KD-HR-WT-003
Working Time Record and 48-Hour Opt-Out
The worker's written agreement to work more than an average of 48 hours, in plain words with the right to end it on seven days' notice or an agreed period of up to three months, the notice record, and a landscape weekly log of hours, night work, rest and breaks with the reference-period average and the night and young worker checks reg 9 needs.
4 pages · 354 fillable fields · works in Adobe Reader, Preview, Chrome, or on a phone — or complete it online in your browser and download the finished document.
Page 1 of 4 — click to enlarge
Read all 4 pages first — watermarked sample, no email Before you submit: the checklist
Statutory basis, cited on the form
- Working Time Regulations 1998 regs 2, 4, 5, 5A, 6, 6A, 7, 9, 10, 11, 12, 23, 27 and 27A
What it is not
It is not a completed document and it is not health and safety advice. You must adapt it to your site and have a competent person complete and sign it off. See why we don't say "compliant".
Format
AcroForm fillable PDF. Every field has a tooltip. Tab order follows the reading order. Works on desktop and mobile, in Adobe and non-Adobe readers.
This revision was prepared against legislation current at 10 August 2026. Revision A0. Check kubitdocs.com/revisions for the current revision before use.
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