Fill and Sign the Meal and Rest Break Recording Form

Basic Form © James R. McDade 209-667-2300 (04-25-06) MEAL AND REST BREAK RECORDING FORM Note: Employers use this form to track rest and meal breaks. Check with legal counsel if you do not know the wage and hour rules. (Delete this note prior to use.)Rest Breaks: Employees who work over 3½ hours in a day must take a paid 10-minute rest break for every 4 hours worked. If you work between 4 to 6 hours in a day, you get 1 rest break. If you work over 6 hours in a day, you must take 2 rest breaks. The rest breaks should be taken about 2 hours after starting work, and approximately 2 hours after taking a meal break. Meal Breaks: Employees who work over 5 hours a day must also take an unpaid meal break of 30 minutes. Meal breaks must begin by the end of the 5th hour of work. If you work 6 hours or less, you can (but do not have to) voluntarily waive your meal break. Meal and rest breaks cannot be combined together to create a longer break. Nor may meal and rest breaks be taken at the very beginning or the end of a shift so that the employee essentially begins work late or leaves work early. Each employee must complete the chart below for each day worked. First 10 Minute Break Meal Break Waived?Second 10 Minute Break Signature Employee Name (Print) Date TakenNot TakenMust work 6 hours or less for waiverTakenNot TakenBy signing, you verify that the information is correct.