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This is your opportunity to tell your story on a claim. Use this form to state how you or your crew could have done this work being claimed. Tell it like you are talking to a friend that does not work for the railroad.

First name:
Last Name:
Email Address:
Employee Number:
Position at Time of Statement:
Is this regarding a Claim?	YES NO
If YES, what Claim?
Location of Witnessed or Discovered Work or Violation
Detailed Description of what you Witnessed What was done? Who was there? When did it happen, and for how long?