Orami01/Test3 · Datasets at Hugging Face

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HIGHWAY USER INJURY INQUIRY FORM
(Continued)
Identifying Information (from first page) :
Date of Accident/Incident (mm/dd/yyyy) Railroad Accident/Incident Number
Highway User’s Last Name

First Name Middle Initial
Narrative Description - Continued (If additional space was needed in the Narrative Description boxes (15b. and 16b.), from the other side of this form, please
continue the narrative in this box.)
Public reporting burden is estimated to average 50 minutes per response for railroads for their part of this form and 45
minutes for highway users or their representatives for their part of this form. This includes the time for reviewing instructions,
searching existing databases, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Responses by the railroad are mandatory and responses by highway users or their representatives to this
collection of information are voluntary. The information collected is a matter of public record, and no confidentiality is
promised to any respondent. Please note that an agency may not conduct or sponsor, and a person is not required to
respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for
this collection is 2130-0500.
FRA Guide for Preparing Accident/Incident Reports
Appendix I - 1 Model Internal Control Plans
APPENDIX I
Model Internal Control Plans, Including Model Statement of Policy
Against Harassment and Intimidation and Model Complaint Procedures
Explanatory Note
The Federal Railroad Administration’s (FRA) safety regulations require railroads to adopt and
comply with a written Internal Control Plan (ICP) on accident/incident reporting. (See Chapter 1
of Guide.) The intent of the ICP requirement is to ensure that the railroad’s Reporting Officer
has the required information to prepare accurate accident/incident reports to FRA and that
employees are not afraid to provide relevant information.
Section 225.33(a) of Title 49 of the Code of Federal Regulations (49 CFR § 225.33(a)) specifies
the components to be included in an ICP. All railroads subject to 49 CFR Part 225 must have
an ICP with either:
two components (corresponding to § 225.33(a)(1)-(2); or
11 components (corresponding to § 225.33(a)(1)-(11).
Certain small railroads need have only a two-component ICP. In particular, railroads that
operate or own track on the general railroad system of transportation that have 15 or fewer
employees covered by the hours of service statute (Title 49 U.S. Code, Chapter 211) and noninsular tourist and historic railroads that operate or own track exclusively off the general system
must have a two-component ICP. (See § 225.3(b), 61 Fed. Reg. 67490 (Dec. 23, 1996).) The
first component involves adopting, disseminating, and complying with a policy statement against
harassment and intimidation, including a statement of the disciplinary action to be imposed for
violation of this policy. The second component entails (i) having both a procedure for
processing complaints of violations and a policy not to retaliate against complainants and (ii)
disclosing such procedure and policy.
Other railroads subject to Part 225 must have a full-scale ICP that includes all 11
components specified in § 225.33(a)(1)-(11).
Primarily to assist small railroads in developing their ICPs, FRA is presenting in this appendix
two model ICPs that can be used. Each contains blanks to be completed by the railroad.
For railroads required to have only a two-component ICP, Model 1 is a suggested twocomponent ICP.
For railroads required to have an 11-component ICP, Model 2 is a suggested ICP for such
railroads with fewer than 200 employees.
FRA Guide for Preparing Accident/Incident Reports
APPENDIX I – Continued
Appendix I - 2 Model Internal Control Plans
These models are only suggestions. A railroad’s trade organization may have its own model
ICP. There is no definitive ICP. Large railroads, because of their complexity, may prefer to
develop an ICP quite different from Model 2, and yet still be consistent with the regulation.
Smaller railroads may also decide to depart from the suggested models. Details, such as the
structure, forms, lines of communication, and instructions, are left to the railroad’s discretion to
design and implement. FRA recommends that railroads structure their ICPs in the same manner
that the CFR shows the components, e.g., 49 CFR 225.33(a)(1), then 225.33(a)(2), then
225.33(a)(3), etc.
A railroad may develop some synthesis between plans and develop its own plan so long as it is
consistent with the regulation. Railroads may follow any applicable model ICP provided in the
Guide and are also encouraged to tailor their ICP based upon their particular operation, structure,
or situation. After the ICP is put in place, if any significant changes to the railroad’s internal
reporting procedures occur, the ICP must be amended.
FRA Guide for Preparing Accident/Incident Reports
APPENDIX I – Continued
Appendix I - 3 Model Internal Control Plans
Model 1:
Model Statement of Policy against Harassment and Intimidation;
Model Complaint Procedures
Policy Statement of [Name of Railroad Company]
Concerning Complete and Accurate Reporting
of Accidents, Incidents, Injuries, and Occupational Illnesses
without Harassment or Intimidation
This railroad is committed to complete and accurate reporting of all accidents, incidents, injuries,
and occupational illnesses arising from the operation of the railroad, to full compliance with the
letter and spirit of the Federal Railroad Administration’s accident reporting regulations, and to
the principle, in absolute terms, that harassment or intimidation of any person that is calculated
to discourage or prevent such person from receiving proper medical treatment or from reporting
such accident, incident, injury, or illness will not be permitted or tolerated and will result in
disciplinary action in the form of ______________ against any employee, supervisor, manager,
or officer of this railroad committing such harassment or intimidation.
This policy statement is required by Federal regulation, 49 CFR § 225.33(a)(1)-(2), and all
employees, supervisory personnel, and management have been provided a copy of this Policy
Statement [when starting employment and/or by its remaining posted in a conspicuous location
where they can reasonably be expected to see it].
[NOTE: 49 CFR § 225.33(a)(2) requires disclosure to all railroad employees, supervisors,
and management of the railroad’s procedures for dealing with complaints of violations of
the preceding policy, and the railroad’s guarantee of “whistleblower” protection to any
person subject to the policy. Disclosure may be accomplished by combining the following
paragraph with the preceding policy statement and disseminating the combination.
Alternatively, the following information may be disclosed separately, by other means.]
[Complaint Procedures]
This railroad will investigate/implement the following procedure to process all complaints from
any person about the policy stated above being violated: ________________________________
___________________________. This railroad will implement the following procedure in order
to impose the appropriate prescribed disciplinary actions on any employee, supervisor, manager,
or officer of the railroad found to have violated the policy: ______________________________
______________________. This railroad shall provide “whistleblower” protection to any

HIGHWAY USER INJURY INQUIRY FORM

(Continued)

Identifying Information (from first page) :

Date of Accident/Incident (mm/dd/yyyy) Railroad Accident/Incident Number

Highway User’s Last Name

First Name Middle Initial

Narrative Description - Continued (If additional space was needed in the Narrative Description boxes (15b. and 16b.), from the other side of this form, please

continue the narrative in this box.)

Public reporting burden is estimated to average 50 minutes per response for railroads for their part of this form and 45

minutes for highway users or their representatives for their part of this form. This includes the time for reviewing instructions,

searching existing databases, gathering and maintaining the data needed, and completing and reviewing the collection of

information. Responses by the railroad are mandatory and responses by highway users or their representatives to this

collection of information are voluntary. The information collected is a matter of public record, and no confidentiality is

promised to any respondent. Please note that an agency may not conduct or sponsor, and a person is not required to

respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for

this collection is 2130-0500.

FRA Guide for Preparing Accident/Incident Reports

Appendix I - 1 Model Internal Control Plans

APPENDIX I

Model Internal Control Plans, Including Model Statement of Policy

Against Harassment and Intimidation and Model Complaint Procedures

Explanatory Note

The Federal Railroad Administration’s (FRA) safety regulations require railroads to adopt and

comply with a written Internal Control Plan (ICP) on accident/incident reporting. (See Chapter 1

of Guide.) The intent of the ICP requirement is to ensure that the railroad’s Reporting Officer

has the required information to prepare accurate accident/incident reports to FRA and that

employees are not afraid to provide relevant information.

Section 225.33(a) of Title 49 of the Code of Federal Regulations (49 CFR § 225.33(a)) specifies

the components to be included in an ICP. All railroads subject to 49 CFR Part 225 must have

an ICP with either:

two components (corresponding to § 225.33(a)(1)-(2); or

11 components (corresponding to § 225.33(a)(1)-(11).

Certain small railroads need have only a two-component ICP. In particular, railroads that

operate or own track on the general railroad system of transportation that have 15 or fewer

employees covered by the hours of service statute (Title 49 U.S. Code, Chapter 211) and noninsular tourist and historic railroads that operate or own track exclusively off the general system

must have a two-component ICP. (See § 225.3(b), 61 Fed. Reg. 67490 (Dec. 23, 1996).) The

first component involves adopting, disseminating, and complying with a policy statement against

harassment and intimidation, including a statement of the disciplinary action to be imposed for

violation of this policy. The second component entails (i) having both a procedure for

processing complaints of violations and a policy not to retaliate against complainants and (ii)

disclosing such procedure and policy.

Other railroads subject to Part 225 must have a full-scale ICP that includes all 11

components specified in § 225.33(a)(1)-(11).

Primarily to assist small railroads in developing their ICPs, FRA is presenting in this appendix

two model ICPs that can be used. Each contains blanks to be completed by the railroad.

For railroads required to have only a two-component ICP, Model 1 is a suggested twocomponent ICP.

For railroads required to have an 11-component ICP, Model 2 is a suggested ICP for such

railroads with fewer than 200 employees.

FRA Guide for Preparing Accident/Incident Reports

APPENDIX I – Continued

Appendix I - 2 Model Internal Control Plans

These models are only suggestions. A railroad’s trade organization may have its own model

ICP. There is no definitive ICP. Large railroads, because of their complexity, may prefer to

develop an ICP quite different from Model 2, and yet still be consistent with the regulation.

Smaller railroads may also decide to depart from the suggested models. Details, such as the

structure, forms, lines of communication, and instructions, are left to the railroad’s discretion to

design and implement. FRA recommends that railroads structure their ICPs in the same manner

that the CFR shows the components, e.g., 49 CFR 225.33(a)(1), then 225.33(a)(2), then

225.33(a)(3), etc.

A railroad may develop some synthesis between plans and develop its own plan so long as it is

consistent with the regulation. Railroads may follow any applicable model ICP provided in the

Guide and are also encouraged to tailor their ICP based upon their particular operation, structure,

or situation. After the ICP is put in place, if any significant changes to the railroad’s internal

reporting procedures occur, the ICP must be amended.

FRA Guide for Preparing Accident/Incident Reports

APPENDIX I – Continued

Appendix I - 3 Model Internal Control Plans

Model 1:

Model Statement of Policy against Harassment and Intimidation;

Model Complaint Procedures

Policy Statement of [Name of Railroad Company]

Concerning Complete and Accurate Reporting

of Accidents, Incidents, Injuries, and Occupational Illnesses

without Harassment or Intimidation

This railroad is committed to complete and accurate reporting of all accidents, incidents, injuries,

and occupational illnesses arising from the operation of the railroad, to full compliance with the

letter and spirit of the Federal Railroad Administration’s accident reporting regulations, and to

the principle, in absolute terms, that harassment or intimidation of any person that is calculated

to discourage or prevent such person from receiving proper medical treatment or from reporting

such accident, incident, injury, or illness will not be permitted or tolerated and will result in

disciplinary action in the form of ______________ against any employee, supervisor, manager,

or officer of this railroad committing such harassment or intimidation.

This policy statement is required by Federal regulation, 49 CFR § 225.33(a)(1)-(2), and all

employees, supervisory personnel, and management have been provided a copy of this Policy

Statement [when starting employment and/or by its remaining posted in a conspicuous location

where they can reasonably be expected to see it].

[NOTE: 49 CFR § 225.33(a)(2) requires disclosure to all railroad employees, supervisors,

and management of the railroad’s procedures for dealing with complaints of violations of

the preceding policy, and the railroad’s guarantee of “whistleblower” protection to any

person subject to the policy. Disclosure may be accomplished by combining the following

paragraph with the preceding policy statement and disseminating the combination.

Alternatively, the following information may be disclosed separately, by other means.]

[Complaint Procedures]

This railroad will investigate/implement the following procedure to process all complaints from

any person about the policy stated above being violated: ________________________________

___________________________. This railroad will implement the following procedure in order

to impose the appropriate prescribed disciplinary actions on any employee, supervisor, manager,

or officer of the railroad found to have violated the policy: ______________________________

______________________. This railroad shall provide “whistleblower” protection to any