Rail Work Permit Form
Request permission to perform work on or near rail infrastructure. Please complete all required details to submit your permit request.
Applicant Full Name
*
First Name
Last Name
Applicant Email Address
*
example@example.com
Applicant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Name
*
Work Location (Describe area or provide nearest rail marker)
*
Proposed Work Dates and Times
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Work
*
Track Maintenance
Signal/Communications
Vegetation Management
Construction/Excavation
Inspection/Survey
Other
Track/Access Requirements
*
Track Possession Required
Access to Adjacent Tracks
Work Near Live Tracks
No Track Access Needed
Key Safety Controls in Place
*
Rail Safety Briefing Completed
Lookout/Protection Staff Assigned
Worksite Delineation (e.g., cones/barriers)
Personal Protective Equipment Provided
Other
Applicant Statement of Readiness
*
I confirm all required safety measures are in place and request approval to proceed.
I am not ready to proceed at this time.
Submit Permit Request
Should be Empty: