Example of a fatigue and event report information

This appendix provides recommended information that can be included in fatigue event reporting. Companies may decide to utilize parts of this information within their current incident reporting system.

Time of event: (When did it happen?):

Hours from report time to when fatigue occurred:  

Describe event (What happened):




Describe how you felt (or what observed)?




Please circle how you felt when the event occurred:

Figur Karolinska Sleepiness Scale (KSS)

Please mark the line below with an 'X' at the point that indicates how you felt

Alert ---------------------------------------------------------------------------------------Drowsy


Relevant information

  Yes/No?   hours mins
Fatigue prior to starting work?   How long had you been awake when the event happened?    
Fatigue during work?   How much sleep did you have in the 24 hours before the event?    
Disrupted sleep?   How much sleep did you have in the 72 hours before the event?    


Suggestive corrected actions

What did you do? Actions taken to manage or reduce fatigue
(e.g. naps, breaks):




What could be done? Suggested corrective actions: