Form FRA F 6180.130 FRA F 6180.130 T&E Passenger Service Employee Background Survey

OMB No. XXXX-XXXX

ID Number:________

T&E Passenger Service
Employee Background Survey

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

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 (T&E) passenger service employees. The study results will inform possible
future FRA policy and regulatory actions in passenger service, will assist the railroad
industry in addressing any work-schedule related fatigue issues of passenger service
employees, and, in general, will contribute to overall railroad operational safety.

___ Personal illness or injury
___ Marital difficulties
___ Birth of a child
___ Death of a spouse
___ Change in sleeping habits
___ Difficulty with the law
___ Illness/injury of family member or friend
___ Financial difficulties
___ Change in living conditions
___ Change in social activities
___ Death of a close family member

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 private to the extent
permitted by law, and will not be disclosed to anyone other than employees and
contractors who work on this study.
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 OMB No. XXXX-XXXX and the expiration date is
Month DD, Year.

Form FRA 6180.130 (07/09)

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3. How does your job provide for rest days?
____ no guaranteed rest days ____ 2 consecutive days per week
____ 2 days per week
____ 1 day per week
____ other (Please explain. For example, 7 on/2 off, 8 on/2 off)
_________________________________________________
4. How many times in the past month did you work on
your rest day? ____
5. How often do you feel well rested and alert over the
course of your work period? Circle one:
Never

Occasionally

Frequently

Always

Stress at Work
Use the following scale to rate how much each factor below
contributes to your stress at work:
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
___Lack of guaranteed uninterrupted rest
___Coordination with other departments
___Ambiguous operating rules or procedures
___Management policies and decisions
___Job security
___Communication problems
___Inadequate staffing
___Crew management
___Responsibility for safety of others
___Lack of break time
___Inadequate time off
___Oversight of new hires
___Other (please specify) ____________________________
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About Yourself
1. Age:
____ years
2. Sex:
____ male
____ female
3. How long have you worked in commuter/passenger
service?
_____ years and ____ months
4. How long have you worked in commuter/passenger
service at your current railroad?
_____ years and ____ months
5. What type of work do you currently do?
____ commuter service
____ intercity service
____ long haul
____ other (please explain) __________________
6. My current position is
____ conductor
____ locomotive engineer
____ asst. conductor/ticket collector
____ yard foreman
____ switchman
____ trainee
____ other (please explain) __________________
7. What is your marital status?
____ single
____ divorced
____ married ____ widowed

____ other

8. How many children or other dependents do you have
(not including your spouse)? ______
9. How many of your dependents are under the age of
2 years?_____
10. 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?_____
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Your Health
1. How many times have you marked off sick in the last
year? ___ days
2. In general, how would you rate your health? Circle one:
Poor
Fair
Good
Excellent
3. Some people feel younger or older than their biological
age. How old do you feel? ____ years
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

____ none

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
accommodations.
____ Provides me with a quiet room.
____ Does not provide either sleep/rest
accommodations or daily per diem.
Your Work Schedule
1. a) If you work a job that has a regular schedule, please
describe your work schedule using this table. Leave rest
days blank and use military time.
S

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

On-duty time

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

Off-duty time

7. Are you receiving medical treatment for your condition?
____ yes
____ no
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:
____ I share a hotel room with one or more other
workers.
____ I sleep in an individual room, not shared with
anyone.
____ I use the company-provided quiet room.

M

T

W

Th

F

S

Break/interim
release length

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

___ 24 hr or from _____ to _____

On average, how many times a day do you check the
line up?____
2. On average, how many on-duty hours do you work per
week, not including interim release? ____

____ I go home to sleep.

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