Excess Hours of Service Report

Excess hours of service report

* Indicates required field

Name *

First

Last

Position: *

Train Called for: *

Was this the train symbol the violation occurred on? *

If no, what is the train symbol the violation occurred on? *

On-Duty Location: *

Date on Duty: *

Time On-Duty: *

Was the train secured before you were dead? *

Yes No

Were you instructed not to tie train down before going dead? *

Yes No

If yes, who instructed you not to secure train? *

Did train require KEY TRAIN securement job briefing? *

Yes No

Excess time authorized by: *

Relieved location: *

Date relieved: *

Time Relieved: *

If relieved by a crew:

Names of relieving crew: *

Relief crew symbol if any; *

Their On duty location: *

Date on duty: *

Time on duty: *

Type of transport to release location: *

Train Van

Van/Transport vehicle number: *

Train Engine ID/Symbol: *

On duty time of Transport: *

Final tie up location: *

Time: *

Date: *

Total time on duty: *

Phone: *

Email *

Comments: *

All alleged violations will be sent to the Ks. Legislative Dir. for review of actual violation. All actual violations will be forwarded to the FRA and to the Heartland Service Unit Superintendent.

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