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Safety Condition
Member Information
First Name
The First Name field is required.
Last Name
The Last Name field is required.
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The Local field is required.
Carrier
The Carrier field is required.
General Committee
The General Committee field is required.
Member Type
Bus Member
Rail Member - Freight
Rail Member - Passenger/Transit
The Member Type field is required.
Contact Information
I would like to be contacted by a union officer?
Email Address
Phone
The Phone field is required.
Safety Condition Details
Description of Safety Hazard
Switch/Derail
Task Overload
Defective/Missing Equipment
Brush/Weeds
Locomotive/Taxi
Signal
Walking Hazard
Facility Issue
Track/Structural
COVID-19 Related
Other
The Description field is required.
State Condition is Located in
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
The State field is required.
Location of the Unsafe Condition
(city, yard, terminal, subdivision, milepost, etc.)
The Location field is required.
Was the company notified of the incident?
If the incident was reported, describe the results received from the company, OR, if the incindent was not reported, explain why they did not do so.
The Reported Results field is required.
Have you been or feel you may have been retaliated against for reporting this?
Describe Other
The Describe Other field is required.
Please tell us the degree that CDC protocols to avoid transmission of COVID-19 are NOT being followed.
Protocol Violation Details field is required
Has the unsafe condition been reported to your carrier/company?
When was the condition reported?
The Reported Date field is required.
To whom was the condition reported?
Was the unsafe condition taken out of service?
Did a carrier/company officer prevent you from mitigating the unsafe condition?
To your knowledge, has the condition been previously reported?
When was the condition reported?
To whom was the condition previously reported?
Are there any additional details that you wish to report?
Optional File Upload to attach to this report
(pdf, jpeg, bmp, tiff, png)
Safety Condition
This form is intended for SMART-TD members to report unsafe conditions at work.
This report will be automatically forwarded to your General Chairperson's office of jurisdiction and applicable State Legislative Director for their records, review, and handling, if necessary.
Note: It is strongly encouraged that the proper carrier officer receives notification of any unsafe hazard, even if they do not have a process for reporting. Equally it is important that your local legislative representative and officers receive a copy of anything reported to the carrier.