Health care missed or late meal break tracking

Missed or Late Meal Break Tracking Form

You are entitled to a 30-minute uninterrupted meal period when working more than five hours. The first meal period must be between the second and fifth hour worked. If you work 11 hours or more during the day, you must receive a second meal period no later than five (5) hours after the end of your first meal period.

Late Mealtime: If you are not given time to have a 30-minute mealtime, you must be paid for your time worked plus 30 minutes. Paying employees 30 minutes for the meal period does not absolve the employer’s responsibility to give you a late 30-minute unpaid mealtime when practicable.

Meal break laws: WAC 296-126-092 and RCW 49.12.480
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Date of Missed or Late Meal period*
Missed or Late Meal breaks:*

Late to Meal Period 1Missed Meal Period 1Late to Meal Period 2Missed Meal Period 2
Name*

First NameLast Name
Employer/Work Location*
Department*
Additional notes
Should be Empty:

Missed or Late Meal Break Tracking Form