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

OMB No. 2130-0005
MONTH AND YEAR

DEPARTMENT OF TRANSPORTATION

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)).

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

**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)).

DIVISION

RAILROAD CODE

NAME OF OFFICE OR STATION (If operator or dispatcher)

TRAIN OR ENGINE NUMBER (If train or engine crew)

DISPATCHER EMPLOYEES ONLY

REPORTING OFFICER (Signature & title)
ADDRESS

NAME OF
EMPLOYEE

***(P) On duty period initiated in excess of 6 or 14
consecutive days; initiated on duty period for 6 or 14
consecutive days without 24 hours off duty or 2 consecutive
calendar days of not initiating a on-duty period at the
employee's home terminal (49 CFR 228.405(a)(3)(ii), (iii)).

9 HOUR OFFICE
12 HOUR OFFICE

TYPE OF SERVICE

OCCUPATION

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

ON DUTY

DATE

TIME

OFF DUTY

DATE

TIME

MM/DD/YYYY HH:MM MM/DD/YYYY HH:MM

TOTAL TIME
ON DUTY

TIME
OFF DUTY
UNTIL NEXT
SERVICE
PERIOD

HH:MM

HH:MM

***(F) 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)).

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

**LIMBO OVER 12
HOURS
> 30 HOURS

***INITIATING ON-DUTY PERIOD
FREIGHT (F) & PASSENGER (P)
EXCEEDED
CONSECUTIVE
DAYS ALLOWED

TIME OFF
< 48/72 HOURS (F)
< 24hrs / 2 Days (P)

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.