Alternative Record for Illnesses Claimed to be Work-Related OMB No. 2130-0500
Form Template
This Alternative Record for Illnesses Claimed to be Work-Related form is used to monitor national rail safety.
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If there is an employee that claims to have received an illness caused by work-related issues, have this digital form filled out and submitted to the Federal Railroad Administration. This form is a digital form that you can download on your mobile smartphone or tablet, and filled out and submitted without the need of pen or paper.
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