Title Page
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Document No.
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Serious Incident
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Station
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Conducted on
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Completed by
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Location
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Enter date and time incident was declared
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Enter time that you as (on-call) were notified
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Enter time of arrival on site by on-call
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Were BTP onsite on arival
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Was the RIO (Rail Incident Officer) onsite on arrival
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Enter name of RIO
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Enter BTP ref number
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Enter freetext of details of incident
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Have BTP declared incident non suspicous
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Was station evacuated
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Who evacuated the station? Was it Police, RIO or Station Staff
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Enter time station evacuated
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Was station open for access to public
- Open for access
- Closed for access
- Part closed to access
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Enter headcode(s) of trains involved
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Track involved
- Up Slow
- Up Fast
- Down Slow
- Down Fast
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Platform(s) involved
- 1
- 2
- 3
- 4
- 5
- 6
- 7
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Are any running lines open
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Which running lines are open
- Up Slow
- Up Fast
- Down Slow
- Down Fast
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Names of staff who witnessed actual incident happen
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Names of staff on site at time of incident
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Names of assisting managers / staff
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Has initial chain of care been started
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Has the 24hr & Part A been competed
- 24 hour
- Part A
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Were Bramaer Howells required
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Station re-opened at
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Signed by
