Individual journey management plan checklist
This journey management plan enables the traveller to document their commute plans in accordance with the fitness for work: fatigue management plan.
What does this form include?
This form contains 35 sections:
Surname
Given Name
Personnel Number
Company
Department
Position
Crew
Roster Pattern
Personnel Details
Name
Contact Number
Relationship
Daily Commute Plan
From Address
Start time Date
To Address
Finish time Date
Activity - All
Route distance (km)
Dayshift
- Additional modes of transport?
- Daily Commute Plan (Remaining shifts, If different)
- Daily Commute Plan (Last Dayshift)
Nightshift
- Do you undertake Nightshift?
Do you have any pre-existing medical conditions that may affect your journey management plan?
- Do you have any pre-existing medical conditions that may affect your journey management plan?
What are your additional controls measures to manage fatigue?
List other controls
Signature - Traveller
Traveller
- I commit to abiding by the controls stated in this IJMP to adequately manage my fitness for work.
Signature - Direct Supervisor
1-up Line Manager
Approved
- I have read and approve this IJMP
Not Approved
- I do not approve IJMP
- Insufficient controls
- Incorrect details
Comments
Overall Risk Ranking
Date Approved Date
This Individual Journey Management Plan Form shall be reviewed bi-annually or if there is a change in
Use this template