Aviation Fit-for-Duty Assessment Form
Use this form to review aviation duty readiness and record a non-sensitive fit-for-duty assessment for the scheduled duty period.
Aviation Status and Scheduling
Full Name
*
First Name
Middle Name
Last Name
Job Role or Position
*
Please Select
Pilot
Co-Pilot
Cabin Crew
Flight Attendant
Dispatcher
Ground Crew
Maintenance
Other
Employee/Crew ID
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Duty/Shift Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Flight/Operation Type
Please Select
Domestic Flight
International Flight
Cargo Operation
Charter Flight
Training Flight
Maintenance Duty
Ground Operation
Other
Fit-for-Duty Assessment
Current fit-for-duty status
*
Fit
Fit with restrictions
Temporarily unfit
Needs review
Overall readiness
*
Low readiness
1
2
3
4
5
6
7
8
9
High readiness
10
1 is Low readiness, 10 is High readiness
Notable factors affecting readiness
Fatigue
Illness
Stress
Medication side effects
Sleep disruption
Recent long duty period
Other work-related concern
Key operational checks
Rows
Status
Notes
Physical condition
1
Alertness
2
Task capability
3
Communication readiness
4
Assessor Review and Notes
Assessor Name or Role
*
Final Comments or Restrictions
Overall Recommendation
*
Approved
Approved with Restrictions
Not Approved
Submit Assessment
Should be Empty: