INITIAL CLAIM FORM

Foreword:

In the past we have allowed our members to simply notify his/her local representative when he/she is aggrieved in some manner by either a local manager or CMS. Unfortunately, and due to the amount of claims being instituted, we find that we must ask you, the Member, to give us some assistance. The information we request below is to expedite your claim or the claim for your fellow yardmaster. Please read the instructions carefully and “fill-in” all the blanks and provide the necessary documentation requested and follow the instruction issued by your Local or District Chairperson.

THIS FORM MUST BE RECEIVED NO LATER THAN 5 DAYS AFTER THE INCIDENT

INSTRUCTIONS:

This form must be completed in it’s entirety and delivered to your LOCAL REPRESENTATIVE. If you do not know how to retrieve the information requested please ask you local representative for assistance. DO NOT send this form without the required documentation. DO NOT send this form to Labor Relations or any other company official. DO NOT send this form to the General Chairmen’s office.

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YOUR NAME:_____________________________YOUR SSN:_______________YOUR JOB NUMBER:_____

YOUR REG ASSIGNED WORK DAYS: M T W T F S S (Circle your work days) YOUR WORK HOURS: ______________

(INDICATE AM OR PM)

DATE OF VIOLATION (S):____________________ TODAY’S DATE:________________________

THIS CLAIM IS BEING FILED FOR:___________________(Scope violation, Runaround, Other)

IF OTHER, EXPLAIN: (If more room is needed use an additional page) _____________________________________________________________________________________________________________________________________________________________________________________________________________.

IF THIS CLAIM IS FOR ANOTHER DOING YARDMASTERS WORK (Scope, Article 1) FULLY EXPLAIN THE CIRCUMSTANCES. (NOTE: If another has instructed a yard/local crew or train, you must provide the name’s of the crew, job number, hours of assignment, train ID, etc. and get a written statement from the crew that [insert individuals name and title] instructed them. In addition, we need statement from those yardmasters on duty that they did not instruct the crew). If this claim form is being used for another calling a train, you must include the ‘call-back’, a copy of the train consist and a brief statement on the ‘call-back’ that no yardmaster on duty called the train and sign the statement and date it. (You can use the Call-Back sheet)

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IF THIS CLAIM IS FOR BEING MISHANDLED (Runaround, Temporary Vacancy, Seniority Issue) PLEASE FULLY EXPLAIN THE CIRCUMSTANCES: (NOTE: If you have been runaround you must provide us with a copy of the crew records from the computer system. If you are not being called by CMS, then have another yardmaster [preferably the one that run’s around you] sign a statement that he witnessed the violation. If the statement is from the junior man, have him write a statement indicating that he was called for Job #____ On duty at _________. Include any other information that may help us to document that a junior man was used, such as the Name of the junior man, his position number, seniority date and his/her position. If the Extra Board was exhausted and the Runaround is from the Augmented Board, please so state. Please state in your statement that you were willing to work and were qualified for the position. )

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OTHER CONTACT: (NOTE: This explanation is intended to provide us with information regarding any contact you may have had with either CMS or your local manager regarding this particular issue. Please include the name of the person, date and time you discussed this issue and what you suggested and clearly explain what he/she said as well. If you need additional space use the back or an additional page)

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INVENTORY OF DOCUMENTATION ATTACHED: _________________________________________________________________________________________________

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(Please sign here)

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(Please print your name here)