Fra F 6180.3

OMB No. 2130-0005
MONTH AND YEAR

DEPARTMENT OF TRANSPORTATION

SHEET NO.

FEDERAL RAILROAD ADMINISTRATION

HOURS OF SERVICE REPORT - RAILROADS
(Employees on duty in excess of that permitted by the Hours of Service Law)

NAME OF RAILROAD

DIVISION

TRAIN OR ENGINE NUMBER (If train or engine crew)

NAME OF OFFICE OR STATION (If operator or dispatcher)

REPORTING OFFICER (Signature & title)

CHECK IF APPLICABLE:
9 HOUR OFFICE

ADDRESS

NAME OF
EMPLOYEE

12 HOUR OFFICE

OCCUPATION

* CONSECUTIVE
TIME OFF DUTY
IN PRECEDING
24-HOUR PERIOD

HRS.

MINS.

ON DUTY

OFF DUTY
TOTAL TIME
ON DUTY

DATE

TIME

DATE

TIME

HRS.

MINS.

TIME
OFF DUTY
UNTIL NEXT
SERVICE
PERIOD
HRS.

MINS.

Time spent in deadhead transportation to a duty assignment is time on duty. Where more than one on duty period is involved,
all times must be shown.

* Must not include any time spent deadheading.
CAUSE:

Public reporting burden for this information collection is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. According to the Paperwork Reduction Act of 1995, a federal
agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with, a collection of
information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 2130-0005. All responses to this
collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden
to: Information Collection Officer, Federal Railroad Administration, 1120 Vermont Ave., N.W., Washington, D.C. 20590.

Form FRA F6180.3

(8-72)

OMB approval expires 12/31/2006

USE REVERSE SIDE IF MORE SPACE IS REQUIRED.