Part B: Final Investigation Railway Occurrence Report Form

Note: The information on this form is collected to administer the provisions of the Railway Safety Act , the Railway Safety Adopted Provisions Regulation and section 26 of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection, use, or disclosure of this information, contact the Records, Information and Privacy Analyst of Technical Safety BC.

Company

Division (where applicable)

Location of Rail Operation

Submitted by

Contact number

Date of Occurrence

Time of Occurrence

Primary Cause of Occurrence

Contributing Factors of Occurrence

Corrective Actions as a Result of Occurrence

Attach Pictures and Supporting Documents

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256 MB limit.
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Declaration

By clicking the submit button, you hereby declare that all information provided within this form is accurate. In addition, you have reported all occurrences that have occurred on your railway in the past calendar year as per Technical Safety BC's Railway Occurrence Reporting Guidelines.

I agree to the declaration

Declaration

By clicking the submit button, you hereby declare that all information provided within this form is accurate. In addition, you have reported all accidents and incidents that have occurred on your railway in the past calendar year as per the British Columbia Safety Authority's Guidelines for Reporting Accidents and Incidents.

^{Form 1433-00 (2013-01-11)}