2016-2017 Passenger Tramway Safety Board

PASSENGER TRAMWAY INCIDENTS Pursuant to Rule 23.2 of the Colorado Passenger Tramway Safety Board’s Rules and Regulations, during the operating season, all “passenger tramway incidents” must be verbally reported to the Board, as soon as reasonably possible, but no later that twenty-four (24) hours after the time of such an incident. A written report must be mailed or faxed to the Board, on forms approved by the Board, within five (5) days of such incident.

Name of Staff Member to whom this incident was orally reported:

____________

Date and Time Incident was orally reported:

Please supply the following information: (Use separate sheet if additional space is required)

______

A. Name of Area: B. Name of Tramway:

Lift ID Number ____________

C. Date of incident: D. Failure Code(s) (required - CPTSB Form 141-03): Description:

E. Cause Code(s) (required - see CPTSB Form 141-03): Description:

F. Action taken as a result of this incident, if any:

G. Length of time the tramway was down:

CPTSB Form 139-16

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2016-2017 Passenger Tramway Safety Board

PASSENGER TRAMWAY INCIDENTS H. Names, addresses and statements of witnesses, if any:

I. Nature and extent of injuries that may have been suffered, including names and addresses of injured:

J. Designate how tramway was stopped: K. Evacuation (yes or no):

If yes, Rope or Evac. Power Unit (R or EPU):

Note: (Evacuation by Rope or Evac. Power Unit - NOT by Diesel Prime Mover) L. Number of affected persons and total time for evacuation (from time tramway first stopped to the end of evacuation): M. Name, title and signature of person reporting: N. Signature of Designated Agent: ____________________________________________________________________________

Submit this form via mail, fax, or email to: Colorado Passenger Tramway Safety Board 1560 Broadway, Suite 1350 Denver, Colorado 80202 FAX: 303-869-0235 EMAIL: [email protected] Telephone numbers are listed herein to aid in compliance with Rule 23.2

CPTSB OFFICE (303) 894-7785 Larry Smith Joyce Young

CPTSB Form 139-16

Office:

Cell:

Location:

(303) 894-7786 (303) 894-7781

(303) 929-3494 (720) 331-8985

Arvada Denver

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