Information
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OPERATIONAL INCIDENT FORM
REPORTED BY
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Name
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Job Title
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Date Reported
INCIDENT DETAILS
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Date of Incident
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Time of Incident
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Signal Number
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Reported to KICC
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Adhesion Related
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Please provide a complete description of the event
LOCATION DETAILS
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Location of Incident
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Further Location Details
WEATHER
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Click all that apply
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Bright Sunlight
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Dull / Overcast
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Fair / Fine
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Falling Rain
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Falling Snow
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Frost
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High Wind
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Indoor / Under Cover
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Thick Fog
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Freezing
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Lightning / Storm
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Mist
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Other
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Visibility Conditions
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Visibility less than 200 yards
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Visibility more than 200 yards
TRAIN DETAILS
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Train ID
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Booked Departure Time
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From
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To
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Leading Unit Number
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2nd Unit Number
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3rd Unit Number
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Coach Number (s)
PERSON INVOLVED
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Employee Name
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Employee Job Title
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Based at
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