Hours of Service Report -- Railroads

OMB No. 2130-0005
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.

MONTH AND YEAR

DEPARTMENT OF TRANSPORTATION

FEDERAL RAILROAD ADMINISTRATION

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)).

/

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

NAME OF RAILROAD

RAILROAD CODE DIVISION

TRAIN OR ENGINE NUMBER (If train or engine crew)

**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)).

NAME OF OFFICE OR STATION (If operator or dispatcher)

REPORTING OFFICER (Signature & title)

DISPATCHER EMPLOYEES ONLY

ADDRESS
9 HOUR OFFICE
TYPE OF SERVICE

NAME OF
EMPLOYEE

12 HOUR OFFICE

OCCUPATION

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

ON DUTY

DATE

MM/DD/YYYY

OFF DUTY

TIME

DATE

TIME

HH:MM

MM/DD/YYYY

HH:MM

TOTAL TIME
ON DUTY

HH:MM

TIME
OFF DUTY
UNTIL NEXT
SERVICE
PERIOD
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)).
***(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)).
TRAIN EMPLOYEES ONLY

MONTHLY TOTALS
FREIGHT ONLY

TIME OFF
*MANDATORY **LIMBO OVER 12
EXCEEDED
SERVICE TOTAL
HOURS
CONSECUTIVE < 48/72 HOURS (F)
> 276 HOURS
> 30 HOURS
DAYS ALLOWED < 24hrs / 2 Days (P)

CAUSE:

Form FRA F6180.3

(03-2012)

OMB approval expires 09/30/2013

***INITIATING ON-DUTY PERIOD
FREIGHT (F) & PASSENGER (P)

USE REVERSE SIDE IF MORE SPACE IS REQUIRED.