I am scheduled to work a shift of 6 hours or less on: 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Employee Name and Employee Number in the designated fields at the top of the form.
3. In the section labeled 'I am scheduled to work a shift of 6 hours or less on:', input the relevant Date(s) for your shift.
4. Next, specify the hours you will be working by filling in the 'From' and 'To' fields. Be sure to circle either a.m. or p.m. as appropriate.
5. Review the understanding statements regarding your meal break waiver, ensuring you are aware of your rights and responsibilities.
6. Sign and date the form in the Employee Signature section to validate your waiver request.
7. If you need to revoke this waiver later, complete the revocation section with your signature and date.

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