BROTHERHOOD OF LOCOMOTIVE ENGINEERS

R. BROOKS WOODWARD MEMORIAL DIVISION 14

 

Unsafe Condition/Practice Report

 

 

Date _____________ Location of Unsafe Condition _____________________________

 

Time _____________ Mile Post Location ________ Train/Job No. _________________

 

Employee Making Report _____________________ Occupation ___________________                                                                            

 

Unsafe Condition/Practice __________________________________________________

________________________________________________________________________

 

Was an Immediate Report made, i.e. Train Dispatcher, Manager, etc. ________________

If so, who? ______________________________________________________________

 

Is Immediate Protection Needed _____ Was Protection Provided ___________________

If So, What ______________________________________________________________

 

Suggested Corrective Action ________________________________________________ ________________________________________________________________________

 

Report Submitted to Amtrak Manager _____ If so, who ________________ Date ______

 

Report Submitted to Amtrak Joint Labor/Management Safety Committee _____________ What Committee _______________________________________________ Date ______

 

Report Submitted to Home Road Office, i.e., CSX, NS, CR, etc. ____________________

If so, who, what office ____________________________________ Date ____________

 

Report Submitted to Division 14 Safety Task Force _____________ Date ____________

 

Report Submitted to BLE State Legislative Director _____________Date ____________ Name ___________________________________State ___________________________

 

Was Corrective Action Taken, If So When and by Whom _________________________

 

Please Describe Action Taken _______________________________________________

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