Form FRA F 6180.3 FRA F 6180.3 Hours of Service Report -- Railroads

OMB No. 2130-0005
MONTH AND YEAR

DEPARTMENT OF TRANSPORTATION

SHEET NO.

Notes:
*Cumulative total for a calendar month greater than
276 hours of time spent in covered service; time
spent awaiting or in deadhead transportation from a
duty assignment to the place of final release; and
time spent in any other service at the behest of the
railroad (49 USC §21103(a)(1)).

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)

**Excess of 30 hours in a calendar month of time
spent awaiting or in deadhead transportation from a
duty assignment to the point of final release following
a period of 12 consecutive hours on duty (49 USC
§21103(c)).

CHECK IF APPLICABLE:

***On duty period initiated in excess of 6 or 7
consecutive days; initiated on duty period for 6 or 7
consecutive days without 48 or 72 hours off duty at
employee's home terminal (49 USC §21103(a)(4)).

9 HOUR OFFICE
ADDRESS

NAME OF
EMPLOYEE

12 HOUR OFFICE

OCCUPATION

CONSECUTIVE
TIME OFF DUTY
IN PRECEDING
24-HOUR
PERIOD
HH:MM

ON DUTY

OFF DUTY
TOTAL TIME
ON DUTY

DATE

TIME

DATE

TIME

HH:MM

TIME
OFF DUTY
UNTIL NEXT
SERVICE
PERIOD
HH:MM

TRAIN EMPLOYEES ONLY
MONTHLY TOTALS
*MANDATORY
SERVICE TOTAL
> 276 HOURS

**LIMBO OVER
12 HOURS
> 30 HOURS

***INITIATING ON-DUTY PERIOD
CONSECUTIVE
DAYS
> 6 OR 7 DAYS

TIME OFF AFTER
6 OR 7 DAYS
< 48/72 HOURS

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, 1200 New Jersey Avenue, S.E., Third
Floor West, Washington, D.C. 20590.

Form FRA F6180.3

(12-10)

OMB approval expires 09/30/2013

USE REVERSE SIDE IF MORE SPACE IS REQUIRED.