FORM D ILLUSTRATION

NORAC MOVEMENT PERMIT FORM D

 

Form D No. _____

Form D No. (s) _________________ Delivered To ___________________

Date  ____/____/____

 

To  ____________________________________________________________________

      ____________________________________________________________________

 

  1.  TEMPORARY SPEED RESTRICTIONS

LINE	TRK(S)	BETWEEN OR AT	SPEED		SPEED SIGNS DISPLAYED
			PSGR	FRT	YES	NO

2.  Operate in _________ direction(s) on ________ trk between ________ and ________

     On ____ trk between ___________ and ___________ Dspr ________ Time ________

     On ____ trk between ___________ and ___________ Dspr ________ Time ________

     On ____ trk between ___________ and ___________ Dspr ________ Time ________

3.  Trains or track cars ahead ________________________________________________

      TC proceed past Stop Signal(s) at _________________________________________

4.  _____ trk out of service between/at ______ in charge of ________________________

     _____ trk out of service between/at ______ in charge of ________________________

5.  ______________________ line __________________ trk  obstructed for maintenance

     between _____________________________and _____________________________

6.  Non-signalled DCS rules in effect on __________________________________ trk(s)

     between _____________________________ and _____________________________

7.  Int and CP signals out of service on ____________trk(s) at _____________________

8.  Remain at __________________ on ______________trk until engine arrives to assist

9.  Operate at Restricted Speed on _________________trk to ______________________

     where train is disabled.

10.  TBS in service at  _____________________________________________________

11.  CSS rules out of service on _____ trk(s) between ____________________________

       and _________________________________________________________________

12.  Protect crossing(s) _____________________________________________________

13.  Other instructions/information ___________________________________________
       ____________________________________________________________________
       ____________________________________________________________________
       ____________________________________________________________________

 

Dispatcher ____________________________ Time Effective _____________________

 

Form D Cancelled, Time _______ , Date ____/____/____ , Dispatcher ______________

 

RULES PRESCRIBING THE USE OF

MOVEMENT PERMIT FORM D

 

LINE               APPLICABLE RULE(S)

     1                 Rule 175

 

     2                 Rules 137, 139, 400, 402, 403, 405, 406, 502, 562, 803, 804, 805, 806,

                        808, 813

 

     3                 Rules 803, 805, 806, 807

 

     4                 Rules 132, 133, 134

 

     5                 Rules 132, 135

 

     6                 Rules 406, 562

 

     7                 Rule 406

 

     8                 Rule 137

 

     9                 Rule 137

 

    10                Rule 174

 

    11                Rule 561

 

    12                Rule 138

 

    13                Rules 132, 139, 177, 400, 406, 506, 507, 562, 563, 805, 806