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Contract Number: BF-20583561 <br /> <br /> <br />17 of 59 <br /> <br />NON-EMPLOYEE PERSONAL INJURY DATA COLLECTION <br /> <br />(If injuries are in connection with rail equipment accident/incident, highway rail grade crossing <br />accident or automobile accident, ensure that appropriate information is obtained, forms completed <br />and that data entry personnel are aware that injuries relate to that specific event.) <br /> <br />Injured Person Type: <br /> <br /> Passenger on train (C) Non-employee (N) <br />(i.e., emp of another railroad, or, non-BNSF emp <br />involved in vehicle accident, including company <br />vehicles) <br /> <br /> Contractor/safety <br />sensitive (F) Contractor/non-safety sensitive (G) <br /> <br /> Volunteer/safety sensitive <br />(H) Volunteer/other non-safety sensitive (I) <br /> Non-trespasser (D) - to include highway users involved in highway rail grade crossing <br />accidents who did not go around or through gates <br /> Trespasser (E) - to include highway users involved in highway rail grade crossing <br />accidents who went around or through gates <br /> Non-trespasser (J) - Off railroad property <br /> If train involved, Train ID: <br />________________________________ <br /> <br />Transmit attached information to Accident/Incident Reporting Center by: <br />Fax 1-817-352-7595 or by Phone 1-800-697-6736 or email to: Accident- <br />Reporting.Center@BNSF.com <br /> <br /> <br />Officer Providing Information: <br /> <br />(Name) (Employee No.) (Phone #) <br /> <br /> <br /> <br /> <br /> <br /> <br />REPORT PREPARED TO COMPLY WITH FEDERAL ACCIDENT REPORTING <br />REQUIREMENTS AND PROTECTED FROM DISCLOSURE PURSUANT TO 49 U.S.C. 20903 <br />AND 83 U.S.C. 490 <br />