INTERVIEW TOOL OMB NO: 2139-0010
EXP. DATE: xx/xx/13
Confirmation Number: C3RS-0000000000 (mmddyy, hr, min – time in 24hr format)
Date: ________________
Time of interview: _______ am pm (will be converted to 24 hr format in system)
Interviewer Name: _______________________
Interviewee Name: _______________________
Interviewee Phone Number: ____________________
Received Confirmation Call: Yes
No
Participating Railroad:
UP
BNSF
CP
Other (Specify ______________________)
Introduction:
Hello, this is (First, Last);
I would like to speak with Mr/Ms (First, Last).
(When you have the person on the line) Hi, (name again) I am a member of the Confidential Close Call Report Interview Team located in Washington, DC. You had indicated on your report that this would be a good time to contact you for an interview. (Pause, there may be a response) The interview may take 30-45 minutes; do you have that much time available now?
(If yes, proceed with the interview)
(If no, ask for another time to conduct the interview) When would be the best time to reschedule the interview call? Record Below:
time: __________________ ,
date: ________________ ,
Ph #: _________________________
Note: May have to remind the person of potential consequence of excessive delay or refusal.
Before we proceed with the interview, I want to provide you with a little background and go over a few ground rules. There is an agreement between the BLET, UTU, UP Railroad, FRA, and the agency I am working for, the Bureau of Transportation Statistics, which provides employees that participate in the C3RS project protection from disciplinary and enforcement actions by UP Railroad and FRA. The purpose of the project is to gather data related to close calls and minor derailments that may not be available following traditional incident investigation procedures. The information you are sharing with me will be kept strictly confidential. Summary data obtained from reports and interviews may be useful in identifying the root causes of incidents and, thereby, improve safety.
Enter Work/Sleep and train consist information obtained from written report or attempt to collect at the beginning of the interview
3-Day Work/Sleep History Information (Very Important)
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Engine #’s: Distributed Power Units: |
Loads: Empties: Tons: Length: ft. No. of Hazardous Material Cars: |
Proceed with interview –
I have reviewed your close call (or minor derailment) report, but before going into the interview I would like to ask you to give me a verbal account of the incident so I can better understand how the incident occurred.
Description of Incident (In the incident description, attempt to get answers to the following questions):
What kind of harm could have occurred?
How and when did you communicate safety concerns related to the incident on which you are reporting?
What was your supervisor’s response?
What was your follow up on the incident with your supervisor?
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Comment field:
Identify interviewee’s job category:
Engineer
Hostler
Conductor
Brakeman
Switch Foreman
Switchman
RCO (operator)
Yardmaster
Hump Foreman
Trim Foreman
Dispatcher
Other - _________________________________
Before we begin the interview, would you please share the following information with our research team?
Gender:
Male
Female
Age: _______ (in years)
Height: _______ (in feet and inches)
Weight: _______ (in lbs.)
Comments field:
How many years of railroad and craft experience do each of the crew members have?
Railroad Craft
Engineer _____ _____
Hostler _____ _____
Conductor _____ _____
Brakeman _____ _____
Switch Foreman _____ _____
Switchman _____ _____
RCO (operator) _____ _____
Yardmaster _____ _____
Hump Foreman _____ _____
Trim Foreman _____ _____
Dispatcher _____ _____
Other – (years) _____ _____
Comment field:
1. Do you usually work a job with (Mark the one that best describes your situation.):
Regular start time job
Unassigned (Pool Turn)
Extra Board
Comment field:
1a. Was the incident job:
Regular start time job
Unassigned (Pool Turn)
Extra Board
2. When the incident occurred, were you being paid by the:
Mile
Hour (Basic Day)
Trip Rate
Comment field:
3. Tell me about your activities after reporting for duty and just prior to the incident:
Comment field:
4. Did the Close Call incident involve the use of brake systems?
Yes If yes, ask the questions in the following drop down box.
No
Comment field:
Drop down box to collect information on Close Calls that involved the use of brakes:
4a. What brake systems were being used and in what order and amount?
TYPE ORDER USED AMOUNT USED
Independent air 1 2 3 _________
Dynamic brakes 1 2 3 _________
Automatic air 1 2 3 _________
Brake questions continued
4b. Had these brake systems been used, prior to the incident?
Yes
No
4c. If the conductor/brakeman is being interviewed; ask if he considered using the emergency brake to control the train and avoid the incident?
Yes
No In No, why not:
Comment field:
5. Do you feel that fatigue or lack of alertness contributed to this incident?
Yes If yes, ask the questions in the following drop down box.
No
Drop down box to collect on fatigue and alertness information:
5a. Did you have trouble sleeping during the 3-day period prior to the incident?
Yes
No
5b. On a scale of 1-4, with 1 being “not good/not rested/not alert” and 4 being “very good/very rested/very alert”, how would you rate yourself on?
The quality of your sleep during your last rest period: 1 2 3 4
How rested you felt when you got up: 1 2 3 4
How alert you felt just prior to the incident: 1 2 3 4
5c. If you were tired, did you attempt to lay-off when called for the incident shift?
Yes
No In No, explain why:
Comment field:
6. How many hours did you have off-duty prior to the incident shift? _____ hrs. _____ mins.
7. How long does it typically take you to commute to and from work from home? ____ hrs. ____ mins.
8. If you feel tired at work, what do you typically do to enhance your alertness? (The scribe should fill in based on the subject’s response. Some potential responses are listed below.)
Caffeinated beverage
Stand up/walk around
Eat (chew) something
Talk
Fresh air
Drink or splash water
Other (Describe below)
Comment field:
9. Were there any issues that affected you ability to get quality sleep?
Yes If yes, ask the questions in the following drop down box.
No
Drop down box to collect information on potential issues related to sleeping:
9a. Were there any personal issues that would have affected your sleep?
Yes
No
Comment field:
9b. Have you ever been diagnosed with any type of sleeping disorder?
Yes If yes, ask follow up questions below:
No
9c. Describe condition:
9d. Describe treatment:
9e. Is the treatment effective: Yes No
9f. Were there any work related factors that affected your sleep?
Yes If yes, describe:
No
Comment field:
10. Were there any issues that affected your ability to concentrate?
Yes If yes, ask the questions in the following drop down box.
No
Comment field:
Drop down box for issues related to ability to concentrate:
10a. Were the issues work related?
Yes If yes, describe:
No
Comment field
10b. Were the issues personal in nature?
Yes No description required
No
11. Was all the required paperwork up-to-date and correct?
Yes If yes, skip to question 12
No If no, ask the questions in the following drop down box
Comment field:
Drop down box for paperwork issues:
11a. What were the problems with the paperwork:
Out-of-date
Inaccessible
Incomplete
Other (explain)
Comment field:
11b. Did the paperwork problem have an effect on this incident?
Yes
No
Comment field:
12. Was a job/safety briefing conducted at the beginning of your shift and/or prior to the incident task?
Yes If yes, ask the questions in the following drop down box.
No If no, ask the subject to explain in detail why there was no briefing.
Comment field:
Drop down box for job briefing questions:
12a. Who conducted the job briefing?
Job title: __________________________
Ask the subject to describe the job/safety briefing using the questions below:
12b. All members of the crew attended:
Yes
No
12c. Discussion of what was to be done and how to do it?
Yes
No
12d. Were all questions about the work task answered and understood?
Yes
No
12e. Did you discuss what might go wrong?
Yes
No
12f. If so, was that discussion followed up with a discussion on what to do then?
Yes
No
Comment field:
13. Did you have any misperceptions about your role in the work task?
Yes (To be filled in by the scribe if the response is yes. What were those misperceptions?)
No
13a. Some potential responses:
What he thought he saw
What he thought he heard
What he thought he smelled
The degree of risk the job involved
Other - Describe:
Comment field:
14. Do you have any job dissatisfaction issues?
Yes If yes describe:
No
Comment field:
15. How well was the crew getting along? Ask for a number rating. On a scale of 1 to 4, with 1 being poorly and 4 being very well:
Rating: ______
Comment field:
16. Were you experiencing any problems performing your job (injury, physical limitation, etc.)?
Yes If yes, describe below:
No
Comment field:
17. Did anyone else on the crew say they were having trouble performing their job?
Yes If yes, describe below:
No
Comment field:
18. Did you fail to perform your assigned duties correctly?
Yes If yes, describe below:
No
Comment field:
19. Did anyone on the crew fail to perform their assigned duties correctly?
Yes If yes, describe below:
No
Comment field:
20. What form(s) of communications were being used during the work task?
Just prior to the incident:
Verbal direct
Radio
Hand signals
Combination or Other Describe below:
Comment field:
21. When the incident occurred:
Verbal direct
Radio
Hand signals
Combination or Other Describe below:
Comment field:
22. Was there any confusion or misunderstanding leading up to the incident?
Yes If yes, ask the follow up question below.
No
Comment field:
22a. In your experience, what was the cause of the confusion or misunderstanding? (The scribe should fill in based on the subject’s response. Some potential responses are listed below.)
The words that were used
Who the message was directed at
Who the message was coming from
Someone was talking too fast to understand
A difference in understanding of how to do the job
A disagreement on how to do the job
Radio interference or other radio problems (Describe below)
Other (Describe below)
Comment field:
23. How frequently do you do this type of job or work task?
Several times a shift
Dailey
Weekly
Once or twice a month
Not very often (Ask the subject if he can remember the last time he performed this task.)
Comment field:
24. Did you know and understand the rules and practices that govern this work task (assignment)?
Yes
No If no, ask for an explanation.
Comment field:
25. Do you feel the rules and practices associated with the job or work task allowed you to perform you work in a safe manner?
Yes
No If no, ask for an explanation and follow up with question 25a below.
Comment field:
25a. Do you have any suggestions for changes to the rules or practices? (The scribe should fill in based on the subject’s response. Some potential responses are listed below.)
Eliminate
Revise (Describe below)
Add to the rule or modify the practice (Describe below)
Other (Describe below)
Comment field:
26. In your opinion, were any rules violated?
Yes If yes, ask the follow up questions in the drop down box below.
No If no, go to question 27
Drop down box for rules questions:
26a. Why do you think the rules were violated in this manner?
Comment field:
26b. Is this type of rule violation uncommon for you?
Comment field:
26c. Have you been tested recently for compliance with these rules?
Yes
No
Comment field:
27. Starting with you, how closely do people comply with safety and operating rules at your work location?
You:
Always
Most of the time
Sometimes
Your co-workers:
Always
Most of the time
Sometimes
Comment field:
28. Can you think of any factors in your work environment that promotes or contributes to bending the rules? (The scribe should fill in based on the subject’s response. Some potential responses are listed below.)
Management role modeling
Peer role modeling
Positive reinforcement from management
Positive reinforcement from peers
Management instructions to violate the rule(s)
Peer instructions to violate the rule(s)
Signage issues
Poorly written rules
Rule violations are common practice
Other (Describe below)
Comment field:
29. Were there any recent changes in the physical plant at the incident location (tracks, switches, etc.)?
Yes If yes, describe below:
No
Comment field:
30. Were there any recent changes in the rules or work practices associated with the incident work task?
Yes If yes, describe below:
No
Comment field:
31. Do you think the weather was a factor in the incident?
Yes If yes, describe the impact on the incident below:
No
Comment field:
32. Were there any other physical factors (noise, vibration, lighting, walking conditions, etc.) that may have contributed to the incident?
Yes If yes, describe below:
No
Comment field:
33. Was their any new technology involved on the equipment used for the incident work task?
Yes If yes, describe below:
No
Comment field:
34. Do you feel that you were sufficiently familiar with equipment or new technology?
Yes
No If no, ask follow up question below:
34a. Were you provided any training on the equipment or new technology?
Yes
No
Comment field:
35. Was any of the track, switches, equipment, ect., involved in the incident defective?
Yes If yes, describe below?
No
36a. When did you become aware of the defective condition(s)?
Prior to the incident occurring
At the time the incident occurred
After the incident occurred
Comment field:
36. How safe did you feel working with the other member(s) of your crew?
Very safe
Safe
Slightly safe For slightly or not safe, comment why below:
Not safe
Comment field:
37. How does management monitor rules compliance? (The scribe should fill in based on the subject’s response. Some potential responses are listed below.)
Efficiency testing
Observations
FTX
Total Safety Culture
Event recorder downloads
Other (Describe)
Comment field:
38. When was the last time you received training on your job or the rules applicable to your job? (Try to get month and year at the very least.)
Month: __________ Year: __________
39. What type of training do you think was most effective for learning you job?
On-the-job (OJT)
Classroom
Combination of the two
Some other type of training procedures (Describe below)
Comment field:
40. Is there anything management should have or could have done to prevent this incident?
Yes If yes, describe what they should/could have done:
No
Comment field:
41. On a scale of 1 to 4, with 1 being poorest or least effective and 4 being best or most effective, how do you rate your supervisor(s) with respect to the following knowledge, skill, and ability factors?
KSA factors |
Ranking (1-4) |
Don’t know |
General knowledge of operating and safety rules |
|
|
Building effective relationships with you and your crew |
|
|
Clear communication of job tasks and instructions |
|
|
Coaching/Mentoring |
|
|
Consistent enforcement of rules and requirements |
|
|
Problem solving |
|
|
42. In the context of this incident, did your supervisor or manager behave inappropriately in any way?
Yes If yes, describe below:
No
Comment field:
43. What do you do when you see or become aware of an unsafe condition, practice or piece of equipment in your workplace?
Take care of it myself (including coaching other employees)
Report it directly to a supervisor or manager
Make a report on the “Safety Hotline”
Report the matter to your union representative
Report the matter to the Safety Committee
Other (Describe)
Comment field:
44. When you reported safety concerns in the past, did management respond and effectively address your concerns?
Yes
No If no, ask the follow up question below:
45a. Did management provide feedback on what would be done to address your safety concern?
Yes
No
Comment field:
45. Do you think your immediate supervisors are generally helpful and supportive of your safety concerns?
Yes
No If no, can you give an example?
Comment field:
46. Overall, how would you rate the effectiveness of communication processes for resolving safety concerns?
Very effective
Moderately effective
Slightly effective For slightly or not effective, comment why below:
Not effective
Comment field:
47. How would your describe the relationship between management and labor at your work location?
Very good
Good
Somewhat adversarial For somewhat or very adversarial, comment why below:
Very adversarial
Comment field
We a just about finished with the interview; just two more questions.
48. In your opinion, was there something that was done that prevented this from becoming a more serious incident?
Yes If yes, describe what was done below:
No
Comment field:
49. Is there anything that could have been done differently that would have prevented this incident?
Yes If yes, describe what could have done below:
No
Comment field:
This space is reserved for the interviewer to comment on the level of risk associated with this incident with respect to: (H = High, M = Moderate, L = Low)
The people (employees) directly involved in the incident H M L
Other employees H M L
Non-railroad people H M L
Damage to equipment and/or property H M L
The environment H M L
Comment field:
End of Interview
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Did all members of the crew participate in the job/safety briefing at the beginning of the shift or work task |
| Author | William Keppen |
| File Modified | 0000-00-00 |
| File Created | 2021-02-03 |