S-3.3, r. 2 - Regulation respecting rail safety

Schedule Disposition versions

2012-09-01

SCHEDULE VI

(s. 108)

ACCIDENT REPORT

Operator: __________________________________________________________________________________

No. of train or other equipment: ___________________________ Direction: ____________________________

Place of the accident: __________________ Mileage point __________________Station: __________________

Date: ______________________ Time: ____________________ Locomotive No.: _______________________

Train gross tonnage: ________________ Number of cars: ________________ Loaded cars: _______________

Conductor: ____________________________________ Engineer: ___________________________________

Description of the accident: ___________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

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Number of victims: Killed: ______________________________ Injured: _____________________________

Status of the victims (passenger, employee, other): _______________________________________________

Apparent causes of the accident: ______________________________________________________________

__________________________________________________________________________________________

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Investigation to come: Yes: ________________________________ No: _______________________________

Other observations: _________________________________________________________________________

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Signature (name, address and position or title of the writer of the report): ______________________________

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O.C. 1401-2000, Sch. VI.