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Hours of Service Violation
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Safety Condition
Workplace Assault
Workplace Assault
Member Information
First Name
Last Name
Local
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Carrier / Employer
General Committee
Member Type
Bus Member
Rail Member - Freight
Rail Member - Passenger/Transit
Craft
Assault Information
Bus Route / Train ID
Time Format
Military
AM/PM
Assault Date / Time
Assault Date / Time
State where the assault took place
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
City where the assault took place
Approximate location of the assault (incuding street and nearest cross street)
Factual description of the assault
Did you sustain injuries in the assault?
Were you or any passengers hospitalized as a result of the assault?
Did the assault stem from a dispute over bus/train fare?
Did the assault stem from a dispute over bus/train running late?
Did the assault occur on board your bus/train?
Were the police contacted in connection with this incident?
Did the police come to the assault scene?
Approximate time it took police to arrive on scene?
Was your dispatcher alerted to this incident?
Did a supervisor show up on the scene?
Approximate time it took supervisor to arrive on scene?
Have you reached out to your Local Chairperson/union?
Was your bus/train equipped with a silent alarm to alert dispatch or police?
If silent alarm equipped, was it engaged?
Has your employer's management team or Human Resources department contacted you to follow up on this assault?
Were you given time off from your employer following this incident?
How much time were you given?
Was this time paid?
Have there been any arrests in connection with this assault?
Was the assault witnessed by a coworker/SMART-TD member?
Preventive Measures
Was there a uniformed security or police officer present on the bus/train at the time of the assault?
Was there a barrier separating you from the passengers on your bus/train?
Yes Fully Enclosed and Bullet Proof
Yes Fully Enclosed
Yes Partially Enclosed
No
The most recent de-escalation training you received prior to this incident was approximately how long ago?
Company/Agency has not provided it
Within 6 months
Within a year
Within 5 years
Within 10 years
It has been more than 10 years
Are signs present or announcements made on your bus/train or terminals regarding laws prohibiting assault of transit professionals?
Contact Information
Would you be willing to discuss the details of your assault with a member of SMART-TD's Bus and Transit Assault Prevention and Safety (BTAPS) committee?
Email Address
Phone
Optional File Upload to attach to this report
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