UPRR Form 52032 Rev. 01/04

Personal Injury Form Guide

Section III

1) DESCRIBE FULLY HOW THE ACCIDENT OCCURED:

Lining bad order switch.

2) WHAT SPECIFICALY CAUSED THE ACCIDENT:

Switch hung up while lining.

3) DID EQUIPMENT OR TOOLS CAUSE OR CONTRIBUTE TO THE CAUSE OF THE ACCIDENT/INJURY?

Yes, bad order switch. (No matter how you get hurt, 3, 4 & 5 are always YES)

4) DID WORKING CONDITIONS CAUSE OR CONTRIBUTE TO THE ACCIDENT/INJURY?

Yes, bad order switch.

5) DID OTHER PERSONS CAUSE OR CONTRIBUTE TO THE CAUSE OF THE ACCIDENT/INJURY?

Yes, those responsible for maintaining the switch.

6) NAMES, OCCUPATIONS AND ADDRESSES OF ALL CREW MEMBERS AND/OR OTHER PERSONS WHO WITNESSED OR HAVE ANY KNOWLEDGE OF ACCIDENT/INJURY:

List crew members, dispatcher, company officers notified - anyone with knowledge of accident, need not have witnessed it.