Railway Not Level Crossing

PART A

Contact

Title:

[choose]

[choose]
Dr
Miss
Mr
Mrs
Ms

Firstname: *

Surname: *

Job Title:

Telephone: *

Email: **

Company

Name: *

Postcode: **

If you don't live in Northern Ireland, or you can't find your address, enter your address below.

Property:

Street: *

Locality:

Town: *

County:

Business: *

[choose]

[choose]
Contractor
Minor Railway
Other - please specify below
Railway Operator

Other: *

Your Reference:

PART B

Incident

Date of Incident: *

Time of Incident(24 Hour Clock): *

Location: **

Line Category:

Other Obstruction:*

Dangerous Occ. No.: *

Dangerous occurrence

A buckle of a running line which necessitates an immediate stoppage of traffic or the immediate imposition of a speed restriction lower than that currently in force.

A failure of the equipment at a level crossing which could endanger users of the road or path crossing the railway.

Any case of a passenger train, or any other train not fitted with continuous self-applying brakes, becoming divided.

Any case of a train on a running line striking or being struck by any object which causes damage (including damage to the windows of the driver’s cab but excluding other damage consisting solely in the breakage of glass) necessitating immediate temporary or permanent repair or which might have been liable to derail the train.

Any case of a train running onto a level crossing when not authorised to do so.

Any case of a train striking a buffer stop, other than in a siding, where damage is caused to the train.

Any case of a train striking a road vehicle or gate at a level crossing.

Any case of a train striking any cattle or horse, whether or not damage is caused to the train, or striking any other animal if, in consequence, damage (including damage to the windows of the driver’s cab but excluding other damage consisting solely in the breakage of glass) is caused to the train necessitating immediate temporary or permanent repair.

Any case of a train, other than one on a railway, striking or being struck by a road vehicle.

Any case of an aircraft or a vehicle of any kind landing on, running onto or coming to rest foul of the line, or damaging the line, which causes damage which obstructs the line or which damages any railway equipment at a level crossing.

Any case where a passenger train or any part of such a train leaves the rails otherwise than deliberately as part of normal railway operations.

Any case where a train, travelling on a running line or entering a running line from a siding, passes without authority a signal displaying a stop aspect unless the stop aspect was not displayed in sufficient time for the driver to stop safely at the signal.

Any case where planned procedures or arrangements have been activated in order to control risks arising from an incident of undue passenger congestion at a station unless that congestion has been relieved within a period of time allowed for by those procedures or arrangements.

Any collision between trains, other than one between a passenger train and another train, on a running line where any train sustains damage as a result of the collision, and any such collision in a siding which results in a running line being obstructed.

Any collision in which a passenger train collides with another train.

Any derailment, of a train other than a passenger train, in a siding which results in a running line being obstructed.

Any derailment, of a train other than a passenger train, on a running line, except a derailment which occurs during shunting operations and does not obstruct any other running line.

Any fire affecting the permanent way or works of a railway which necessitates the suspension of services over any line, or the closure of any part of a station or signal box or other premises, for a period: (a) in the case of a fire affecting any part of a railway below ground, of more than 30 minutes, and (b) in any other case, of more than 1 hour.

Any fire or severe arcing or fusing which seriously affects the functioning of signalling equipment.

Any of the following classes of accident which occurs or is discovered whilst the train is on a running line: (a) the failure of an axle; (b) the failure of a wheel or tyre, including a tyre loose on its wheel; (c) the failure of a rope or the fastenings thereof or of the winding plant or equipment involved in working an incline; (d) any fire, severe electrical arcing or fusing in or on any part of a passenger train or a train carrying dangerous goods; (e) in the case of any train other than a passenger train, any severe electrical arcing or fusing, or any fire which was extinguished by a fire-fighting service; (f) any other failure of any part of a train which is likely to cause an accident to that or any other train or to kill or injure any person.

Any other fire which causes damage which has the potential to affect the running of a railway.

The failure of a rail in a running line or of a rack rail, which results in: (a) a complete fracture of the rail through its cross-section; or (b) a piece becoming detached from the rail which necessitates an immediate stoppage of traffic or the immediate imposition of a speed restriction lower than that currently in force.

The following classes of accident where they are likely either to cause an accident to a train or to endanger any person: (a) the failure of a tunnel, bridge, viaduct, culvert, station, or other structure or any part thereof; (b) any failure in the signalling system which endangers or which has the potential to endanger the safe passage of trains other than a failure of a traffic light controlling the movement of vehicles on a road; (c) a slip of a cutting or of an embankment; (d) flooding of the permanent way; (e) the striking of a bridge by a vessel or by a road vehicle or its load; or (f) the failure of any other portion of the permanent way or works not specified above.

The runaway of an escalator, lift or passenger conveyor.

For further guidance on dangerous occurrences which are reportable in relation to railways, please see: http://www.legislation.gov.uk/nisr/2004/196/regulation/2/made

PART C

Injured Party

Title:

[choose]

[choose]
Dr
Miss
Mr
Mrs
Ms

Firstname:

Surname:

Postcode: *

If you don't live in Northern Ireland, or you can't find your address, enter your address below.

Property:

Street:

Locality:

Town:

County:

Age:

Gender:

Gender

Female

Male

Status:

[choose]

[choose]
Contractor
Employee
Other
Passenger
Person on business
Person on property
Trespasser

If ‘Other’, specify details: **

PART D

Injury

Injury Type:

[choose]

[choose]
AMPUTATION involving loss of part/whole of limb, digit etc Excludes loss of tooth or nail
ASPHYXIA/POISON Absorption, ingestion or inhalation of toxic substances & asphyx by gases
BURNS from electricity, flame, hot/cold object, external chemical burns, welders eye flash
CONCUSS/INTERNAL damage without fracture to skull, chest, pelvis, abdomen etc
CONTUSION superficial injuries which do not break the skin surface, bruises & crushing
DISLOCATION without fracture
ELECTRICITY loss of consciousness, shock etc form electricity/electrical appliances
FRACTURE with dislocation, chipped or cracked bone; hairline fracture.
LACERATION & open wounds resulting in several tendon, nerve, blood vessels & stitches
LOSS OF SIGHT of eye (major whether permanent or temporary)
MULTIPLE injuries of more than 1 type where no 1 injury is more severe
NATURAL CAUSES including heart attack
OTHER KNOWN where injury is not included in another category. Includes traumatic shock
OTHER N/K where no information is available to identify the nature of injury
STRAIN and sprains including back/torn ligaments
SUPERFICIAL abrasions, scratches, blisters, bites, cuts, puncture wounds, graze

Injury Site:

[choose]

[choose]
ANKLE - Ankle
BACK - Back including spine in the back.
EAR - Ear
EYE - Eye including eyelids
FACE - OTHER PARTS: other parts of face (including jaw and teeth)
FINGER - 1 or more fingers including thumb(s).
FOOT - Foot including heel.
GENERAL LOCS - General locations where the body system is affected e.g. drowning & asphyxi
HAND - Hand
HEAD - Parts of head; skull; forehead; etc. but excluding face.
LOWER LIMB - Lower limb including calf, knee thigh, hip.
NECK - Neck including spine in the neck.
SEVERAL HEAD - Several locations of head.
SEVERAL L / LIMB - Several locations of lower limb.
SEVERAL LOCS - Several locations where more than 1 part of the body is affected.
SEVERAL TORSO - Several location of neck, back and trunk.
SEVERAL U/LIMB - Several locations of upper limb.
TOE - 1 or more toes
TRUNK - chest, abdomen, pelvis, groin.
UNSPECIFIED LOCS - Part(s) of the body affected not known
UPPER LIMB - Upper limb including arm, shoulder, elbow, collar bone, shoulder blade.
WRIST - Wrist.

Event Type:

[choose]

[choose]
FATALITY
INJURY TO A MEMBER OF THE PUBLIC (TAKEN TO HOSPITAL)
MAJOR INJURY
OVER 3-DAY

PART E

Accident*

Train Accident:

[choose]

[choose]
Collision
Derailment
Fire
Other
Running into obstruction

Failure:

[choose]

[choose]
Permanent way etc
Rolling stock

Accidents to passengers involving trains:

[choose]

[choose]
Crossing the lines at stations.
Falling off a platform and being struck or run over by a train.
Falling out of carriages while train is moving.
Getting On or Off Trains
Opening or Closing Carriage Doors
Other

Other accidents to passengers:

[choose]

[choose]
Being struck by barrows, falling over packages etc
Electric shock on electrified railways.
Falling off a platform onto the line.
Other
Slipping, tripping, falling on the same level.
Using stairs and escalators at stations.

Accident to railway employees and contractors involving moving trains:

[choose]

[choose]
Accident during the running of trains.
Accident to staff working on or near the track.
Other
Shunting accident

Other accidents to railway employees and contractors:

[choose]

[choose]
Animal - any injury by any animal.
Assault/Violence - Physical assault or violence. - result of a deliberate criminal act.
Collapse/Overturn - Trapped by something collapsing or overturning.
Drowning/Asphyx - Drowning,suffocation or asphyxiation.
Explosion - Exposure to an explosion.
Exposure/Hot Sub - Exposure to or contact with harmful or hot substance or object.
Fall - High - Fall over 2 metres.
Fall - Low - Fall up to and including 2 metres.
Fall - Not Known - Height of fall not known.
Fire - exposure to fire.
Handling/Sprains - Injured while handling, lifting or carrying - sprains & strains.
Machinery - Contact with moving machine or material being machined
Not Known - Kind of accident not known.
Other Kind - Other kind of accident.
Strike/Step On - Struck against something fixed or stationary, stepping on something.
Struck by: moving, including flying or falling object- inc acc involving powered handtools
Transport - Struck by moving vehicle
Trip - Slip, trip or fall on same level.
Volt - Contact with electricity or electrical discharge.

Trains

Reporting Number:

Time of Origin (24 Hour Clock):

Place of Origin:

Destination:

Speed:

Train Type:

Delays

Affected Lines:

Delay from (24 Hour Clock):

Delay to (24 Hour Clock):

Description

Details: **

Name	Property	Street	Locality	Town	County	Postcode	NameKey