By signing this form, I certify that I have worked the hours listed and my breaks were taken. I have not had any work related injuries or illnesses that I have not reported. MEALS AND REST BREAKS: Rest breaks of not less than 10 consecutive minutes must be taken for every four hours worked occurring as near as possible to the middle of the work period. Rest breaks may not be combined or added to meal breaks. They may not be used to come in or leave 10 minutes early or late. Employees must take a 30 minute meal break for every work period of more than five hours. If six hours of work will complete the day's work, the employee may choose to not to take the meal break. A second meal break of no fewer than 30 minutes must be taken for all workdays consisting of more than 10 hours.