IRRITABILITY
1. FEELING IRRITABLE |
|
2. GENERALLY ANNOYED WITH OTHERS |
|
3. PRETTY UNFRIENDLY/ TESTY |
|
4. IMPATIENT |
|
5. WOULD REALLY LIKE TO BE ALONE FOR A WHILE |
|
6. GETTING ANGRY |
|
7. DISAGREEABLE |
|
8. WISH I WEREN’T WITH THESE PEOPLE |
|
9. FEELING GROUCHY WITH PEOPLE |
|
FATIGUE/ LOW ENERGY
1. VERY TIRED |
|
2. REALLY FATIGUED |
|
3. BURNED OUT |
|
4. WORN OUT |
|
5. FEELING EXHAUSTED |
|
6. CAN’T GO ON MUCH LONGER |
|
7. NOT ENERGETIC |
|
8. TOO TIRED TO MOVE |
|
9. FEEL DRAINED |
|
POOR SLEEP
1. SLEEPY |
|
2. WISH I HAD SLEPT LONGER |
|
3. WISH I HAD SLEPT MORE SOUNDLY |
|
4. COULD FALL ASLEEP RIGHT HERE |
|
5. NODDING OFF |
|
6. EYES ARE CLOSING |
|
7. FORCING SELF TO KEEP EYES OPEN |
|
8. BOUNCING, TAPPING, SHAKING TO STAY AWAKE |
|
9. YAWNING |
|
WORK FRUSTRATION
1. PREFER TO NOT WORK NOW |
|
2. WISH I DIDN’T HAVE TO DO THINGS RIGHT NOW |
|
3. HOPE NOTHING ELSE NEEDS TO BE DONE |
|
4. TOO MUCH IS EXPECTED OF ME RIGHT NOW |
|
5. TIRED OF WORKING |
|
6. WORK FEELS LIKE DRUDGERY |
|
7. FEELS LIKE A GRIND |
|
8. WISH THE WORK WOULD END |
|
9. WOULD LIKE HELP WITH THE WORK |
|
PHYSICAL DISCOMFORT
1. MUSCLES HURT |
|
2. BODY STIFF |
|
3. CAN’T GET COMFORTABLE |
|
4. ARMS AND LEGS HURT |
|
5. WANT TO STRETCH |
|
6. SKIN STICKY/ DIRTY |
|
7. WHAT I’M WEARING IS UNCOMFORTABLE |
|
8. HEAD ACHES |
|
9. EYES TIRED |
|
CREWMEMBER
ACTIVITY & SLEEP
LOG
PARTICIPANT NUMBER __________
Please complete Logbook entries and PVT test:
Before Trip (pre-trip)
Upon arrival at Hotel (post-flight)
Hotel (layover) Logbook, PVT optional
Before pickup at Hotel (post-layover)
Upon arrival at homebase (post-trip)
Use appropriate code-letter or number below in each row of matrix.
Activity Rating
A = Awake 1 = Well Rested
R = Resting 2 = Moderately Rested
S = Sleep (>15 min) 3 = Slightly Rested
N = Nap (≤15 min) 4 = Not at all Rested
T = PVT Test Time
Fatigue
1 - Feeling active and vital; alert; wide awake.
2 - Functioning at a high level, but not at peak; able to concentrate.
3 - Relaxed; awake; not at full alertness; responsive.
4 - A little foggy; not at peak; let down
5 - Fogginess; beginning to lose interest in remaining awake; slowed down.
6 - Sleepiness; prefer to be lying down; fighting sleep; woozy.
7 - Almost in reverie; sleep onset soon; lost struggle to remain awake
Example of completed Matrix
PILOT entries in bold
Entry Circle Log-Time Below
JFK |
2100 |
2200 |
2300 |
0000 |
0100 |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
||||||||||||
GMT |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
0900 |
1000 |
1100 |
1200 |
1300 |
||||||||||||
BOM |
0730 |
0830 |
0930 |
1030 |
1130 |
1230 |
1330 |
1430 |
1530 |
1630 |
1730 |
1830 |
||||||||||||
Activity |
S |
S |
S |
S |
S |
S |
S |
S |
S |
S |
S |
S |
S |
S |
S |
S |
S |
A |
A |
A |
A |
A |
A |
A |
Fatigue |
|
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3 |
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Rating |
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2 |
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JFK |
0900 |
1000 |
1100 |
1200 |
1300 |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
||||||||||||
GMT |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
2100 |
2200 |
2300 |
0000 |
0100 |
||||||||||||
BOM |
1930 |
2030 |
2130 |
2230 |
2330 |
0030 |
0130 |
0230 |
0330 |
0430 |
0530 |
0630 |
||||||||||||
Activity |
A |
A |
A |
A |
A |
A |
A |
A |
A |
T |
A |
A |
A |
A |
R |
R |
A |
A |
A |
A |
A |
A |
S |
S |
Fatigue |
|
|
|
|
|
|
|
|
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3 |
|
|
|
|
|
3 |
|
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5 |
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Rating |
|
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|
|
|
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3 |
|
|
|
|
|
|
|
|
|
|
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|
|
|
ARR (post-trip): Please rate “1= not at all” through “5 = very much” as each applies for about the last hour or so.
POOR CONCENTRATION
1. DIFFICULTY CONCENTRATING |
|
2. HARD TIME PAYING ATTENTION |
|
3. CAN’T STAY AT A TASK |
|
4. DISTRACTIBLE WHILE DOING THINGS |
|
5. HAVING TO RE-READ MATERIAL |
|
6. LOSING TRACK OF CONVERSATIONS |
|
7. HAVING TO PAY EXTRA ATTENTION TO UNDERSTAND |
|
8. DAYDREAMING |
|
9. NOT THINKING STRAIGHT/ EFFICIENTLY |
|
BOREDOM
1. NOTHING SEEMS INTERESTING |
|
2. NOT CARING ABOUT WHAT IS HAPPENING |
|
3. NONE OF THIS IS FUN ANYMORE |
|
4. NOT INTERESTED IN WHAT IS HAPPENING |
|
5. INDIFFERENT |
|
6. BORED WITH MISSION |
|
7. TIRED OF SAME OLD THING |
|
8. THINGS ARE TEDIOUS |
|
9. TIME IS PASSING TOO SLOWLY |
|
SLOWED REACTIONS
1. NOT MOVING VERY MUCH |
|
2. JUST LOOKING AROUND |
|
3. HAVING TO THINK BEFORE ACTING |
|
4. THINGS SEEM IN SLOW MOTION |
|
5. ARMS FEEL HEAVY |
|
6. REACTIONS ARE SLOWED |
|
7. MOVEMENTS SEEM DELAYED |
|
8. CAN’T KEEP UP WITH TASKS |
|
9. RESPONDING TAKES EFFORT |
|
ANXIETY
1. FEEL ANXIOUS |
|
2. FEEL TENSE IN MUSCLES |
|
3. FEEL NERVOUS |
|
4. WORRIED ABOUT THINGS |
|
5. MUSCLES ARE JITTERY |
|
6. TAPPING FINGERS OR FOOT |
|
7. STOMACH FEELS UPSET |
|
8. JUMPY |
|
9. VIGILANT |
|
DEPRESSION
1. FEEL DEPRESSED |
|
2. FEEL UNHAPPY |
|
3. FEEL SAD |
|
4. NOT ENJOYING THIS |
|
5. FEEL DISCOURAGED |
|
6. WISH I FELT HAPPIER |
|
7. WORRIED I MIGHT NEVER FEEL BETTER |
|
8. NO CONTROL OVER ANY OF THIS |
|
9. WHAT I DO DOESN’T MATTER |
|
ARR (post-trip) Circle Log-Time
JFK |
2100 |
2200 |
2300 |
0000 |
0100 |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
||||||||||||
GMT |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
0900 |
1000 |
1100 |
1200 |
1300 |
||||||||||||
BOM |
0730 |
0830 |
0930 |
1030 |
1130 |
1230 |
1330 |
1430 |
1530 |
1630 |
1730 |
1830 |
||||||||||||
Activity |
|
|
|
|
|
|
|
|
|
|
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|
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|
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|
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|
|
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|
Fatigue |
|
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Rating |
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|
JFK |
0900 |
1000 |
1100 |
1200 |
1300 |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
||||||||||||
GMT |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
2100 |
2200 |
2300 |
0000 |
0100 |
||||||||||||
BOM |
1930 |
2030 |
2130 |
2230 |
2330 |
0030 |
0130 |
0230 |
0330 |
0430 |
0530 |
0630 |
||||||||||||
Activity |
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Fatigue |
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Rating |
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AWAKENINGS and REASON (EXAMPLE: 5 Min. @ 0430; turbulence)
1. _____min. at __________ ________________________________
2. _____min. at __________ ________________________________
3. _____min. at __________ ________________________________
Sleep Rating (Please circle one number for each item)
Falling asleep Not Difficult 1 2 3 4 5 Difficult
My sleep was Not Deep 1 2 3 4 5 Deep
Arising was Not Difficult 1 2 3 4 5 Difficult
I now feel Not Rested 1 2 3 4 5 Rested
VISUAL ANALOG SCALE
very little-------------------------------------------------------------------------------------very much
1. How alert do you feel?
2. How sad do you feel?
3. How tense do you feel?
4. How much of an effort is it to do anything?
5. How happy do you feel?
6. How weary do you feel?
7. How calm do you feel?
8. How sleepy do you feel?
Sleep & Alertness Strategies: ________
________
CAFFEINE & H2O INTAKE (coffee, tea, soda, water, other)
TYPE __________________ AMT _____________ TIMES ___________________
LOGBOOK ENTRY EXAMPLE (cont)
Visual Analog Scale
DRAW a line between the endpoints approximating your response to each question as seen in the example below.
VISUAL ANALOG SCALE
1. How alert do you feel?
very little _______________________________________|________ very much
2. How sad do you feel?
very little __|_____________________________________________ very much
3. How tense do you feel?
very little ___________|____________________________________ very much
4. How much of an effort is it to do anything?
very little __|_____________________________________________ very much
5. How happy do you feel?
very little _____________________________________________|__ very much
6. How weary do you feel?
very little _______|________________________________________ very much
7. How calm do you feel?
very little _______________________________|________________ very much
8. How sleepy do you feel?
very little _____________________________________|__________ very much
Pre-trip: In bed time? _________________ Circle Log-Time
JFK |
2100 |
2200 |
2300 |
0000 |
0100 |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
||||||||||||
GMT |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
0900 |
1000 |
1100 |
1200 |
1300 |
||||||||||||
BOM |
0730 |
0830 |
0930 |
1030 |
1130 |
1230 |
1330 |
1430 |
1530 |
1630 |
1730 |
1830 |
||||||||||||
Activity |
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Fatigue |
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Rating |
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|
JFK |
0900 |
1000 |
1100 |
1200 |
1300 |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
||||||||||||
GMT |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
2100 |
2200 |
2300 |
0000 |
0100 |
||||||||||||
BOM |
1930 |
2030 |
2130 |
2230 |
2330 |
0030 |
0130 |
0230 |
0330 |
0430 |
0530 |
0630 |
||||||||||||
Activity |
|
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|
|
|
|
|
|
|
|
|
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Fatigue |
|
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Rating |
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|
AWAKENINGS and REASON (EXAMPLE: 5 Min. @ 0430; turbulence)
1. _____min. at __________ ________________________________
2. _____min. at __________ ________________________________
3. _____min. at __________ ________________________________
Sleep Rating (Please circle one number for each item)
Falling asleep Not Difficult 1 2 3 4 5 Difficult
My sleep was Not Deep 1 2 3 4 5 Deep
Arising was Not Difficult 1 2 3 4 5 Difficult
I now feel Not Rested 1 2 3 4 5 Rested
VISUAL ANALOG SCALE
very little-------------------------------------------------------------------------------------very much
1. How alert do you feel?
2. How sad do you feel?
3. How tense do you feel?
4. How much of an effort is it to do anything?
5. How happy do you feel?
6. How weary do you feel?
7. How calm do you feel?
8. How sleepy do you feel?
Sleep & Alertness Strategies: ________
________
CAFFEINE & H2O INTAKE (coffee, tea, soda, water, other)
TYPE __________________ AMT _____________ TIME ___________________
Notes/Comments during return flight (e.g., ate something during layover that didn’t set well, swapped rest times, or whatever…)
IRRITABILITY
1. FEELING IRRITABLE |
|
2. GENERALLY ANNOYED WITH OTHERS |
|
3. PRETTY UNFRIENDLY/ TESTY |
|
4. IMPATIENT |
|
5. WOULD REALLY LIKE TO BE ALONE FOR A WHILE |
|
6. GETTING ANGRY |
|
7. DISAGREEABLE |
|
8. WISH I WEREN’T WITH THESE PEOPLE |
|
9. FEELING GROUCHY WITH PEOPLE |
|
FATIGUE/ LOW ENERGY
1. VERY TIRED |
|
2. REALLY FATIGUED |
|
3. BURNED OUT |
|
4. WORN OUT |
|
5. FEELING EXHAUSTED |
|
6. CAN’T GO ON MUCH LONGER |
|
7. NOT ENERGETIC |
|
8. TOO TIRED TO MOVE |
|
9. FEEL DRAINED |
|
POOR SLEEP
1. SLEEPY |
|
2. WISH I HAD SLEPT LONGER |
|
3. WISH I HAD SLEPT MORE SOUNDLY |
|
4. COULD FALL ASLEEP RIGHT HERE |
|
5. NODDING OFF |
|
6. EYES ARE CLOSING |
|
7. FORCING SELF TO KEEP EYES OPEN |
|
8. BOUNCING, TAPPING, SHAKING TO STAY AWAKE |
|
9. YAWNING |
|
WORK FRUSTRATION
1. PREFER TO NOT WORK NOW |
|
2. WISH I DIDN’T HAVE TO DO THINGS RIGHT NOW |
|
3. HOPE NOTHING ELSE NEEDS TO BE DONE |
|
4. TOO MUCH IS EXPECTED OF ME RIGHT NOW |
|
5. TIRED OF WORKING |
|
6. WORK FEELS LIKE DRUDGERY |
|
7. FEELS LIKE A GRIND |
|
8. WISH THE WORK WOULD END |
|
9. WOULD LIKE HELP WITH THE WORK |
|
PHYSICAL DISCOMFORT
1. MUSCLES HURT |
|
2. BODY STIFF |
|
3. CAN’T GET COMFORTABLE |
|
4. ARMS AND LEGS HURT |
|
5. WANT TO STRETCH |
|
6. SKIN STICKY/ DIRTY |
|
7. WHAT I’M WEARING IS UNCOMFORTABLE |
|
8. HEAD ACHES |
|
9. EYES TIRED |
|
Pre-trip: Please rate “1= not at all” through “5 = very much” as each applies for about the last hour or so.
POOR CONCENTRATION
1. DIFFICULTY CONCENTRATING |
|
2. HARD TIME PAYING ATTENTION |
|
3. CAN’T STAY AT A TASK |
|
4. DISTRACTIBLE WHILE DOING THINGS |
|
5. HAVING TO RE-READ MATERIAL |
|
6. LOSING TRACK OF CONVERSATIONS |
|
7. HAVING TO PAY EXTRA ATTENTION TO UNDERSTAND |
|
8. DAYDREAMING |
|
9. NOT THINKING STRAIGHT/ EFFICIENTLY |
|
BOREDOM
1. NOTHING SEEMS INTERESTING |
|
2. NOT CARING ABOUT WHAT IS HAPPENING |
|
3. NONE OF THIS IS FUN ANYMORE |
|
4. NOT INTERESTED IN WHAT IS HAPPENING |
|
5. INDIFFERENT |
|
6. BORED WITH MISSION |
|
7. TIRED OF SAME OLD THING |
|
8. THINGS ARE TEDIOUS |
|
9. TIME IS PASSING TOO SLOWLY |
|
SLOWED REACTIONS
1. NOT MOVING VERY MUCH |
|
2. JUST LOOKING AROUND |
|
3. HAVING TO THINK BEFORE ACTING |
|
4. THINGS SEEM IN SLOW MOTION |
|
5. ARMS FEEL HEAVY |
|
6. REACTIONS ARE SLOWED |
|
7. MOVEMENTS SEEM DELAYED |
|
8. CAN’T KEEP UP WITH TASKS |
|
9. RESPONDING TAKES EFFORT |
|
ANXIETY
1. FEEL ANXIOUS |
|
2. FEEL TENSE IN MUSCLES |
|
3. FEEL NERVOUS |
|
4. WORRIED ABOUT THINGS |
|
5. MUSCLES ARE JITTERY |
|
6. TAPPING FINGERS OR FOOT |
|
7. STOMACH FEELS UPSET |
|
8. JUMPY |
|
9. VIGILANT |
|
DEPRESSION
1. FEEL DEPRESSED |
|
2. FEEL UNHAPPY |
|
3. FEEL SAD |
|
4. NOT ENJOYING THIS |
|
5. FEEL DISCOURAGED |
|
6. WISH I FELT HAPPIER |
|
7. WORRIED I MIGHT NEVER FEEL BETTER |
|
8. NO CONTROL OVER ANY OF THIS |
|
9. WHAT I DO DOESN’T MATTER |
|
IRRITABILITY
1. FEELING IRRITABLE |
|
2. GENERALLY ANNOYED WITH OTHERS |
|
3. PRETTY UNFRIENDLY/ TESTY |
|
4. IMPATIENT |
|
5. WOULD REALLY LIKE TO BE ALONE FOR A WHILE |
|
6. GETTING ANGRY |
|
7. DISAGREEABLE |
|
8. WISH I WEREN’T WITH THESE PEOPLE |
|
9. FEELING GROUCHY WITH PEOPLE |
|
FATIGUE/ LOW ENERGY
1. VERY TIRED |
|
2. REALLY FATIGUED |
|
3. BURNED OUT |
|
4. WORN OUT |
|
5. FEELING EXHAUSTED |
|
6. CAN’T GO ON MUCH LONGER |
|
7. NOT ENERGETIC |
|
8. TOO TIRED TO MOVE |
|
9. FEEL DRAINED |
|
POOR SLEEP
1. SLEEPY |
|
2. WISH I HAD SLEPT LONGER |
|
3. WISH I HAD SLEPT MORE SOUNDLY |
|
4. COULD FALL ASLEEP RIGHT HERE |
|
5. NODDING OFF |
|
6. EYES ARE CLOSING |
|
7. FORCING SELF TO KEEP EYES OPEN |
|
8. BOUNCING, TAPPING, SHAKING TO STAY AWAKE |
|
9. YAWNING |
|
WORK FRUSTRATION
1. PREFER TO NOT WORK NOW |
|
2. WISH I DIDN’T HAVE TO DO THINGS RIGHT NOW |
|
3. HOPE NOTHING ELSE NEEDS TO BE DONE |
|
4. TOO MUCH IS EXPECTED OF ME RIGHT NOW |
|
5. TIRED OF WORKING |
|
6. WORK FEELS LIKE DRUDGERY |
|
7. FEELS LIKE A GRIND |
|
8. WISH THE WORK WOULD END |
|
9. WOULD LIKE HELP WITH THE WORK |
|
PHYSICAL DISCOMFORT
1. MUSCLES HURT |
|
2. BODY STIFF |
|
3. CAN’T GET COMFORTABLE |
|
4. ARMS AND LEGS HURT |
|
5. WANT TO STRETCH |
|
6. SKIN STICKY/ DIRTY |
|
7. WHAT I’M WEARING IS UNCOMFORTABLE |
|
8. HEAD ACHES |
|
9. EYES TIRED |
|
Before Pick-up at HOTEL (post layover): Please rate “1= not at all” through “5 = very much” as each applies for about the last hour or so.
POOR CONCENTRATION
1. DIFFICULTY CONCENTRATING |
|
2. HARD TIME PAYING ATTENTION |
|
3. CAN’T STAY AT A TASK |
|
4. DISTRACTIBLE WHILE DOING THINGS |
|
5. HAVING TO RE-READ MATERIAL |
|
6. LOSING TRACK OF CONVERSATIONS |
|
7. HAVING TO PAY EXTRA ATTENTION TO UNDERSTAND |
|
8. DAYDREAMING |
|
9. NOT THINKING STRAIGHT/ EFFICIENTLY |
|
BOREDOM
1. NOTHING SEEMS INTERESTING |
|
2. NOT CARING ABOUT WHAT IS HAPPENING |
|
3. NONE OF THIS IS FUN ANYMORE |
|
4. NOT INTERESTED IN WHAT IS HAPPENING |
|
5. INDIFFERENT |
|
6. BORED WITH MISSION |
|
7. TIRED OF SAME OLD THING |
|
8. THINGS ARE TEDIOUS |
|
9. TIME IS PASSING TOO SLOWLY |
|
SLOWED REACTIONS
1. NOT MOVING VERY MUCH |
|
2. JUST LOOKING AROUND |
|
3. HAVING TO THINK BEFORE ACTING |
|
4. THINGS SEEM IN SLOW MOTION |
|
5. ARMS FEEL HEAVY |
|
6. REACTIONS ARE SLOWED |
|
7. MOVEMENTS SEEM DELAYED |
|
8. CAN’T KEEP UP WITH TASKS |
|
9. RESPONDING TAKES EFFORT |
|
ANXIETY
1. FEEL ANXIOUS |
|
2. FEEL TENSE IN MUSCLES |
|
3. FEEL NERVOUS |
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4. WORRIED ABOUT THINGS |
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5. MUSCLES ARE JITTERY |
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6. TAPPING FINGERS OR FOOT |
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7. STOMACH FEELS UPSET |
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8. JUMPY |
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9. VIGILANT |
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DEPRESSION
1. FEEL DEPRESSED |
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2. FEEL UNHAPPY |
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3. FEEL SAD |
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4. NOT ENJOYING THIS |
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5. FEEL DISCOURAGED |
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6. WISH I FELT HAPPIER |
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7. WORRIED I MIGHT NEVER FEEL BETTER |
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8. NO CONTROL OVER ANY OF THIS |
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9. WHAT I DO DOESN’T MATTER |
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Before Pick-up at HOTEL (post-layover) Circle Log-Time
JFK |
2100 |
2200 |
2300 |
0000 |
0100 |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
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GMT |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
0900 |
1000 |
1100 |
1200 |
1300 |
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BOM |
0730 |
0830 |
0930 |
1030 |
1130 |
1230 |
1330 |
1430 |
1530 |
1630 |
1730 |
1830 |
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Fatigue |
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JFK |
0900 |
1000 |
1100 |
1200 |
1300 |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
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GMT |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
2100 |
2200 |
2300 |
0000 |
0100 |
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BOM |
1930 |
2030 |
2130 |
2230 |
2330 |
0030 |
0130 |
0230 |
0330 |
0430 |
0530 |
0630 |
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Fatigue |
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AWAKENINGS and REASON (EXAMPLE: 5 Min. @ 0430; turbulence)
1. _____min. at __________ ________________________________
2. _____min. at __________ ________________________________
3. _____min. at __________ ________________________________
Sleep Rating (Please circle one number for each item)
Falling asleep Not Difficult 1 2 3 4 5 Difficult
My sleep was Not Deep 1 2 3 4 5 Deep
Arising was Not Difficult 1 2 3 4 5 Difficult
I now feel Not Rested 1 2 3 4 5 Rested
VISUAL ANALOG SCALE
very little-------------------------------------------------------------------------------------very much
1. How alert do you feel?
2. How sad do you feel?
3. How tense do you feel?
4. How much of an effort is it to do anything?
5. How happy do you feel?
6. How weary do you feel?
7. How calm do you feel?
8. How sleepy do you feel?
Sleep & Alertness Strategies: ________
________
CAFFEINE & H2O INTAKE (coffee, tea, soda, water, other)
TYPE __________________ AMT _____________ TIME ___________________
Notes/Comments during flight (e.g., excessive turbulence, cabin noise, something irritating happened, or whatever…)
ARR (post-flight) Circle Log-Time
JFK |
2100 |
2200 |
2300 |
0000 |
0100 |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
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GMT |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
0900 |
1000 |
1100 |
1200 |
1300 |
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BOM |
0730 |
0830 |
0930 |
1030 |
1130 |
1230 |
1330 |
1430 |
1530 |
1630 |
1730 |
1830 |
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Fatigue |
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JFK |
0900 |
1000 |
1100 |
1200 |
1300 |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
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GMT |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
2100 |
2200 |
2300 |
0000 |
0100 |
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BOM |
1930 |
2030 |
2130 |
2230 |
2330 |
0030 |
0130 |
0230 |
0330 |
0430 |
0530 |
0630 |
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Activity |
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Fatigue |
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Rating |
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AWAKENINGS and REASON (EXAMPLE: 5 Min. @ 0430; turbulence)
1. _____min. at __________ ________________________________
2. _____min. at __________ ________________________________
3. _____min. at __________ ________________________________
Sleep Rating (Please circle one number for each item)
Falling asleep Not Difficult 1 2 3 4 5 Difficult
My sleep was Not Deep 1 2 3 4 5 Deep
Arising was Not Difficult 1 2 3 4 5 Difficult
I now feel Not Rested 1 2 3 4 5 Rested
VISUAL ANALOG SCALE
very little-------------------------------------------------------------------------------------very much
1. How alert do you feel?
2. How sad do you feel?
3. How tense do you feel?
4. How much of an effort is it to do anything?
5. How happy do you feel?
6. How weary do you feel?
7. How calm do you feel?
8. How sleepy do you feel?
Sleep & Alertness Strategies: ________
________
CAFFEINE & H2O INTAKE (coffee, tea, soda, water, other)
TYPE __________________ AMT _____________ TIME ___________________
Layover Circle Log-Time
JFK |
2100 |
2200 |
2300 |
0000 |
0100 |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
||||||||||||
GMT |
0200 |
0300 |
0400 |
0500 |
0600 |
0700 |
0800 |
0900 |
1000 |
1100 |
1200 |
1300 |
||||||||||||
BOM |
0730 |
0830 |
0930 |
1030 |
1130 |
1230 |
1330 |
1430 |
1530 |
1630 |
1730 |
1830 |
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Activity |
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Fatigue |
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Rating |
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JFK |
0900 |
1000 |
1100 |
1200 |
1300 |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
||||||||||||
GMT |
1400 |
1500 |
1600 |
1700 |
1800 |
1900 |
2000 |
2100 |
2200 |
2300 |
0000 |
0100 |
||||||||||||
BOM |
1930 |
2030 |
2130 |
2230 |
2330 |
0030 |
0130 |
0230 |
0330 |
0430 |
0530 |
0630 |
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Activity |
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Fatigue |
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Rating |
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Sleep Rating (Please circle one number for each item)
Falling asleep Not Difficult 1 2 3 4 5 Difficult
My sleep was Not Deep 1 2 3 4 5 Deep
Arising was Not Difficult 1 2 3 4 5 Difficult
I now feel Not Rested 1 2 3 4 5 Rested
VISUAL ANALOG SCALE
very little-------------------------------------------------------------------------------------very much
1. How alert do you feel?
2. How sad do you feel?
3. How tense do you feel?
4. How much of an effort is it to do anything?
5. How happy do you feel?
6. How weary do you feel?
7. How calm do you feel?
8. How sleepy do you feel?
Notes/Comments during layover
File Type | application/msword |
File Title | Attachment C |
Author | TNesthus |
Last Modified By | Taylor CTR Dahl |
File Modified | 2008-09-15 |
File Created | 2008-09-15 |