Pre-Shift Fitness & Vehicle Readiness Report for Transit Operators

Operator ID Number

Full Legal Name

Operator Role/Position

Shift Start Date and Time

Shift Type/Rotation

Assigned Vehicle/Unit Number

Route/Line Designation

Base Depot/Operating Location

Emergency Contact Number

Years of Experience in Current Role

Consecutive Days on Duty (including today)

Total Hours Worked in Previous 7 Days

Medical Certification Expiry Date

Primary Language for Operational Communication

Hours of Sleep in Last 24 Hours

Hours of Sleep in Last 48 Hours

Time You Went to Sleep (most recent rest period)

Time You Woke Up (most recent rest period)

Overall Sleep Quality Rating (1=Poor, 5=Excellent)

Did you experience any sleep interruptions?

Describe nature, frequency, and duration of interruptions:

Did you take any naps in the last 24 hours?

Specify nap duration and time of day:

Did you use any sleep aids or medication to assist with sleep?

Specify type, dosage, and time taken:

Do you feel adequately rested and refreshed upon waking?

Explain why you do not feel rested (e.g., sleep debt, poor quality, stress):

Time Since Waking (in hours)

Commute Time to Work (in minutes)

Did you work any overtime or extra shifts in the last 24 hours?

Provide details of overtime hours and nature of work:

Sleep Environment Quality (1=Very Poor, 5=Optimal)

Are you experiencing cumulative fatigue or sleep debt from previous shifts?

Describe persistent fatigue symptoms:

Are you currently experiencing any illness, infection, or health symptoms?

Describe symptoms, onset time, severity, and any medical consultation sought:

Are you experiencing symptoms of infectious disease (fever, cough, sore throat, etc.)?

Detail symptoms and whether you have been cleared by occupational health:

Have you taken any prescription or over-the-counter medication in the last 24 hours?

List medication name, dosage, time taken, and any side effects (drowsiness, dizziness, nausea):

Have you consumed any alcohol in the last 24 hours?

Specify type, quantity, time of last consumption, and current blood alcohol assessment:

Have you used any non-prescribed substances that may impair performance?

Provide details (this will trigger confidential medical review and may require substance testing):

Is your vision adequate for duty (with or without corrective lenses)?

Describe vision issue, last examination date, and whether corrective lenses are worn:

Is your hearing adequate for duty (with or without hearing aids)?

Describe hearing issue, last audiogram date, and any accommodations needed:

Are you experiencing any pain, discomfort, or mobility limitations?

Specify location, severity (1-10 scale), and impact on operating ability:

Do you have any dental pain or issues affecting your ability to concentrate?

Describe dental issue and planned treatment:

Current Mental Alertness Level (1=Very Drowsy, 5=Fully Alert)

Current Stress Level (1=Very Stressed, 5=Calm/Composed)

Current Emotional State

Can you perform safety-critical tasks without cognitive impairment?

Describe any cognitive difficulties (concentration, memory, decision-making, reaction time):

Fatigue Level Self-Assessment

Do you have any scheduled medical appointments or treatments during this shift?

Provide appointment time, expected duration, and impact on shift:

Hydration Status (1=Dehydrated, 5=Well Hydrated)

Hunger/Nutritional Status (1=Very Hungry, 5=Satisfied)

I confirm that all medical and health information provided is accurate and complete to the best of my knowledge.

Have you completed the exterior walk-around visual inspection?

Specify what was not checked and reason (e.g., time constraint, safety concern):

Are all brake systems responding correctly (service, parking, emergency)?

Describe brake system issue, pedal feel, warning lights, or unusual sounds:

Do all door control systems operate smoothly and safely?

Describe door system malfunction, including door numbers and specific failure mode:

Are all communication systems functional (radio, PA, emergency communication)?

Specify which communication system is faulty and test results:

Are all signaling and indicator systems operational?

Describe signaling system defect, including specific lights or displays:

Is the speedometer accurate and calibrated?

Describe speedometer discrepancy or calibration issue:

Is all mandatory emergency equipment present and accessible?

List missing or inaccessible emergency equipment (first aid, fire extinguisher, emergency brake, etc.):

Are all primary control systems responsive and functioning?

Specify control system issues (throttle, steering, traction, etc.):

Is the HVAC system operating correctly (heating, ventilation, air conditioning)?

Describe HVAC malfunction and temperature control issues:

Are all interior and exterior lights functioning properly?

List specific lighting failures (headlights, taillights, interior, destination signs):

Is the windshield clear and are wipers/washers operational?

Describe visibility issue, wiper defect, or washer fluid problem:

Is the operator seat adjustable and in safe condition?

Describe seat condition issue (adjustment, wear, safety restraints):

Are all mirrors and camera systems clean, adjusted, and functional?

Specify which mirror or camera system has issues:

Are all onboard computer and diagnostic systems functioning without critical errors?

List error codes, warning messages, or system warnings from diagnostic display:

Is the vehicle clean and sanitized to operational standards?

Describe cleanliness or sanitation concerns:

Did you identify any defects or anomalies during inspection?

Defect Details and Severity Classification

I confirm that the vehicle cab inspection has been completed thoroughly and accurately according to standard operating procedures.

Dispatch Supervisor Name

Supervisor ID Number

Have you reviewed all sections (1-4) of this pre-shift report in detail?

Are there any concerns regarding operator fitness, vehicle readiness, or documentation completeness?

Detail all concerns, observations, and required corrective actions:

Categories of Concern Identified (select all that apply)

Final Fitness for Duty Determination

Is escalation to higher management or medical review required?

Specify escalation reason and contact person notified:

Additional Supervisor Comments and Operational Instructions:

Dispatch Supervisor Digital Signature

Supervisor Review Completion Timestamp

I confirm that this pre-shift report has been properly reviewed and the operator has been cleared (or not cleared) for duty according to established safety protocols.