S-3.3, r. 3 - Règlement sur la sécurité du Réseau électrique métropolitain

Texte complet
Annexe I
(a. 58)
RAPPORT D’ACCIDENT
Exploitant:
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Description du matériel roulant ____________________________________________________________
Direction: _____________________________________________________________________________
Lieu de l’accident: _____________________________________________________________________
Date: _______________________________ Heure ____________________________________
Description de l’accident: _______________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Nombre de blessés: ____________________________________________________________________
Nombre de décès: _____________________________________________________________________
Statut des victimes (passagers, employés, autres):
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Causes apparentes de l’accident:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Enquête à venir: Oui __________ Non ___________
Autres observations:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Lieu et date de signature: ________________________________________________________________
Signature: __________________________________________________________
(nom, adresse et fonction de l’auteur du rapport)
161-2018D. 161-2018, Ann. I.
Annexe I
(a. 58)
RAPPORT D’ACCIDENT
Exploitant:
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Description du matériel roulant ____________________________________________________________
Direction: _____________________________________________________________________________
Lieu de l’accident: _____________________________________________________________________
Date: _______________________________ Heure ____________________________________
Description de l’accident: _______________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Nombre de blessés: ____________________________________________________________________
Nombre de décès: _____________________________________________________________________
Statut des victimes (passagers, employés, autres):
––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
Causes apparentes de l’accident:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Enquête à venir: Oui __________ Non ___________
Autres observations:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Lieu et date de signature: ________________________________________________________________
Signature: __________________________________________________________
(nom, adresse et fonction de l’auteur du rapport)
161-2018D. 161-2018, Ann. I.