REST BREAK VIOLATION COMPLAINT

COMPLAINT FOR FAILURE TO PROVIDE REQUIRED REST PERIODS

IMPORTANT NOTICE

Rest break laws vary significantly by state. There is no federal law requiring rest breaks. This complaint template is primarily designed for states with rest break requirements, particularly California, which has comprehensive rest break protections.

States with Rest Break Laws Include:
- California (most comprehensive)
- Colorado
- Kentucky
- Minnesota
- Nevada
- Oregon
- Vermont
- Washington

PART 1: COMPLAINANT INFORMATION

Full Legal Name: _______________________________________________

Current Address:
- Street: _______________________________________________
- City: _________________________ State: _____ ZIP: ___________

Contact Information:
- Phone: _________________________
- Email: _________________________
- Preferred Contact Method: ☐ Phone ☐ Email ☐ Mail

PART 2: EMPLOYER INFORMATION

Employer Name: _______________________________________________

Doing Business As (DBA): _______________________________________________

Employer Address:
- Street: _______________________________________________
- City: _________________________ State: _____ ZIP: ___________

Employer Phone: _________________________

Type of Business/Industry: _______________________________________________

Supervisor/Manager Name: _______________________________________________

HR Contact: _______________________________________________

PART 3: EMPLOYMENT INFORMATION

Job Title: _______________________________________________

Date of Hire: _________________________

Date Employment Ended (if applicable): _________________________

Employment Status:
☐ Currently Employed
☐ Terminated
☐ Resigned
☐ Laid Off

Employment Type:
☐ Full-Time
☐ Part-Time
☐ Temporary/Seasonal

Employee Classification:
☐ Non-Exempt (Hourly)
☐ Non-Exempt (Salaried)
☐ Exempt (claimed by employer)

Hourly Rate/Salary: $__________ per __________

PART 4: WORK SCHEDULE INFORMATION

Typical Work Schedule:

Average Hours Per Day: _________________________

Average Hours Per Week: _________________________

PART 5: REST BREAK REQUIREMENTS (CALIFORNIA)

California Rest Period Requirements Under IWC Wage Orders:

Key Requirements:
- Rest periods must be at least 10 consecutive minutes
- Rest periods are paid time
- Rest periods should be in the middle of each 4-hour work period "insofar as practicable"
- Employees must be relieved of all duties during rest periods
- Rest periods cannot be combined with meal periods

"Major Fraction" Rule:
- Working more than 2 hours beyond a 4-hour period entitles employee to another rest break
- Example: Working 6.5 hours = 2 rest breaks (0-4 hours = 1 break; 4-6.5 hours = 1 break)

PART 6: TYPE OF REST BREAK VIOLATION (Check All That Apply)

Failure to Authorize and Permit Rest Periods

☐ No rest break authorized for shifts of 3.5+ hours
☐ Insufficient number of rest breaks provided
☐ Rest breaks not authorized/permitted

Shortened Rest Periods

☐ Rest breaks less than 10 minutes
☐ Rest breaks cut short by supervisor
☐ Called back to work before 10 minutes elapsed

Interrupted Rest Periods

☐ Required to remain available during rest break
☐ Required to carry radio/phone during break
☐ Interrupted by work calls/questions
☐ Unable to leave work station

Working Through Rest Periods

☐ Workload prevents taking breaks
☐ Understaffing prevents coverage for breaks
☐ Told not to take rest breaks
☐ Discouraged from taking rest breaks
☐ Pressure to skip breaks

Timing Issues

☐ Rest breaks not offered at appropriate intervals
☐ All breaks pushed to end of shift
☐ Forced to take break immediately after meal period

Rest Breaks Not Paid

☐ Rest break time deducted from pay
☐ Required to clock out for rest breaks
☐ Pay reduced for taking rest breaks

Retaliation

☐ Disciplined for taking rest breaks
☐ Hours reduced for taking rest breaks
☐ Negative performance review for taking breaks
☐ Terminated for taking or reporting rest break violations
☐ Other adverse action: _________________________

PART 7: DETAILED DESCRIPTION OF VIOLATION

Describe how the rest break violations occurred:
(Include specific examples, dates, circumstances, and who was involved)

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

What was the employer's reason or explanation for not providing rest breaks?
_______________________________________________
_______________________________________________

What happened when you tried to take rest breaks?
_______________________________________________
_______________________________________________

Did you report the rest break issues to management?
☐ Yes ☐ No

If yes:
- Date(s) reported: _________________________
- To whom: _________________________
- Response: _______________________________________________

PART 8: REST BREAK VIOLATION LOG

Record of Missed, Short, or Denied Rest Periods:

(Continue on additional pages if necessary)

PART 9: PREMIUM PAY CALCULATION (CALIFORNIA)

Under California Labor Code § 226.7:
Employers must pay one additional hour of pay at the employee's regular rate of pay for each workday that a rest period is not provided.

IMPORTANT: Only ONE hour of premium pay is owed per workday for rest break violations, regardless of how many rest breaks were missed that day.

Premium Pay Calculation:

Regular Hourly Rate: $_________________________

Violation Period:
- Start Date: _________________________
- End Date: _________________________ ☐ Ongoing

Rest Period Violations by Month:

TOTAL REST BREAK PREMIUM PAY OWED: $_________________________

PART 10: COMBINED MEAL AND REST BREAK VIOLATIONS

Were you also denied meal breaks?
☐ Yes ☐ No

If yes, file a separate Meal Break Violation Complaint or combine claims

Note: Under California law, an employee can recover up to TWO hours of premium pay per workday:
- One hour for meal break violations
- One hour for rest break violations

Combined Premium Pay (if applicable):

PART 11: SUPPORTING DOCUMENTATION

Documents Available (check all that apply):

☐ Time records/punch cards
☐ Work schedules
☐ Pay stubs (showing hours worked)
☐ Personal log of rest breaks
☐ Employee handbook/rest break policy
☐ Text messages/emails about breaks
☐ Witness statements
☐ Photographs (schedules, policies, postings)
☐ Electronic records (clock-in/out data)
☐ Performance reviews mentioning breaks
☐ Written warnings related to breaks
☐ Other: _________________________

PART 12: WITNESSES

Are there witnesses to the rest break violations?
☐ Yes ☐ No

Witness Information:

Witness 1:
- Name: _______________________________________________
- Position: _________________________
- Phone: _________________________
- What can they confirm? _______________________________________________

Witness 2:
- Name: _______________________________________________
- Position: _________________________
- Phone: _________________________
- What can they confirm? _______________________________________________

Witness 3:
- Name: _______________________________________________
- Position: _________________________
- Phone: _________________________
- What can they confirm? _______________________________________________

PART 13: OTHER AFFECTED EMPLOYEES

Are other employees affected by similar rest break violations?
☐ Yes ☐ No ☐ Unknown

If yes:
- Estimated number: _________________________
- Departments/positions: _______________________________________________
- Would they participate in a complaint? ☐ Yes ☐ No ☐ Unknown

PART 14: STATE-SPECIFIC NOTES

CALIFORNIA

• IWC Wage Orders: 10-minute paid rest for every 4 hours (or major fraction)
• Premium pay: One hour of pay per workday rest period not provided
• Statute of Limitations: 3 years for rest break claims
• Rest breaks are PAID time
• Employer must "authorize and permit" rest periods
• Cannot require employees to stay on premises
• File with: Division of Labor Standards Enforcement (DLSE)

TEXAS

• No state rest break law for adult workers
• Federal law (FLSA) does not require rest breaks
• If breaks under 20 minutes are provided, they must be paid
• No state enforcement mechanism

FLORIDA

• No state rest break law for adult workers
• Minors have break requirements under Florida Statutes § 450.081
• No state enforcement mechanism for adult workers

NEW YORK

• No general rest break law for most workers
• Factory workers entitled to breaks under certain conditions
• Some industry-specific rules apply
• File with NY Department of Labor for applicable violations

PART 15: FILING OPTIONS

I plan to file this complaint with:

☐ California Division of Labor Standards Enforcement (DLSE)
- File a wage claim: www.dir.ca.gov/dlse/howtofilewageclaim.htm
- Phone: 1-844-522-6734
- Premium pay claims included in wage claim

☐ Other State Labor Agency
- State: _________________________
- Agency: _________________________
- Website: _________________________

☐ Private Attorney/Lawsuit
- May file individual or class action
- May recover premium pay, interest, penalties, attorney fees

☐ Small Claims Court
- For individual claims within jurisdictional limit
- California limit: $12,500 for individuals

PART 16: DECLARATION

I declare under penalty of perjury under the laws of the State of _________________________ that the foregoing is true and correct to the best of my knowledge and belief.

Complainant Signature: _______________________________________________

Printed Name: _______________________________________________

Date: _________________________

PART 17: ATTORNEY INFORMATION (IF APPLICABLE)

Attorney Name: _______________________________________________

Law Firm: _______________________________________________

Address: _______________________________________________

Phone: _________________________ Email: _________________________

Bar Number: _________________________

CHECKLIST BEFORE FILING

☐ Verified state has rest break laws
☐ All sections completed
☐ Violation dates documented
☐ Premium pay calculated correctly (1 hour per workday)
☐ Supporting documents gathered
☐ Copies made for records
☐ Statute of limitations verified
☐ Considered legal consultation

CALIFORNIA-SPECIFIC RESOURCES

• DLSE Rest Period FAQ: www.dir.ca.gov/dlse/faq_restperiods.htm
• Labor Code § 226.7: leginfo.legislature.ca.gov
• IWC Wage Orders: www.dir.ca.gov/iwc/wageorderindustries.htm
• File Wage Claim: www.dir.ca.gov/dlse/howtofilewageclaim.htm

FREQUENTLY ASKED QUESTIONS

Q: Can I waive my rest breaks?
A: In California, employers must "authorize and permit" rest breaks. While employees are not forced to take breaks, employers cannot prevent or discourage them. If you feel pressured not to take breaks, you may have a claim.

Q: Are rest breaks paid?
A: Yes. In California, rest breaks are counted as hours worked and must be paid at your regular rate.

Q: Can my employer require me to stay on premises during rest breaks?
A: Generally, no. You should be free from work duties and able to leave your immediate work area during rest breaks.

Q: What if I miss both a meal break and rest break in one day?
A: You may be entitled to TWO hours of premium pay - one for the missed meal break and one for the missed rest break(s).

Q: How do I prove I wasn't given rest breaks?
A: Keep a personal log documenting each day's breaks. Time records, witness statements, and communications about breaks can also serve as evidence.

This template is provided for informational purposes only and does not constitute legal advice. Rest break laws vary significantly by state. Consult with a qualified employment attorney licensed in your state for advice specific to your situation.