FELA Contact Form

Name

Email Address

Phone Number

Were you injured in the course of employment as a railroad worker? If not, are you related to a railroad worker who was injured on the job? How?

What was your job title/job description at the time of the incident that gave rise to your injury?

When did the incident giving rise to your injury occur?

How did the incident occur? What were you doing at the time? Were you being supervised?

Was an accident report generated by your employer after the incident? Was any other hearing or proceeding held? Did you make any statements at those proceedings?

Do you know the names of any co-workers or other individuals who may have witnessed the incident?
Yes  No 

What injuries did you sustain as a result of the incident?

Are you currently receiving medical treatment as a result of the incident?
Yes  No 

Have you discussed this matter with any representative of other parties involved in the incident, such as your employer or a railroad company attorney?
Yes  No 

How have your injuries affected your overall life experience and well-being?

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