Nebraska State Legislative Board Brotherhood of Locomotive Engineers and Trainmen
HOS Violation Report
My Name is:
My phone number is:
My E-mail is:
My address is:
City:
,
State:
, Zip:
My Occupation is:
Engineer
Conductor
Brakeman
Fireman
My Employer is:
BNSF
Union Pacific
Other Crew Member information:
Name:
Address:
City:
,
State:
, Zip:
Occupation:
Conductor
Engineer
Brakeman
Fireman
CREWS SERVICE INFORMATION:
Train ID:
On Duty Time:
, Date:
, Station:
, State:
Notified
Dispatcher
Yardmaster
of duty limitations at (times)
&
Stopped train at (Time)
, Date:
(Nearest Station)
, and (State)
Time relieved from service (Time you finish tying down train and/or are instructed to relieve yourself from duty:
TOTAL TIME ON DUTY per HOURS OF SERVICE ACT:
HRS.,
MINS.
(Note: Total time from on-duty time to time relieved from service, deadhead transportation to final terminal is limbo time, not On-Duty Time.)
Mode of Deadhead Transportation:
Contract Van
Not Applicable
Company Van
Train
Contract Bus
Other
Time Deadhead Transportation Began:
Time Deadhead Transportation Ended:
Time Released from service:
, Date:
Station:
, State:
Please enter remarks as needed to explain the cause of the HOS violation.
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rmeek@bleteam.org
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Last modified: 12/08/07
