Form FRA F 6180.127 FRA F 6180.127 Train and Engine Service Employee Background Survey

Train and Engine Service Employee
Background Survey

ID Number:________

Form FRA 6180.127 (08/07)

Public reporting burden for this information collection is estimated to average 15
minutes per response, including time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing
this collection of information. Please note that an agency may not conduct or sponsor,
and a person is not required to respond to a collection of information unless it
displays a valid OMB control number. The OMB control number for this
information collection is xxxx-yyyy.

The data collected from this study will be used primarily for statistical purposes, and
is authorized by law (49 U.S.C. 20901). Your participation in this study is
completely voluntary. Your personal information will be kept strictly confidential,
and will not be disclosed to anyone other than employees and contractors who work on
this study.

The Federal Railroad Administration (FRA) is conducting a study of the work
schedules and sleep patterns of railroad operating crews. The purpose of the study is
to develop an understanding of the issue of work schedule-related fatigue of train and
engine service employees. The study results will inform possible future FRA policy
and regulatory actions, will assist the railroad industry in addressing any workschedule related fatigue issues of train and engine service employees, and, in general,
will contribute to overall railroad operational safety.

___ Death of a close family member

___ Change in social activities

___ Change in living conditions

___ Financial difficulties

___ Illness/injury of family member or friend

___ Difficulty with the law

___ Change in sleeping habits

___ Death of a spouse

___ Birth of a child

___ Marital difficulties

___ Personal illness or injury

Please indicate with a 9 whether any of the events listed below
has occurred to you in the last 6 months:

Life Events

5

Occasionally

Frequently

Always

4

_____________________________________________

_____________________________________________

No Stress
A Little Stress
Stressful
Very Stressful
1
2
3
4
Please assign a rating to each of the following items:
___ Lack of control over work schedule
___ Loss of sleep
___ Coordination with other departments
___ Ambiguous operating rules or procedures
___ Management policies and decisions
___ Job security
___ Communication problems
___ Inadequate staffing
___ Responsibility for safety of others
___ Lack of break time
___ Inadequate time off
___ Oversight of new hires
___ Lack of guaranteed uninterrupted rest
___ Other (please specify) ____________________________

Use the following scale to rate how much each factor below
contributes to your stress at work:

Stress at Work

Never

6. How often do you feel physically drained at the end of
your work period? Circle one:

5. How often do you feel mentally drained at the end of your
work period? Circle one:
Never
Occasionally
Frequently
Always
____ female

____ other

8. a) Do you drink caffeinated beverages?
_____ yes _____ no
b) On average, how many cups and/or cans of these
beverages do you drink per day?_____

7. How many of your dependents are under the age of
2 years?_____

6. How many children or other dependents do you have
(not including your spouse)? ______

5. What is your marital status?
____ single
____ divorced
____ married ____ widowed

4. My current position is
____ locomotive engineer
____ RCL operator
____ conductor
____ hostler
____ brakeman
____ yard foreman
____ trainman
____ switchman
____ trainee
____ other (please explain) __________________

3. What type of work do you currently do?
____ yard operations
____ road freight
____ local freight
____ hostler
____ passenger or commuter operations
____ other (please explain) __________________

2. How long have you worked in train or engine service at
your current railroad?
_____ years and ____ months

1. How long have you worked in train or engine service?
_____ years and ____ months

Sex: ____ male

About Yourself
Age: ____ years

1

2

___I share a hotel room or camp car with one or more
other workers.
___I sleep in an individual room, not shared with
anyone.
___I use the company-provided quiet room.

Sleep/Rest Arrangements
Please complete this section only if your job requires you to spend
time at an away terminal or interim release point.
1. When held at the away-from-home terminal or point of
interim release, most times:

7. Are you receiving medical treatment for your condition?
____ yes
____ no

6. Do you have sleep apnea?
____ yes
____ no

5. Have you been diagnosed as having a sleep disorder?
____ yes
____ no (skip questions 6 and 7)

____ other (please explain) ______________________

4. What type of educational materials or training has your
railroad provided you on fatigue, sleep hygiene, napping,
or sleep disorders?
____ videotape ____ safety briefing
____ brochure

3. Some people feel younger or older than their biological
age. How old do you feel? ____ years

2. In general, how would you rate your health? Circle one:
Poor
Fair
Good
Excellent

Your Health
1. How many times have you marked off sick in the last
year? ___ days

M

T

W

Th

F

___ 24 hr or from _____ to _____

______(hr:min)

S

Never

Occasionally

Frequently

Always

4. How often do you feel well rested and alert over the
course of your work period? Circle one:

3

3. How many times in the past year have you been used off
your regular assignment or used to cover work that your
pool does not usually cover? ____

2. On average, how many hours do you work per week?
____

call window

away call time

(b) If you work a job that does not have a regular
schedule, please answer the following:
at home call time
______(hr:min)

End time

Start time

S

Your Work Schedule
1. (a) If you work a job that has a fixed starting time, please
describe your work schedule using this table. Leave rest
days blank.

2. When at an away terminal or point of interim release, the
company:
___Provides me with sleeping accommodations.
___Provides a daily per diem and I must find my own
overnight accommodations.
___Provides me with a quiet room.
___Does not provide either sleep/rest accommodations
or daily per diem.