Driver Fatigue Monitoring Log Form
Log and monitor driver fatigue observations during shift or trip operations. Please complete all fields for each observation.
Driver Name or Employee ID
*
Vehicle or Unit Identifier
*
Date and Time of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Trip or Shift Description
*
Fatigue Indicators Observed
*
Yawning or frequent blinking
Difficulty keeping eyes open
Drifting out of lane
Delayed reactions
Missing traffic signs/signals
Micro-sleeps or nodding off
Other
Severity Level
*
Mild
Moderate
Severe
Immediate Action Taken
*
Driver break/rest stop
Driver replaced
Trip delayed/postponed
No action required
Other
Person Completing Log
*
Follow-up Required?
*
Yes
No
Additional Comments or Notes
Submit Log
Should be Empty: