TRACK OCCUPANCY PERMIT

CONFLICTING FOREMEN
On __________________________________________________________________ Track
Conflicting with Foreman
A Between _____________________________________________________________________

___________________________ and __________________________________________________________________________

On __________________________________________________________________ Track
Conflicting with Foreman
B Between _____________________________________________________________________

___________________________ and __________________________________________________________________________

1 No: ________ To Foreman __________________________ 2 Authority No _____________________ Superseded

6 THIS AUTHORITY AUTHORIZES EXCLUSIVE OCCUPANCY (YES or leave blank for NO)

Work Between _________________________________________ and ______________________________________________

9
on ___________________________________ Track. Instructions _________________________________________________

Work Between _________________________________________ and ______________________________________________

10
on ___________________________________ Track. Instructions _________________________________________________

Work Between _________________________________________ and ______________________________________________

11
on ___________________________________ Track. Instructions _________________________________________________

12 Behind that has left at

13 Behind that has left at

CALL RTC: 26 Complete RTC Copied by

Item No.(s) _____________ _____________ of Authority No. ____________________________________________________

30
Cancelled at ______________________ RTC __________________________________________________________________

Item No.(s) _____________ _____________ of Authority No. ____________________________________________________

31
Cancelled at ______________________ RTC __________________________________________________________________

Authority No. ____________________________________________________________________________________________

32
Cancelled at ______________________ RTC __________________________________________________________________
SEPARATED WORK GROUPS
SUB FOREMAN 1 Repeated Authority Reported clear

SUB FOREMAN 2 Repeated Authority Reported clear

SUB FOREMAN 3 Repeated Authority Reported clear

SUB FOREMAN 4 Repeated Authority Reported clear

MOVEMENT CLEARING RECORD
SUB FRMN SUB FRMN SUB FRMN SUB FRMN
Train ID Time Train Train
1 2 3 4 Route
and Direction Authorized clear of Limits
Clear Clear Clear Clear

(Revised 06-11 XEROX FORM 220508)