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BNSF <br /> RA/G WAY <br /> atisAP=" <br /> )5:4/L IVAY NON-EMPLOYEE PERSONAL INJURY DATA COLLECTION <br /> (If injuries are in connection with rail equipment accident/incident, highway rail grade crossing accident or automobile <br /> accident, ensure that appropriate information is obtained, forms completed and that data entry personnel are aware that <br /> injuries relate to that specific event.) <br /> Injured Person Type: <br /> Passenger on train (C) Non-employee (N) <br /> (:e.,amp of another railroad or,non-BNSF amp involved in vehicle accident including <br /> company vehicles) <br /> Contractor/safety sensitive (F) Contractor/non-safety sensitive (G) <br /> Volunteer/safety sensitive (H) Volunteer/other non-safety sensitive (I) <br /> Non-trespasser (D)-to include highway users involved in highway rail grade crossing accidents who did not <br /> go around or through gates <br /> Trespasser (E) - to include highway users involved in highway rail grade crossing accidents who went <br /> around or through gates <br /> Non-trespasser(J)-Off railroad property <br /> If train involved,Train ID: <br /> Transmit attached information to Accident/Incident Reporting Center by: <br /> Fax I-817-352-7595 or by Phone 1-800-G97-G73G or email to: Accident-Reporting.CenterNI NSF.com <br /> Officer Providing Information: <br /> (Name) (Employee No.) (Phone#) <br /> REPORT PREPARED TO COMPLY WITH FEDERAL ACCIDENT REPORTING REQUIREMENTS AND PROTECTED FROM <br /> DISCLOSURE PURSUANT TO 49 U.S.C.20903 AND 83 U.S.C.490 <br /> 43 <br />