Fatigue Symptoms Checklist for Bus Operators

Employee to complete Part 1

Manager / Supervisor to Complete Part 2 (can be completed even if part one has not been completed)

What is the level of risk associated with this person continuing without intervention? Consider the following:

§ Has a fatigue related incident occurred or is it likely to occur?

§ Has the person self reported or been identified by another person as a fatigue risk?

Circle the risk number in the matrix below after considering consequence and likelihood

If a risk to continued operation has been identified proceed to Part 4 – Supervisory Actions

Part 4 – Supervisory Actions

Suspected Issue	Suggested Action
Drugs and Alcohol	Refer to POL 72 – Drugs and Alcohol Policy and arrange test with the safety hotline number or Depot Manager.
Fatigue	§ Consider the following and discuss with employee: – Task rotation – Rest break until complies with fatigue hours – Alternative duties § Confirm AFM Bus operators training in TLIF 1007C (Apply fatigue management strategies) § Counsel operator to ensure fatigue responsibilities are being carried out § Report near miss using FORM 178 – Injury/Incident Form § Complete a Corrective Action report if further action is required, e.g. training in fatigue § Referral to EAP if necessary § If any change in bus operator health status, complete FORM 633 and inform Transport for NSW
Health or Medical problems	Arrange for medical referral Refer to PROC 50.30 – Health Monitoring

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