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  • Witness Statement Online

    Sample form below. You can edit this form and edit this text. The text will show up at the top of the form page, just as you see it now. You can edit the form using the buttons above.

    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?


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