Chapter 6 - Appendices
Attach any supporting documents here. This may include:
- Relevant safety manuals
- Relevant CARs or guidance notes from Transport Canada
- Sleep diary form for collecting data
- Symptom checklist
- Description of the fatigue occurrence reporting form or database
- Additional reading material that may be of particular interest to employees
Points to Consider
- Is there any information that users of the FRMS manual will require easy access to?
Sleep Diary – FRMS Study
Month & Year: .............................. Name: ........................................
|Start Date/ Time ddhhmm||Pre-sleep Fatigue Level||End Time hhmm||Post-sleep Fatigue Level||Sleep Quality||Remarks|
|eg||27 1400||1 2 3 4 5 6 7||2130||1 2 3 4 5 6 7||1 2 3 4 5 6||Broken sleep due to sick child|
- Fully alert, wide awake
- Very lively, responsive, but not at peak
- Okay, somewhat fresh
- A little tired, less than fresh
- Moderately tired, let down
- Extremely tired, difficulty concentrating
- Completely exhausted, unable to function effectively
Qualité du sommeil
- Very good
- Very poor
- Did not sleep
Please complete a single line of the sleep diary for each attempted or actual sleep period (i.e., major sleeps and naps) even if you do not actually fall asleep.
Record start date/time and pre-sleep fatigue level immediately prior to "lights out." Start time is the time that you start attempting to sleep (i.e., "lights out") not the time that you fall asleep.
Note: start/end times should not include time spent reading, watching TV, etc.
Record end time and post-sleep fatigue level approximately 20 minutes after the sleep period ends. End time is the time that you get up or start reading, watching TV, etc., in bed. It may differ from wake up time.
Rate the quality of your sleep compared to a "normal" sleep period.
Make any relevant comments (e.g., regarding the sleep environment, interruptions, ambient noise, etc.).
Name: ............................ Date:.................... Circle: Pre/Post Shift
|Yawning||Difficulty concentrating||More quiet or withdrawn than normal|
|Heavy eyelids||Lapses in attention||Lacking in energy|
|Eye-rubbing||Difficulty remembering what you are doing||Lacking in motivation to do the task well|
|Head drooping||Failure to communicate important information||Irritable or grumpy behaviour|
|Micro-sleeps||Failure to anticipate events or actions||Other|
|Other||Accidentally doing the wrong thing (error)|
|Accidentally not doing the right thing (omission)|
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