1. Personnel Details
Surname
Given Name
Personnel Number
Company
Department
Position
- Dayshift
- A
- B
- C
- D
- Split
- Relief
- Other
- Other
- 6D6O6N6O
- 1/2D6D1/2D7O7N7O
- 7D7O7N7O
- 5D2O
- 3D3N6O
Other (If applicable)
Name
Contact Number
Relationship
2. Individual Journey Management Details
- 1st Dayshift
- Dayshifts
- Last Dayshift
- 1st Nightshift
- Nightshifts
- Last Nightshift
- Not Applicable
- Work
- Commute - Self Drive
- Commute - Company
- Commute - Flight
- Commute - Bus
- Rest Opportunity
- Sleep Opportunity
- Waiting Time
Route distance (km)
Additional modes of transport?
Daily Commute Plan (Remaining shifts, If different)
Daily Commute Plan (Last Dayshift)
Do you undertake Nightshift?
3. Proposed Controls
Do you have any pre-existing medical conditions that may affect your journey management plan?
- Mandatory Sleep Periods
- Mandatory Rest Breaks ie Every 2 hours when driving
- Site Provided Travel Arrangements ie Bus, Flight
- Fatigue Awareness Training
- Supplied Accomodation ie Blackout curtains, Early Checkin/Late Checkout
- Other Controls
List other controls
4. Approval Checklist
I commit to abiding by the controls stated in this IJMP to adequately manage my fitness for work.
I have read and approve this IJMP
I do not approve IJMP
Insufficient controls
Incorrect details
Comments
Overall Risk Ranking
This Individual Journey Management Plan Form shall be reviewed bi-annually or if there is a change in conditions.
