Fill online: Consent to overtime and overtime register

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Your details

Name of the establishment

Fills 3 places in the document.

Address of the establishment

OSH registration number

Name of the worker

Fills 4 places in the document.

Employee code

Fills 3 places in the document.

Department

Daily / Weekly / Monthly

Normal hours of work in a day

On the Rule 69 basis / on the daily or weekly basis, whichever gives more overtime

Hours in the ordinary working day

Quarterly overtime ceiling in hours

Rule 69 of the OSH (Central) Rules 2026 / the State OSH rules

Weekly overtime limit in hours

Designation of the officer who receives withdrawals

First day of the quarter

Last day of the quarter

Overtime hours agreed for the occasion

Dates of the overtime

Reason for the overtime

Has been read by me / has been read and explained to me in the language stated below

Language in which the terms were explained

Date of the consent

Name of the witness

Designation of the witness

Name of the authorised signatory

Designation of the authorised signatory

Date the copy was given to the worker

Date of withdrawal

Name of the officer who received the withdrawal

Date the withdrawal was received

Rule 69 basis / Higher of daily and weekly

Employee code, row 1

Week beginning (date), row 1

Mon hours, row 1

Tue hours, row 1

Wed hours, row 1

Thu hours, row 1

Fri hours, row 1

Sat hours, row 1

Sun hours, row 1

Employee code, row 2

Week beginning (date), row 2

Mon hours, row 2

Tue hours, row 2

Wed hours, row 2

Thu hours, row 2

Fri hours, row 2

Sat hours, row 2

Sun hours, row 2

Employee code, row 3

Week beginning (date), row 3

Mon hours, row 3

Tue hours, row 3

Wed hours, row 3

Thu hours, row 3

Fri hours, row 3

Sat hours, row 3

Sun hours, row 3

Employee code, row 4

Week beginning (date), row 4

Mon hours, row 4

Tue hours, row 4

Wed hours, row 4

Thu hours, row 4

Fri hours, row 4

Sat hours, row 4

Sun hours, row 4

Employee code, row 5

Week beginning (date), row 5

Mon hours, row 5

Tue hours, row 5

Wed hours, row 5

Thu hours, row 5

Fri hours, row 5

Sat hours, row 5

Sun hours, row 5

Employee code, row 6

Week beginning (date), row 6

Mon hours, row 6

Tue hours, row 6

Wed hours, row 6

Thu hours, row 6

Fri hours, row 6

Sat hours, row 6

Sun hours, row 6

Employee code, row 7

Week beginning (date), row 7

Mon hours, row 7

Tue hours, row 7

Wed hours, row 7

Thu hours, row 7

Fri hours, row 7

Sat hours, row 7

Sun hours, row 7

Employee code, row 8

Week beginning (date), row 8

Mon hours, row 8

Tue hours, row 8

Wed hours, row 8

Thu hours, row 8

Fri hours, row 8

Sat hours, row 8

Sun hours, row 8

Employee code, row 9

Week beginning (date), row 9

Mon hours, row 9

Tue hours, row 9

Wed hours, row 9

Thu hours, row 9

Fri hours, row 9

Sat hours, row 9

Sun hours, row 9

Employee code, row 10

Week beginning (date), row 10

Mon hours, row 10

Tue hours, row 10

Wed hours, row 10

Thu hours, row 10

Fri hours, row 10

Sat hours, row 10

Sun hours, row 10

Employee code, row 11

Week beginning (date), row 11

Mon hours, row 11

Tue hours, row 11

Wed hours, row 11

Thu hours, row 11

Fri hours, row 11

Sat hours, row 11

Sun hours, row 11

Employee code, row 12

Week beginning (date), row 12

Mon hours, row 12

Tue hours, row 12

Wed hours, row 12

Thu hours, row 12

Fri hours, row 12

Sat hours, row 12

Sun hours, row 12

Employee code, row 13

Week beginning (date), row 13

Mon hours, row 13

Tue hours, row 13

Wed hours, row 13

Thu hours, row 13

Fri hours, row 13

Sat hours, row 13

Sun hours, row 13

Employee code, row 14

Week beginning (date), row 14

Mon hours, row 14

Tue hours, row 14

Wed hours, row 14

Thu hours, row 14

Fri hours, row 14

Sat hours, row 14

Sun hours, row 14

Employee code, row 15

Week beginning (date), row 15

Mon hours, row 15

Tue hours, row 15

Wed hours, row 15

Thu hours, row 15

Fri hours, row 15

Sat hours, row 15

Sun hours, row 15

Daily-rated / Other (1)

Other hours at the overtime rate, row 1

Yes / No (1)

Monthly wages, row 1

Daily-rated / Other (2)

Other hours at the overtime rate, row 2

Yes / No (2)

Monthly wages, row 2

Daily-rated / Other (3)

Other hours at the overtime rate, row 3

Yes / No (3)

Monthly wages, row 3

Daily-rated / Other (4)

Other hours at the overtime rate, row 4

Yes / No (4)

Monthly wages, row 4

Daily-rated / Other (5)

Other hours at the overtime rate, row 5

Yes / No (5)

Monthly wages, row 5

Daily-rated / Other (6)

Other hours at the overtime rate, row 6

Yes / No (6)

Monthly wages, row 6

Daily-rated / Other (7)

Other hours at the overtime rate, row 7

Yes / No (7)

Monthly wages, row 7

Daily-rated / Other (8)

Other hours at the overtime rate, row 8

Yes / No (8)

Monthly wages, row 8

Daily-rated / Other (9)

Other hours at the overtime rate, row 9

Yes / No (9)

Monthly wages, row 9

Daily-rated / Other (10)

Other hours at the overtime rate, row 10

Yes / No (10)

Monthly wages, row 10

Daily-rated / Other (11)

Other hours at the overtime rate, row 11

Yes / No (11)

Monthly wages, row 11

Daily-rated / Other (12)

Other hours at the overtime rate, row 12

Yes / No (12)

Monthly wages, row 12

Daily-rated / Other (13)

Other hours at the overtime rate, row 13

Yes / No (13)

Monthly wages, row 13

Daily-rated / Other (14)

Other hours at the overtime rate, row 14

Yes / No (14)

Monthly wages, row 14

Daily-rated / Other (15)

Other hours at the overtime rate, row 15

Yes / No (15)

Monthly wages, row 15

Employee code, summary row 1

Name of the worker, summary row 1

Employee code, summary row 2

Name of the worker, summary row 2

Employee code, summary row 3

Name of the worker, summary row 3

Employee code, summary row 4

Name of the worker, summary row 4

Employee code, summary row 5

Name of the worker, summary row 5

Employee code, summary row 6

Name of the worker, summary row 6

Employee code, summary row 7

Name of the worker, summary row 7

Employee code, summary row 8

Name of the worker, summary row 8

Employee code, summary row 9

Name of the worker, summary row 9

Employee code, summary row 10

Name of the worker, summary row 10

Name of the preparer

Designation of the preparer

Date of preparation

Name of the reviewer

Designation of the reviewer

Date of review

Take the consent before overtime is first asked for · one copy to the worker, one to the personnel file · renew each quarter

[Name of the establishment]
Establishment: [Address of the establishment] | Registration number under section 3, OSH Code 2020: [OSH registration number]

WORKER'S CONSENT TO WORK OVERTIME

Name of the worker: [Name of the worker] | Employee code: [Employee code] | Department: [Department] | Wage period: [Daily / Weekly / Monthly]

[Name of the establishment] (the "Company") asks for your consent to work overtime on the terms in Part A. Please read them, or have them read and explained to you, before you sign Part B.

Part A. What the Company asks, and on what terms

1. Normal hours. Your normal hours of work are [Normal hours of work in a day] hours a day and not more than forty-eight hours in a week, as shown in the notice of periods of work displayed in the establishment. You have a rest interval of at least thirty minutes after five hours of continuous work, a spread-over of not more than twelve hours in a day including any overtime, and one rest day in every week.

2. What counts as overtime. Overtime is work beyond eight hours in a day where you are paid by the day, and beyond forty-eight hours in a week in any other case (Rule 69(1) of the Occupational Safety, Health and Working Conditions (Central) Rules 2026, or the corresponding State rule). The Company counts overtime [on the Rule 69 basis / on the daily or weekly basis, whichever gives more overtime].

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