UTU LOCAL 171

MISSED TRANSPORTATION FORM

DATE_______________________

INSTRUCTIONS: FILL OUT THIS FORM FOR EACH DATE TRANSPORTATION IS MISSED. COMPLETING THIS FORM IS THE ONLY WAY TO DOCUMENT MISSED TRANSPORTATION. WE CANNOT CORRECT THE PROBLEM UNLESS IT IS DOCUMENTED.

MAKE SURE TO DATE THE FORM ABOVE.

SUBMIT THIS FORM TO A UTU LOCAL 171 OFFICER OR PLACE IN ANY UTU LOCAL 171 CLAIMS BOX.

SUBURBAN ASSIGNMENT_______________    CONDUCTOR_____________________________

ESTIMATE NUMBER 0F FARES AND TICKETS NOT COLLECTED FOR EACH TRAIN:

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REASON FOR MISSED FARES (CHECK ONE)

___ CREW MANAGEMENT DID NOT FILL JOB (JOB NO.)_________

___ NOT ENOUGH CREW MEMBERS ASSIGNED TO TRAIN

___ OTHER (EXPLAIN)__________________________________________________

COMMENTS: __________________________________________________________

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NAME AND SIGNATURE OF PERSON COMPLETING THIS FORM_________________________