Pilot Fatigue Survey
Choose the response that best describes your circumstances and fatigue level.
Where did you hear about this form?
*
Personal email
Word of mouth
Found on website
Which age range are you in?
18 - 29
30 - 39
40 - 49
50 - 60
60+
What is your rank?
Captain
First Officer
Other
What operations do you currently fly?
Domestic (within RSA)
Regional (Sub-Saharan)
Domestic and Regional
International
Other
Crew Compliment?
Single Crew
Multi-crew (2 Pilots)
Multi-crew (2 Pilots and Flight Engineer
What is your current base of operation?
Johannesburg
Cape Town
Durban
Port Elizabeth
East London
Other
What is your main method of commuting to work?
Car
Motorbike
Aircraft
Train
Other
If you had an 06h00 local home base sign on, how many hours prior would you have to GET UP/WAKE UP to be at work on time?
0.5
0.75
1.0
1.25
1.5
1.75
2.0
2.5
3.0
3.5
4.0
5.0+
I would leave the day before
If you normally fly to work, what is your approximate flight time?
Less than 1 hour
1 hour to 2 hours
2 hours to 3 hours
3 hours to 4 hours
4 hours to 5 hours
Greater than 5 hours
If you live away from base, do you usually:
Travel the day before duty
Travel on day of duty
Not applicable
Looking back over the last 2 months at work, how often did you experience significant fatigue from your job as a pilot?
Three or more times a week
Two times a week
Once a week
Once in two weeks
Once a month
Never
On how many occasions in the past six months have you not reported for duty due to fatigue?
In retrospect, over the past three months have there been flights that you should have turned down due to fatigue?
Yes
No
In the past six months have you used sick leave to solve a fatigue issue?
Yes
No
How much sleep do you typically require to feel completely rested and alert for the day?
Less than 5 hours
5 to 6 hours
6 to 7 hours
7 to 8 hours
8 to 9 hours
Greater than 9 hours
How much of the time over the past four weeks did you feel full of life?
All of the time
Most of the time
About half of the time
Some of the time
A little of the time
None of the time
How much of the time over the past four weeks did you have a lot of energy?
All of the time
Most of the time
About half of the time
Some of the time
A little of the time
None of the time
How much of the time over the past four weeks did you feel worn out?
All of the time
Most of the time
About half of the time
Some of the time
A little of the time
None of the time
How much of the time over the past four weeks did you feel tired?
All of the time
Most of the time
About half of the time
Some of the time
A little of the time
None of the time
During the past four weeks, to what extent has fatigue interfered with your normal social activities with family, friends, neighbours or groups?
Not at all
Slightly
Moderately
Quite a bit
Extremely
How often have you used prescription sleeping pills to sleep over the last 3 months?
Never
1 to 2 times
3 to 5 times
6 to 10 times
11 to 20 times
More than 20 times
How often have you used non-prescription (over the counter) medication to sleep over the last 3 months?
Never
1 to 2 times
3 to 5 times
6 to 10 times
11 to 20 times
More than 20 times
How often have you used melatonin to sleep over the last 3 months?
Never
1 to 2 times
3 to 5 times
6 to 10 times
11 to 20 times
More than 20 times
Do you believe that alcohol helps you to sleep?
Yes
No
How often have you used alcohol to help you sleep over the last 4 weeks?
Never
1 to 2 times
3 to 5 times
6 to 10 times
11 to 20 times
More than 20 times
How often have you used alternative medicines (eg. herbal therapy, homeopathic medicine) over the past 3 months in order to reduce fatigue or improve sleep (excluding coffee, tea and energy drinks?
Never
1 to 2 times
3 to 5 times
6 to 10 times
11 to 20 times
More than 20 times
During the past three months, is your caffeine intake from all sources (coffee, tea or energy drinks) greater on work days compared to non-work days (assume a standard cup of coffee is about 80mg of caffeine)?
1 to 2 cups/day less at home than a work day
3 to 5 cups/day less at home than a work day
6 or more cups/day less at home than a work day
Same as a work day
1 to 2 cups/day more at home than a work day
3 to 5 cups/day more at home than a work day
6 or more cups/day more at home than a work day
At the current time, what best describes your current attitude towards your employer?
Extremely positive
Moderately positive
Neutral
Moderately negative
Extremely negative
My company is making an effort to manage fatigue risk?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
My company only uses Flight and Duty to manage fatigue?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
My company is using additional measures to manage fatigue?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Please rate the following statement: "Fatigue Management has made a significant difference to the management of pilot fatigue over recent times"
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
What area of your operation causes the most concern for you with respect to fatigue? (check up to 3 and if we have not categorised one of your concerns please specify under other)
Early duty
Night duty
Alternating day and night duties with insufficient time to adjust
Successive night duty
Successive overseas/long range flights
Successive early duty
Total number of hours duty in a week
Total number of hours at work in a month
Long duty starting early
Long duty at night
Long duty during the day
High number of sectors in a duty day
High sectors combined with early starts and long days
Long "sits" between flights
Long range flights without augmentation
Long range flights with insufficient augmentation
Layover duration too short
Layover duration too long
Layover duration not suitable for circadian sleep cycle
Other circadian issues
Unable to sleep in the on-board rest facility
Reserve - 4 hour
Standby - 1 hour
None
Other
The company Flight and Duty ensures I am adequately rested before each duty?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Minimum rest periods are sufficient to ensure I'm adequately rested before each duty?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Travelling time to and from a place of rest is accounted for in my company?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
My company follows the minimum requirement as prescribed by the SACAA?
Yes
No
My company's Flight and Duty is more restrictive than the SACAA?
Yes
No
My monthly hard hour limits are ...?
How many consecutive days can you work?
How is a day off defined in your company?
Use of overtime is a common occurrence in my employment?
Yes
No
My Company provides Fatigue Management training?
Yes
No
My Company has a Fatigue specific form to report fatigue issues?
Yes
No
Is controlled rest on the Flight Deck allowed in your operations?
Yes
No
Are you encouraged to take leave?
Yes
No
Is nutrition accounted for in your schedule?
Yes
No
Does your Company provide food and drinks during operations?
Yes
No
Does your Company have a definition for the Window of Circadian Low?
Yes
No
Any additional comments?
Submit
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