Fatigue Risk Report

• Use the following form to complete a Fatigue Risk Report.
  
  Fatigue Risk Reports are presented at each FSAG meeting and summarised for reporting in the MSRM.

General

• Do you wish to submit a confidential report?

  YES

  NO

• Title and Name

• Staff number

• Email Address and/or Contact Number:

  Select Email Address Contact Number

  • Email Address
  • Contact Number

• Email address

• Contact number

• Date/Time of Occurrence

  Date

• Is time local or UTC?

  Local

  UTC

• Sector

  Select 7524 AKL - CHC - SYD 7526 AKL - SYD 7528 AKL - CHC - SYD 7311 CNS - BNE 7312 BNE - TSV 7314 TSV - CNS 7331 MEL - BNE 7332 BNE - MEL 7333 MEL - PER 7334 PER - MEL 7335 MEL - SYD 7336 SYD - MEL 7337 MEL - LST 7338 LST - MEL 7341 BNE - MEL 7342 MEL- BNE 7371 HBA - LST 7372 MEL - HBA 7373 LST - MEL 7393 PER - MEL 7394 MEL - PER 7523 SYD - AKL 7525 SYD - AKL 7527 SYD - AKL 7531 AKL - HKG 7532 HKG - CNS - SYD Other (Please specify)

  • 7524 AKL - CHC - SYD
  • 7526 AKL - SYD
  • 7528 AKL - CHC - SYD
  • 7311 CNS - BNE
  • 7312 BNE - TSV
  • 7314 TSV - CNS
  • 7331 MEL - BNE
  • 7332 BNE - MEL
  • 7333 MEL - PER
  • 7334 PER - MEL
  • 7335 MEL - SYD
  • 7336 SYD - MEL
  • 7337 MEL - LST
  • 7338 LST - MEL
  • 7341 BNE - MEL
  • 7342 MEL- BNE
  • 7371 HBA - LST
  • 7372 MEL - HBA
  • 7373 LST - MEL
  • 7393 PER - MEL
  • 7394 MEL - PER
  • 7523 SYD - AKL
  • 7525 SYD - AKL
  • 7527 SYD - AKL
  • 7531 AKL - HKG
  • 7532 HKG - CNS - SYD
  • Other (Please specify)

• Sector details

• Duty Description

• Is Duty > 11 hours

  YES

  NO

• Approximate duty extension beyond 11 hours

• Augmented Crew

  YES

  NO

Sleep Info

• Hours awake at sign-on

• Sleep in 24 hrs prior to sign-on

• Hours allocated crew rest (if applicable)

• Time free of duty prior to sign-on

• Sleep in 72 hrs prior to sign-on

• Hours slept/rested in crew rest (if applicable)

Rest Facilities

• Was there an issue with a hotel?

  YES

  NO

• Hotel Location

• Hotel Room No

• Check in Date

  Date

• Length of Slip

• Did you utilise base crew rest facilities?

  YES

  NO

• Crew rest facilities used

  Melbourne

  Sydney

  Other (specify below)

• Length of Rest Period

Reason for Fatigue (if applicable)

• Select any fatigue factors

  Select Time since previous duty Layover length Length of duty Duration of in-flight rest Quality of in-flight rest Quality of hotel rest Disrupted home rest Circadian disruption Workload during flight Disruption / flight delay Roster Change / trip swap Called out Paxing sector Personal health Other (specific below)

  • Time since previous duty
  • Layover length
  • Length of duty
  • Duration of in-flight rest
  • Quality of in-flight rest
  • Quality of hotel rest
  • Disrupted home rest
  • Circadian disruption
  • Workload during flight
  • Disruption / flight delay
  • Roster Change / trip swap
  • Called out
  • Paxing sector
  • Personal health
  • Other (specific below)

• When did you identify your fatigue risk

  Select Home Port Slip port Prior to sign-on Post duty At sign-on After paxing sector Mid duty (specify hours) Other (please specify)

  • Home Port
  • Slip port
  • Prior to sign-on
  • Post duty
  • At sign-on
  • After paxing sector
  • Mid duty (specify hours)
  • Other (please specify)

• Hours since sign-on

Assessment

• How you felt at time of report; 1. Fully alert, wide awake. 2. Very lively, responsive but not at peak. 5. Moderately tired, let down. 3. OK, somewhat fresh. 6. Extremely tired, very difficult to concentrate. 4. A little tired, less than fresh. 7. Completely exhausted.

• At completion of the flight duty consider the following;
  * utilising port crew rest facility before returning home
  * utilising other accommodation for rest before returning home
  * public transportation or taxi to home

• Comments Please include a brief description of any relevant sequence of events and/or circumstances that led to this report.

Actions Taken

• Was action taken

  YES

  NO

• Communication

  Select Other crew advised Crewing advised Ops Mgr advised Chief Pilot advised Self monitored Asked other to monitor

  • Other crew advised
  • Crewing advised
  • Ops Mgr advised
  • Chief Pilot advised
  • Self monitored
  • Asked other to monitor

• Ground Action

  Select Utilise hotel accommodation Utilise other accommodation Utilise base rest/ napping facilities Delayed trip/drive home Utilise public transport

  • Utilise hotel accommodation
  • Utilise other accommodation
  • Utilise base rest/ napping facilities
  • Delayed trip/drive home
  • Utilise public transport

• In-Flight Action

  Select Adjusted crew rest Adjusted crew duties Controlled rest used

  • Adjusted crew rest
  • Adjusted crew duties
  • Controlled rest used

• Removal

  Select Removal from duty

  • Removal from duty

• Other

• Comments (Please include any suggested corrective actions)