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Investigation Declaration Form


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Investigation Declaration Form

Reporting country
 
Other country

This is ""border crossing"" investigation
Report ID:   Label

1. The legal basis for the decision to investigate is:

2. Details of the occurrence
Date:
Time:
Type of railway system:
Check Railway
 
Check Metro
 
Check Tramway
 
Occurrence type:
Check Accident
 
Check Incident
 
Associated events/accidents:
RU involved:
 
IM involved:
 
Type of train/movement:
 
Location
Details 1:
Details 2:
Location description:

Occurrence description:

Casualties

Material damage
To:
Check infrastructure
Check rolling stock
Check 3rd party property
Check environment
Check none
Material damage description:
 

3. Causes
Direct and immediate causes of the occurrence
 
Additional text description
 
Underlying causes relating to skills, procedures and maintenance
 
Additional text description
 
Root causes relating to the regulatory framework conditions and application of the SMS
 
Additional text description
 

4. Recommendations

 
Additional text description:
 

5. Reporting organisation
Name:

Declaration date:

Attachments

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