Physical Burdens (*2) | Few(0) | Heavy(1) | Very Heavy(3) |
|
*1. Please decide by taking into consideration such factors as frequency and hours of night work . Night work is a shift partially between 10 pm and 5 am or right through.
*2. Physical burden due to manual work, work in hot or cold conditions, etc. |
| Assessment of Work Conditions: Please total the numbers in the brackets for each question. |
Total: ________ Points |
|
A | 0 Points | B | 1-2 Points | C | 3-5 Points | D | 6 Points or More |
|
|
| 3. Overall Assessment |
Use the following table to determine the degree of your work related burdens from 0 to 7, based on your assessment of subjective symptoms and work conditions.
|
Points of Your Work Related Burdens |
| Work Conditions |
A | B | C | D |
Subjective
Symptoms | I | 0 | 0 | 2 | 4 |
II | 0 | 1 | 3 | 5 |
III | 0 | 2 | 4 | 6 |
IV | 1 | 3 | 5 | 7 |
|
| * The results of people with such symptoms as diabetes, high blood pressure, etc., may not be accurate. |
Your work related burden is ________ points (0-7) |
| |
Results | Points | Work Related Burdens |
0-1 | Low |
2-3 | Rather High |
4-5 | High |
6-7 | Very High |
|
|
| 4. Preventive Measures against Accumulation of Fatigue How was the result on the degree of your work related burdens? This check list is based on the results of medical research to prevent health impairments and allows you to assess the degree of your work related burdens. If your point was between 2 to 7, you may have accumulated fatigue and need to improve specific “work conditions” listed in checklist 2 (those items for which you scored 1 or 3 points). Try to improve those items which can be improved at your own discretion. For those items which cannot be improved at your own discretion, consult your superior, industrial physician, etc., to improve work conditions. There are instances, however, where non work-related factors such as lifestyle patterns are the main causes of the symptoms. If this is the case, it is important to review your sleeping and resting patterns. In order not to accumulate fatigue, it is necessary to reduce burdens and make sure to get enough sleep and rest. Shortening working hours can reduce work related burden and make it easier to get sleep and rest .Therefore, shortening working hours is effective in preventing the accumulation of fatigue. If your overtime working hours exceed 45 hours a month, shortening working hours is highly recommended .
(Reference Information ) Relationship between Overtime work, Cerebrovascular diseases and ischemic heart diseases
Overtime work not only increases your workloads but also reduces the chance to sleep and relax. Therefore, it is considered to be one of the main causes of fatigue accumulation. Please refer to the following chart, which is based on medical information and shows the relationship between overtime working hours (“overtime working hours” is defined hours worked within one week which excludes 40 hours (legal working hours)) and the risks of health impairments such as cerebrovascular diseases including cerebral hemorrhages (encephalorrhagia) and ischemic heart diseases including myocardial infarction. Even if the degree of your work related burden was low on the above checklist, precaution should be taken if you work long overtime .
|
Overtime
working hours | Under 45 hours
within one month | Risk of health impairments rises
gradually along with the
increase of working hours
| Over 100 hours within one month or 80
hours per month for 2 to 6
months |
Risk of health impairments | Low | High |
|
| |
|
| |
A PDF file of the “Self-Diagnosis Check List for Assessment of Worker’s Accumulated Fatigue”(Japanese version) is available at the Ministry of Health, Labour and Welfare homepage: http://www.mhlw.go.jp
An online “Self-Diagnosis Check List for Assessment of Worker’s Accumulated Fatigue” (Japanese version) that features a automatic assessment function is available at the Japan Industrial Safety and Health Association homepage: http://www.jisha.or.jp/ and the Japan Advanced Information Center of Safety and Health homepage: http://www.jaish.gr.jp/
* Assessment categories of this checklist was revised from those of the former checklist which had been formulated in FY 2003.
|
|
| |
Outline of comprehensive program for the prevention of health impairment due to overwork |
- Recognition standards for the workmen’s accident compensation payments for brain and heart diseases (including KAROSHI : deaths from overwork) was revised in December 2001 on the basis of medical research in recent years. and it was determined to consider accumulation of fatigue over long periods as clearly excessive burdens . In response to this revision, “Comprehensive Program for the Prevention of Health Impairment Due to Overwork” was formulated in February 2002 in addition to existing measures to ensure workers’ health.
|
Measures employers should take in order to prevent health impairments
caused by overwork
| (1) | |
Reducing overtime working hours
Employers must comply with standards concerning limitations on the extension of working hours as determined in the agreement specified in article 36 of the Labor Standards Law and should keep overtime working hours less than 45 hours per month.
|
| (2) |
|
Promoting the utilization of annual paid holidays |
| (3) |
|
Implementing thorough health management
In addition to through implementation of medical examinations and follow-up measures after executing medical examinations stipulated in the Industrial Safety and Health Law, employers should also carry out the measures listed below depending on overtime working hours of each worker. Furthermore, employers of small sized enterprises, which have not appointed an industrial physician, should make use of regional industrial health center services. |
| |
|
a) |
|
In the event any employer has workers engage in overtime work exceeding 45 hours a month, such employer should receive advice and guidance from the industrial physician regarding health management at the workplace.
|
| |
|
b) |
|
In the event any employer has workers engage in overtime work exceeding 100 hours within one month or 80 hours per month for a period of two to six months, such employer should have the workers receive health guidance through interviews with the industrial physician. If deemed necessary by the industrial physician, the employer shall have the workers undergo medical examinations and shall take necessary follow-up measures based on the results.
|
| |
|
c) |
|
In the event of occupational diseases due to overwork, the employer should receive advice from the industrial physician, investigate the causes from various perspectives and establish measures to prevent recurrences. |
|
|
|
|
top