Information

  • OPERATIONAL INCIDENT FORM

REPORTED BY

  • Name

  • Job Title

  • Date Reported

INCIDENT DETAILS

  • Date of Incident

  • Time of Incident

  • Signal Number

  • Reported to KICC

  • Adhesion Related

  • Please provide a complete description of the event

LOCATION DETAILS

  • Location of Incident

  • Further Location Details

WEATHER

  • Click all that apply

  • Bright Sunlight

  • Dull / Overcast

  • Fair / Fine

  • Falling Rain

  • Falling Snow

  • Frost

  • High Wind

  • Indoor / Under Cover

  • Thick Fog

  • Freezing

  • Lightning / Storm

  • Mist

  • Other

  • Visibility Conditions

  • Visibility less than 200 yards

  • Visibility more than 200 yards

TRAIN DETAILS

  • Train ID

  • Booked Departure Time

  • From

  • To

  • Leading Unit Number

  • 2nd Unit Number

  • 3rd Unit Number

  • Coach Number (s)

PERSON INVOLVED

  • Employee Name

  • Employee Job Title

  • Based at

  • Add signature

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