Train Accidents and Injuries Contact Form

Name

Email Address

Phone Number

Describe the train accident in which you were injured. What were the date and time of the accident and exactly where did it occur?

What railroad operated the train that injured you?

At the time of the accident were you a railroad employee?
Yes  No 

Did the accident occur or were you injured while you were a railroad passenger?
Yes  No 

Were you outside the train when the accident occurred as a passenger in a motor vehicle that collided with the train or as a pedestrian?
Yes  No 

Can you identify any features of the scene that contributed to the accident?
Yes  No 

For example, were the sight lines sufficient and were the crossings clearly marked?

What were the conditions? Light or dark? Wet or dry? Snow or ice?

Did the police or any other investigative agency come to the scene of the accident?
Yes  No 

Do you have a copy of any reports that were issued?
Yes  No 

Was anyone else injured in the accident or collision?
Yes  No 

Can you name any other witnesses?
Yes  No 

What injuries did you suffer in the train accident?

What medical treatments have you received and what treatment do you continue to receive?

Please list your treating hospitals, physicians and therapists.

What is your long-term prognosis?

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