UPRR Form 52032

Personal Injury Form Guide

SECTION VI - NATURE OF INJURY/OCCUPATIONAL ILLNESS AND TREATMENT

1) THRU 5)

Fill out appropriately.

6) WERE THERE ANY DEFECTS IN THE EQUIPMENT? YES / NO

Yes

7) IF ANSWER TO QUESTION 6 IS YES, STATE THE NATURE OF THE DEFECTS, IDENTIFY THE DEFECTIVE EQUIPMENT AND COMPLETE (8).

Bad order switch.

8) WERE THE DEFECTIVE CONDITIONS MARKED? YES / NO

No, it was not marked.

9) DID THIS ACCIDENT RESULT FROM RIDING ON, BOARDING, OR ALIGHTING FROM, OR BEING STRUCK OR RUN OVER BY MOVING EQUIPMENT? YES / NO

No, in this switch injury scenario, but always answer appropriately for your particular situation.

Sign, date and make sure you get a copy of the completed form.