When Railroad Disciplines You After Reporting An Injury

 

Name:
Address:
City: State: Zip:
Country:
Home Phone:
Cell Phone:
Email:
Railroad employed by:
Occupation:
Date of work/safety violation:
Nature of injury/safety violation:
Location of injury/safety violation:
Date reported injury/safety violation:
 
Summary description of how and why your injury or thesafety violation occurred:

What was the date the Railroad first started discipline process against you?

What were the disciplinary charges brought by the Railroad?

What was the final or actual discipline the railroad assessed against you?

What was the date of the final or actual discipline assessed against you?

Explain how the Railroad did not have any reasonable basis for disciplining or retaliating against you--in other words, explain how you did not actually violate the safety rules or procedures the Railroad says you violated:

Please give the name and phone numbers of any witnesses with knowledge of this situation: for example, any co-workers and union representatives who can confirm what happened and why the Railroad did not have any basis for disciplining or retaliating against you: