PROTOKÓŁ NR...................
z objazdu linii................................................................................................................ tor nr.............
dokonanego w dniu........................... przez.........................................................................................
w kabinie maszynisty pojazdu kolejowego nr......................lub w ostatnim wagonie pociągu
nr........................ prowadzonego przez lokomotywę serii....................................
Podczas objazdu linii stwierdzono następujące usterki:
1. Usterki zagrażające bezpieczeństwu ruchu pociągów: ...........................................................................................................................................................
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o fakcie stwierdzonego zagrożenia powiadomiono..................................................................................
Do czasu usunięcia zagrożenia wprowadzono następujące obostrzenia...................................................
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2. Nierówności pionowe w km..............................................................................................................
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3. Nierówności poziome w km...............................................................................................................
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4. Wichrowatość toru w km...................................................................................................................
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5. Usterki w rozjazdach.........................................................................................................................
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Niewłaściwe osygnalizowanie..........................................................................................................
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7. Nieprawidłowości w spotykaniu pociągów przez personel posterunków technicznych.......................
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8. Inne usterki.......................................................................................................................................
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9. Zalecenia i wnioski dokonującego objazdu linii..................................................................................
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O usunięciu usterek lub podjętych działaniach Sekcja Eksploatacji......................................................
powiadomi Zakład Linii Kolejowych w terminie do dnia.......................................................................
........................, dnia...........................
Protokół sporządził ................................................... (imię, nazwisko)
Protokół otrzymują:
1. Sekcja Eksploatacji..................................................
2. Zakład Linii Kolejowych..........................................