Schedule B

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Report to the Board of Railway Commissioners for Canada as required by Section 292 of the Railway Act and General Order of the Board No. 244.

1.	Date
2.	Hour
3.	Train.	Conductor.	Engine.
		Engineer.
4.	Place
4.	Province
5.	Name of person or persons injured or killed.
6.	Age
7.	Passenger, employee or others
8.	Residence.
9.	Description of injury
10.	How accident occurred Note—If injury or damage be to a bridge, culvert, viaduct or tunnel, answer numbers, 1, 2, 4, 9 and 10.
N.B.—Use only one form for each accident, attaching plain extension sheets if insufficient space here.		Signature  ..  ..  ..  ..  ..  ..  .. .
		Title  ..  ..  ..  ..  ..  ..  .. .