Sample Meal and Rest Break Policy

Employment Practices
Sample Meal and Rest Break Policy
Sample Policy
[Employer name/practice name] provides his/her employees with lunch and rest breaks during the course
of each workday.
Employees who work for more than five hours in a day must have a lunch break of at least 30 minutes.
Depending on the daily schedule, lunch may vary from 30 minutes to one hour. Lunchtime is unpaid and
therefore all employees are required to clock out during this period. Failure to clock out can be grounds
for disciplinary action.
If employees work no more than six hours in a day and request to waive their meal break, the meal break
can be mutually waived. Sample waiver provided below.
If employees choose to stay on the premises during their lunch period, the following locations are
available:
Staff break room and outside lunch area. [Customize locations for your practice]
A 10-minute, paid rest period must be taken approximately halfway through any work period of four hours
or more, as close to the middle of the work period as possible. Employees working eight hours are
entitled to two 10-minute rest breaks each day, one in the morning and one in the afternoon. Rest periods
are not required for employees who work less than 3 1/2 hours in a workday.
Rest breaks are paid, therefore, employees are not required to clock out. Rest breaks are to be
uninterrupted and employees will be relieved of all their duties during the break.
Rest breaks are self-managed and failure to take mandatory breaks can be grounds for disciplinary
action. It is the employee’s responsibility to notify [employer or representative] if unable to take an
uninterrupted rest or meal period.
Authorized meal and rest periods cannot be used to shorten your workday or be accumulated for any
other purpose. Additionally, rest periods may not be combined with a meal period.
Additional considerations:
 It is the employer’s responsibility to communicate the meal and rest break laws to employees.
 The employee’s meal break must occur no later than four hours and 59 minutes after the
employee’s start time.
 Employees who are not provided a rest break or are not able to take meal breaks are entitled to
an additional one hour of pay for each incident. The additional time should be provided to the
employee on the next regularly scheduled payroll date.
 Employers must provide employees uninterrupted time, relieve their employees of all duties
during required rest periods and relinquish any control over how employees spend their break
time.
 Should an employee’s time be interrupted, employers may reasonably reschedule a rest period
when the need arises. Such circumstances should be “the exception rather than the rule.” If a rest
period is interrupted, an employer can provide another rest period to replace the interrupted one
or pay the premium pay of one additional hour of pay for the missed rest break.
California Department of Industrial Relations dir.ca.gov/dlse/faq_mealperiods.htm
© 2017 California Dental Association

Meal Break Waiver (Shift ending in six hours or less)
I, _______________________________________ am scheduled to work a shift of six hours or less on:
Date (s): _______________________________
From the hours of ________ a.m. / p.m. (circle one) to ________ a.m. / p.m. (circle one).
 I understand that I may waive my 30-minute unpaid meal break only when my work and/or
scheduled shift will be completed in six hours or less in one workday.
 I understand that in order for this waiver to be valid, an authorized company official must also
authorize the waiver in writing by signing below.
 I understand that I may revoke this agreement to waive, in writing, my meal break at any time by
signing this form as indicated below.
Employee Signature: ________________________________________ Date: ____________
Revocation: I hereby revoke this waiver.
Employee Signature: ________________________________________ Date: ____________
__________________________________________________________________
Employer Use Only:
 Your meal break waiver request has been approved and submitted.
 Your meal break waiver request has been denied.
Employer/Supervisor Signature: ________________________________ Date: ___________
______________________________
Employer/Practice Name
Place copy in employee personnel file.

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Employment Practices

Sample Meal and Rest Break Policy

California Department of Industrial Relations dir.ca.gov/dlse/faq_mealperiods.htm

© 2017 California Dental Association

I, _______________________________________ am scheduled to work a shift of six hours or less on:

Date (s): _______________________________

Employee Signature: ____________________________ Date:

Revocation: I hereby revoke this waiver.

Employee Signature: ____________________________ Date:

Employer/Supervisor Signature: ______________________ Date: _

Place copy in employee personnel file.

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