SMART-TD Ohio State Legislative Board

Report Safety Issues

Date of Event:

Time of Event:

Name:

Local:

Email:

Phone:

Railroad:

Location (Dist./Sub/MP/City/State):

Building Address (if Applicable):

I'm Reporting the Following Issue:

Equipment Type:

Reporting Mark and Number of Equipment:

Line of Road / Yard:

Reported Issue To:

Name of Person Reported To (If Applicable):

Date Reported:

Time Reported:

Train Information (Engs - Lds/Mtys - Tns - Length - Axles):

Was Train DP?:

Position of DP:

Which Units Had Emmission/Fume Issues?:

Road Crossing Issue:

Crossing Milepost:

Street Name / DOT ID:

Estimated Time Crossing Was Blocked:

Additional Information:

SMART Transportation Division - Ohio State Legislative Board

PO BOX 484

BLACKLICK, OH. 43004

(419) 565-2629

PROTECTING THE SAFETY AND LEGISLATIVE NEEDS OF THE CONDUCTOR, ENGINEER, AND YARDMASTER CRAFTS