Driver Fatigue Management Plan

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Form 1 – Safe Driving Plan

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.

The key areas in this model document are:

- Section 4 Questions 1-4


To be completed by the Scheduler at least once a day (prior to driver’s being allocated a task) with reference to Form 2.

  1. Retrieve the relevant Form 2 for the driver from [file location 3].

  2. Complete all sections of the form in blue/black ink.

  3. Advise the customer of the proposed plan.

  4. Advise the driver of the proposed plan.

  5. Have the Driver sign the form.

  6. Sign the form.

  7. Copy the form and hand it to the Driver.

  8. Place the completed form in [file location 2]

Section 1 – Company and Supply Chain Details




[Transport Company Name]

Transport Operator

Freight Customer

Section 2 – Driver/Vehicle Details

Date: Driver Name:

Person completing form:

Rego. Number/s:

Tick vehicle type: Truck / Trailer:  B-Double:  Road Train: 

Tick Driving Hours Scheme: STDH:  BFM:  AFM: 

Section 3 – Proposed Trip Plan




Start Time







NOTE: The driver is to use discretion and rest where or when required provided that regulated driving hours are not exceeded.

Section 4 – Fitness for Duty / Fatigue Checklist (Completed by Scheduler)

  1. Has the driver had a reset rest break in the preceding 14 days

Yes / No

  1. If the driver has worked in the preceding 24 hours:

  • Does the shift keep a similar work pattern? (night / day work)

  • Has a minimum of 7 hours continuous rest?

Yes / No

Yes / No

  1. Does the driver have sufficient work hours remaining to comply with legal limits?

Yes / No

  1. Does the plan provide opportunity for the minimum required rest breaks?

Yes / No

Changes to driving plan made by: Scheduler (Initials)

Customer (Initials)

Driver (Initials)

Driver notified of relevant scheduled changes if any?

Yes / No

Date: ____________________ Time: ________________

Section 5 – General Risk Assessment

Are there any other risks associated with this trip?

  1. Vehicle issues:

Yes / No

  1. Speed issues or restrictions:

Yes / No

  1. Communication or remoteness:

Yes / No

  1. Fauna or vegetation:

Yes / No

  1. Weather or visibility:

Yes / No

  1. Other (Specify):

Yes / No

Section 6 – Special Instructions/Contingencies

Drivers may modify this Safe Driving Plan providing work hour / rest requirements are met and notification of any changes is provided to the Scheduler as soon as possible by telephone.

Specific fatigue management instructions for this trip are:

Section 7 - Declarations

Driver acknowledgement

I understand that I am working under [Transport Company Name]’s AFM accreditation and have had the necessary training to do so.

I agree with the work and rest times allowed for this trip and agree to advise the Scheduler of any changes to this trip plan.
I have inspected the named vehicle/s and have rectified any defects likely to affect its safe operation.
Driver’s Signature: ______________________________________________________
Scheduler acknowledgement

I certify that this plan has been discussed with the driver and customer.

Scheduler’s Signature: __________________________________________________________

Page of [Transport Company Name] – AFM Policy and Procedures
Version 1, [Date of Page]

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