Rail accident or incident notification form

Section A – Requirements for all notifications

For guidance on completing this form, go to the What to notify page.

Organisation name:

Location:

Contact name:

Phone:

Incident number/code:

Location:

Line section ID/name:

Metrage:

Date and time of incident:

Accident/incident description:

Remedial actions taken:

Complete any fields in this section that are applicable to the incident. If none are applicable, scroll to the bottom of the page and click 'Submit'.

If someone was injured or died in the incident, select their role using the drop-down menu below.

If more than one type of person was involved, please add these details to the description field
Public on mobility scooters or in wheelchairs are classified under 'Public - pedestrian'

Description of vehicle (eg make/model):

Description of damage:

Description of property:

Description of damage:

If you have relevant documents or photos, attach them here. Please keep your own records of your submission.

Attachment 1

Attachment 2

Attachment 3

If you would like to submit additional attachments, please email railoccurrence@nzta.govt.nz