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ID Number______________
If you have questions, you can contact:
Amanda DiFiore
781.684.3978
[email protected]
or
Judy Gertler
781.684.4270
[email protected]
FRA F6180.131 (07/09)
Instructions for T&E Passenger Service Employee Log
This log is divided into 14 sections, one for each day that you will
be recording data. Each section has a page for recording your selfassessments of your sleep and your alertness. A table for recording
sleep, personal time, commute to / from work, work periods,
breaks / interim release, and limbo time follows the self-ratings.
Please assign the time in each day to one of the six categories. Draw
a vertical line in the appropriate column to indicate the time that
you spent in that activity. Put a horizontal bar at the top and bottom
of the vertical line to indicate the beginning and end of the activity.
Please enter the actual start and stop time of each activity period.
Next to the vertical line in the “Sleep” column, write an “A” if you
slept away from home or “H” if you slept at home. Place an “X” on
the vertical line in the “Sleep” column when your sleep is interrupted.
Next to the “X”, write the actual time of the interruption and if the
interruption occurred because of personal reasons (write “P”) or was
work-related (write “W”). Be sure to record all sleep periods,
including naps. You should report all naps that you take during
work, break / interim release, and limbo.
For the purpose of the survey, a break is defined as a period less than
four hours in length when you are not operating the train, but are still
considered on duty. Interim release is defined as a period of four hours
or more at a designated terminal. Record breaks and interim release
in the same column. Place a “T” next to a period of interim release
or break if the time is spent on your train. Place an “O” next to these
periods if the time is spent off of your train.
Limbo time is defined as time that is neither on duty nor off duty. It
is the time after which Hours of Service expire and an employee stops
operating the train until he or she is released from duty. A common
example of limbo time occurs when an employee is waiting for
transportation such as a taxicab, jitney or deadheading to the point
of final release, including the time spent traveling to the final release
point.
You may use the blank page following each daily entry for any
comments about the day’s activities. This is optional.
The following pages contain two sample entries for two consecutive
days. These examples illustrate how to record information in this log
book. The first example is for a straight through assignment. The
second is an example that shows how to log a split assignment.
Study Compensation
Complete the last page of this log book to indicate your preference for
the study compensation.
Sample Entry 1 - Straight Through Assignment
Sunday night you go to sleep sometime before midnight, and you
wake up at 6:30 a.m. Monday morning. You are scheduled to begin
work today at 5 p.m. During the day, you decide to work around the
house, run errands, and interact with your kids, until you have to get
ready for work. You prepare for work, get in your car at 4:15 p.m.,
and arrive at work at 4:50 p.m. You report for duty at 5 p.m.
You proceed to work through the night, and into Tuesday morning.
Your shift ends at 1:45 a.m. You drive home and watch television
for a half an hour before you go to bed at 2:50 a.m. At 7 a.m. you are
awakened by your family leaving for work and school. You go back
to sleep and finally wake up at 10:30 a.m.
During the day you mow the lawn and go to a doctor’s appointment.
Before you pick up your kids from school, you take a short nap from
2-3 p.m. After you pick the kids up, you have an early dinner and
then leave the house once again at 4:15 p.m. arriving at work at 4:45
p.m. You report for work at 5 p.m., however, the train is delayed by
10 minutes. You work through midnight.
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
0000
H
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0630
0630
0800
1000
1200
1400
1600
1615
1615
1650
1650
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Activity
Enter actual start and end time for all activities.
Midnight
0200
0400
0600
0800
1000
Sleep
A=away
H=home
H
0250
Personal
Commute
0200
0250
0145
0220
Work
Break/Interim
Release
T=on train
O=off train
XP
1030
1030
1200
1400
1600
1400
1500
1615
1615
1645
1645
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Sample Entry 2 - Split Assignment
It’s Thursday night and your last day of work for the week is
tomorrow. You go to sleep sometime before midnight, and you wake
up at 4 a.m. Friday morning. You have breakfast, get ready, and
depart from your home at 5:15 a.m. You arrive at work at 5:45 a.m.
and report for duty at 5:50 a.m. At 10:30 a.m. you have interim
release and report to the company provided quiet room. You read
for a short while before you take a nap from noon to 2 p.m.. Prior
to returning to duty, you take a short walk. After a 4.5 hour interim
release, you work until 7:40 p.m.
After work you immediately drive home arriving at 8:10 p.m. You
shower, get ready, and go out for a late dinner and a movie. You get
back home and go to bed at midnight. At 5 a.m. you are awakened
by a crew caller inquiring if you are qualified for a territory that
needs to be covered for the weekend. You tell them that you are not
qualified and cannot cover the territory. You go back to sleep and
wake up at 8 a.m.
During the day you visit your family and then run errands. You
spend the rest of the day with your friends returning home at 10 p.m.
You go to bed at 10:30 p.m.
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
H
Personal
Work
0145
0220
0200
0400
0400
Commute
Break/Interim
Release
T=on train
O=off train
0400
0515
0600
0515
0545
0545
0800
1000
1200
1400
1030
A
1030
O
1200
1400
1500
1600
1500
1800
2000
1940
2010
2010
1940
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
H
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
0800
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
2230
2230
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Day 1
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
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_ ______________________________________________________
Day 2
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
Day 3
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
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_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
Day 4
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
Day 5
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
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_ ______________________________________________________
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Day 6
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
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Day 7
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
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Day 8
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
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Day 9
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
Day 10
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
Day 11
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
Day 12
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
Day 13
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
Day 14
Date_____ /_____ / 2009
Sleep Quality Assessments
Rate your sleep upon rising from longest sleep period
Ease of falling asleep
1
2
Very difficult
3
4
5
Very easy
Ease of getting up
1
2
Very difficult
3
4
5
Very easy
Length of sleep
1
2
Wholly insufficient
3
4
5
More than sufficient
Quality of sleep
1
Very poor
3
4
2
5
Very good
Indicate how you feel now
1
Very sleepy
2
3
4
5
Very alert
Alertness Assessments
Rate how you feel at the start and end of work.
If the work period ends tomorrow, record your end of work
rating on tomorrow’s assessment
Start of Work
Indicate how you feel now
1
2
Very sleepy
End of Work
Indicate how you feel now
1
2
3
4
5
Very alert
3
4
5
Very alert
Very sleepy
Complete the second set of ratings if you
have two work periods that begin on this day.
2nd Start of Work
Indicate how you feel now
1
2
Very sleepy
2nd End of Work
Indicate how you feel now
1
2
Very sleepy
3
4
5
Very alert
3
4
5
Very alert
Activity
Enter actual start and end time for all activities.
Midnight
Sleep
A=away
H=home
Personal
Commute
Work
Break/Interim
Release
T=on train
O=off train
0200
0400
0600
0800
1000
1200
1400
1600
1800
2000
2200
Midnight
When your sleep is interrupted, place an “X” in the sleep column
and record the time and reason (P = personal, W = work).
Limbo
Comments on Today’s Activities
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
_ ______________________________________________________
As compensation for my participation in this study,
I prefer to receive a gift certificate to:
q
q
Home Depot
Sears
Please send the gift certificate to:
Name:________________________________________
Address______________________________________
City__________________________________________
State______________ Zip________________________
_____________________________________________
Signature
The Federal Railroad Administration (FRA) is conducting a
study of the work schedules and sleep patterns of railroad
operating crews. The purpose of the study is to develop an
understanding of the issue of work schedule-related fatigue of
train and engine (T&E) passenger service employees. The study
results will inform possible future FRA policy and regulatory
actions in passenger service, will assist the railroad industry
in addressing any work-schedule related fatigue issues of
passenger service employees, and, in general, will contribute
to overall railroad operational safety.
The data collected from this study will be used primarily for
statistical purposes, and is authorized by law (49 U.S.C. 20901).
Your participation in this study is completely voluntary. Your
personal information will be kept private to the extent
permitted by law, and will not be disclosed to anyone other
than employees and contractors who work on this study.
Public reporting burden for this information collection is
estimated to average 15 minutes per response, including time
for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing
and reviewing this collection of information. Please note that
an agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it
displays a valid OMB control number. The OMB control
number for this information collection is OMB No. XXXX-XXXX
and the expiration date is Month DD, Year.
| File Type | application/pdf |
| File Modified | 2009-08-18 |
| File Created | 2009-08-10 |