Close Call Report Form

Your Details

Name of Reporter

Organisation

Other

Mobile

Oracle Project Code

Are you reporting this on behalf of another person

YesNo

Name of Reporter on behalf of

Mobile

Name of Close Call Event

When was the Close Call?

Please give a brief description of the event

Has this issue been resolved?

YesNo

How did you make it safe? Or, why could you not?

What likely injury, damage or harm was prevented?

Region/Central Function

Route/Business Unit

Level 3

Level 4

Level 5

Level 6

Level 7

Location - Area

TracksideNon Trackside

ELR

Mileage

Unit of Measurement

YardsChainsKilometres (NR High Speed)

Yards

Chains

Kilometres (NR High Speed)

Location

Station

NR Premises

Other

Please provide some more detail about the location

What3Words

Latitude

Longitude

Close Call Origin

e.g. 2 images one close up and one further away. Please do not upload more than 15 seconds of video footage.