SE Environmental Incident Report

ENVIRONMENTAL INCIDENT REPORT FORM

• Date Reported

  Date

• Reported by - free text

• Job Title

  Select Conductor Conductor Manager Driver Driver (High Speed) Driver (Trainee) Driver Instructor Driver Manager Duty Station Manager Engineering Staff Gateline staff Local Operations Manager Office Staff (Including Managers) Onboard Manager Platform Staff Railway Enforcement Revenue Protection Shunter Driver Station Manager Ticket Office Staff

  • Conductor
  • Conductor Manager
  • Driver
  • Driver (High Speed)
  • Driver (Trainee)
  • Driver Instructor
  • Driver Manager
  • Duty Station Manager
  • Engineering Staff
  • Gateline staff
  • Local Operations Manager
  • Office Staff (Including Managers)
  • Onboard Manager
  • Platform Staff
  • Railway Enforcement
  • Revenue Protection
  • Shunter Driver
  • Station Manager
  • Ticket Office Staff

INCIDENT DETAILS

• Date and time of incident

  Date

• Reported to KICC? <br>ALL INCIDENTS MUST BE REPORTED TO KICC

  Yes

  No

• Complete description of the event - free text

LOCATION DETAILS

• Location of incident - free text

• Further Location Details - free text

• Has the spill entered a water course? (Eg a stream)

  Yes

  Unknown

  No

  Not Applicable

• Was the spill/leak on ballast/unmade ground?

  Yes

  Unknown

  No

  Not Applicable

• How was the incident dealt with?

• Were any injuries sustained?<br>NB IF YES PLEASE ALSO COMPLETE AN ACCIDENT REPORT

  Yes

  Unknown

  No

  Not Applicable

TRAIN DETAILS

• Train ID

• Booked Departure Time

  Date

• Train Origin

• Train Destination

• Leading Unit Number

• 2nd Unit Number

• 3rd Unit Number

• Coach Number(s)

DATE AND SIGN

• Date

  Date

• Signed

  Drawing