PBR YourVoice

What are you reporting(Required)

Reporter Details

Rostered Position(Required)

Phone(Required)

Email(Required)

Incident / Hazard / Near Miss

Event Type(Required)

Date of Incident(Required)

Location (Station, yard, loco, track, building, PBM#, etc)(Required)

Branch Applicable(Required)

Select the Branch most relevant to this Incident

Train / Loco / Carriage No: (if relevant)

Description of what happened(Required)

What other factors contributed to this incident(Required)

Actions Taken Immediately(Required)

(If applicable) Upload evidence of incident

Drop files here or

Max. file size: 256 MB.

Injury

Rostered Position(Required)

Branch Applicable(Required)

Select the Branch most relevant to this Injury

Date of Injury(Required)

Injury Location Location (Station, yard, loco, track, building, PBM#, etc)(Required)

Description of what happened (sequence of events):(Required)

Body Part(s) affected:(Required)

Specify Type of Injury(Required)

Treatment Outcome (if known)

Specify Contributing Factors(Required)

Equipment/Tools/Vehicles Involved

What was done straight after the incident(Required)

Maintenance

Asset / Equipment No. or ID:(Required)

Locomotive Part ID(Required)

Issue Noticed (describe)(Required)

Immediate Action Taken (if any)(Required)

Safety Critical Risk Rating(Required)

Risk as per Safety Reporting Procedure

(If relevant) Please upload related files

Max. file size: 256 MB.

Feedback / Complaint / Compliment

Branch Applicable(Required)

Select the Branch most relevant to this Feedback

Date

Location (if applicable)

Details(Required)

(If relevant) Please upload related files

Max. file size: 256 MB.

Child Safety

Age (approx)(Required)

Gender(Required)

What was the concern?(Required)

Details of Concern (what was seen/heard/disclosed)(Required)

Person(s) of Concern (if known):

Immediate Action Taken to Protect Child:(Required)

PBR YourVoice

Reporter Details

Incident / Hazard / Near Miss

Injury

Maintenance

Feedback / Complaint / Compliment

Child Safety

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