Form FRA F 6180.33 FRA F 6180.33 Railroad Safety Inspector’s Report, Violation of Hours o

OMB No. 2130-0509
RAILROAD SAFETY INSPECTOR'S REPORT

U.S. Department of Transportation
Federal Railroad Administration

VIOLATION OF HOURS OF SERVICE LAW

1. Character of Violation

2. Violation Report No.

3. Railroad

4. Place

5. Officer

6. Date

7. Train No.

8. Engine No.

10. From

11. To

12. F6180.96 Report Number - Date

9. Name of Inspector(s)

14. Violation of Title 49, U.S. Code

13. Line Item Number

Subsection

Section

16. Division

15. Operation/Facility

9a. ID No.

17. Track

Note: Employee's occupation may be abbreviated. Violations occurring at different stations should be reported on separate sheets.
18. Name and Address
of Employee

19. Occupation

20. On Duty

21. Off Duty

22. Total Time
On Duty

23. Total Time
Off Duty

Place
Date
Time
Place
Date
Time
Place
Date
Time
Place
Date
Time
Place
Date
Time
Place
Date
Time
24. Synopsis of Violation

Public reporting burden for this information collection is estimated to average 4 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 2130-0509. 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, SE, Washington, D.C. 20590.

Form FRA F6180.33

(9/04)

OMB approval expires 01/31/2019

U.S. Department of Transportation
Federal Railroad Administration

25. Regular Office Hours of Dispatchers or Operators

25a. First Shift

M. to

M.:

M.:

M. to

M.

25b. Second Shift

M. to

M.:

M.:

M. to

M.

25c. Third Shift

M. to

M.:

M.:

M. to

M.

26. Cause of Excess Services

27. Inspector Recommendation

28. Signature of Inspector(s)

30. Railroad Notification

29. Date of Signature

Time:
Name:
Title:
Date:
31. List of Documents Attached
Note: In listing data copied from railroad's records, show name, title, and official address of custodian of each record.