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Territory Qualification Violation Form
View this page for more information on when a pilot is required.
Name
Email Address
Phone
What member of the crew were you?
Conductor
Engineer
Fireman
Brakeman/Switchman/Helper
Conductor Pilot
Engineer Pilot
Conductor-in-Training (new hire)
Familiarizing Conductor on Training
Familiarizing Engineer on Training
Other
Train symbol
On-Duty Date
On-Duty time
Subdivision
Mason City
Trenton
Fairmont
Tara
Geneva
Oskaloosa
Columbus
Falls City
Albert Lea
Other
Beginning milepost of unfamiliar territory
Ending milepost of unfamiliar main operated
Manager name
Date when instructed
Approximate time instructed
Have you ever been over this segment of track?
Yes
No
Approximate Time since you last traversed this segment
Less than a year prior
1-2 years prior
2+ years prior
Other crew members
Crew Position
Conductor
Engineer
Conductor In Training (new hire)
Fireman In Training
Conductor Pilot
Engineer Pilot
Name
Qualified on the territory?
Yes
No
In your own words, tell us what happened
Submit
