Incident Report Your Name Alexander, Gerry Allen, Duncan Ames, Stan Aronovitch, Chuck Bennett, Jeff Bourgault, Kyle Brosseau, Bob Cappers, Steve Carrier Sr., Doug Carter, Derek Castendyk, Cullen Coots, Richard Cosgro, Matt Cosgro, Rich Crawford, Bill Curry, Mike Dandridge, Jon delaVega, Mike Dresner, Lew Drye, Rob Engler, Eric Frost, Mike Gabriel, Chester Gingell, Rob Glickman, Todd Grady, John Griffith, Charles Harrje, Gail Haskell, Peter Hessler, Fred Hooper, Scott Hubner, Devon Jayne, Allan Kirkpatrick, Dana Koellmer, Jeff Kornechuk, Dave Lane, Richard LaRoche, Denise LaRoche, Tom Mallory, Bill Marnik, Bill McGinley, Terry McMahon, Jay Mercurio, John Miller, Chelsea Miner, Jon Nawrocki, Jim Newton, Dave Pascucci, Rich Perkins, Bob Perkins, Donna Rees, Bill Rogers, Dave Ruddell, Ron Schantz, Jim Speer, Tim Stephenson, Don Sylvester, Mark Sylvester, Paul Taylor, Keith Tenaglia, Brian Tsihlis, Phil Tucker, Tom vanBokkelen, James Vardaro, Dan Whiteman, Jeremy Wilson, Peter Wolf, Rick Find your name, it will automatically populate fields in grey below.If your name is missing, contact safety@trolleymuseum.org Your First Name Your Last Name Your Full Name Your Phone Number: Your Email Address: Date & Time Report Written: Date of Incident: Time of Incident: Incident Type derailment dewire fell off the stool loading passenger person under car with pole still up pole rope swinging around rail bikes switch incident trip and fall trucks went in two different directions unloading passenger work crew If your unique Incident Type is missing, contact safety@trolleymuseum.org Were First Responders Called? no yes Who were the first responders? Cars Involved Fleet Cars Involved: CT 1160 CT 303 Nashua 38 Boston 4387 Boston 5821 WV 639 City Of Manchester Non-Fleet Cars Involved: Cleveland 1227 Twin Cities 1267 Montreal 2 Toronto 2890 Locomotive 300 Biddeford 31 Line Car 4 Snow Plow 5106 CT 838 Other Cars Involved: Bobcat Parts Warehouse Propane Forklift Parts Warehouse Electric Forklift Was the car damaged? no yes Was the shop notified? no yes Where on the car was it damaged?Check the box where the damage has occurred How was the car damaged? What was the weather at the time of the incident? âī¸ Sun âī¸ Cloud đ Foggy đ¨ī¸ Cloud with Snow âī¸ Cloud with Lightning and Rain đŠī¸ Cloud with Lightning đ§ī¸ Cloud with Rain â Sun Behind Cloud đ¤ī¸ Sun Behind Small Cloud đĨī¸ Sun Behind Large Cloud âī¸ Ice đ§ Wet đĻī¸ Sun Behind Rain Cloud đĒī¸ Tornado đ Full Moon đ Crescent Moon đ New Moon đŦī¸ Wind đ Fallen Leaves Incident Location Select the direction that the vehicle was traveling. Select the name of the Track Location where the incident occurred. Talbott Park Gregoire's Crossing Meserve's Crossing Yard Limit Sign Seward Switch Walker Junction Farview Interior Farview Yard Central Interior Central Yard Highwood Interior Highwood Yard Riverside Interior Riverside Yard Riverside Crossing SOAC Track Butler Grove Lead South Boston Interior South Boston Yard Shop 2 Interior Shop 2 Yard Shop 2 Lead Shop 2 Derail McKay Crossing Doherty Switch Morrison Hill Station North Loop Switch Arundel Station South Loop (Double-Slip) Switch Visitor's Center B17 Dwarf Signal Shuttle Position Well Switch Shop 1 Interior Shop 1 Yard Shop 1 Lead Shop 1 Derail Display Track Place a pin where the exact location of the incident occurred Detailed description of location of incident: Describe the circumstances as completely as possible, including the roles you played. Witnesses Click the (â) plus sign to add a person Operators: Staff: Other Members: Other/Non-Member witnesses of the incident. Please include their contact information. What were the contributing factors of the incident? What are your follow up recommendations: By checking this box, I certify that everything I've written above is accurate and a complete account of the incident as I observed and experienced it. Click the Checkbox ABOVE, then click the submit button to submit the form Submit