Form 7 – Internal Review Planner (complete as per instructions overleaf)

Use this document as a template for your fatigue risk management system.

This form can be replaced with one from your current system if it is equivalent in the key areas and meets the standards and outcomes.

Instructions

To be completed by Operations Manager at least once every three months to record participation in AFM accreditation and review accreditation performance.

1.  Retrieve relevant forms and reports.

2.  Indicate number of items per cell by writing the number in the cell in the relevant column in blue/black ink.

3.  At completion of the review, arrange for the reviewer to record any comments from the review, enter the date the review was completed and initial the form.

4.  Place the completed form in [file location 9].

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Form 7 – Internal Review Planner (complete as per instructions overleaf)

Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec
Participating Drivers
·  Added
·  Removed
·  Total
Participating Schedulers
·  Added
·  Removed
·  Total
Driver Medicals
·  New needed
·  Completed
·  Restrictions
·  Identified
·  Actioned
·  Outstanding
Work diary issues
·  NCAR raised
·  Action taken
·  NCAR resolved
Work and rest hour issues
·  NCAR raised
·  Action taken
·  NCAR resolved
Fatigue related incidents
·  NCAR raised
·  Action taken
·  NCAR resolved
Compliance history issues
·  NCAR raised
·  Action taken
·  NCAR resolved
Total NCARs issued
Total Actions Taken
Total NCARs resolved
Trend (e.g., increasing)
Comments
Initials:
Date:

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