European Rail Safety Climate Survey 2021

Expression of interest

On behalf of my organisation, which I am legally representing, I hereby express my interest in cooperating with the European Union Agency for Railways (ERA) on the European Rail Safety Climate Survey (ERSCS), as a partner, as described in the ERSCS Cooperation Protocol.

My organisation

Exact name of my organisation*

Type of my organisation*

Country*

Website of my organisation*

The features of the survey for my organisation

Total number of possible respondents in your organisation*

Preferred opening date of the survey (between 01/03/2021 and 01/06/2021)*

Survey languages:
please indicate the languages in which you would like to run the survey in your organisation

Language *

Language

Additional information

My personal data

First name*

Last name*

Job title*

Email address*

The Safety Climate Survey Coordinator in my organisation

Coordinator first name*

Coordinator last name*

Coordinator job title*

Coordinator email address*

Confirmation

I confirm the following statements:*

I have the legal authority to represent my organisation in the following actions: expression of interest in cooperating with ERA as a partner on the ERSCS, request for information, appointment of the safety climate survey coordinator.
I agree on behalf of my organisation with the ERSCS Cooperation Protocol available at the Agency website.
I agree that my contact details are processed according the Privacy Statement.

The European Union Agency for Railways is committed to user privacy. The data you submit will only be used in connection with this survey, and stored in a safe place. Click here to learn more about data protection at ERA concerning this survey.

This form is optimised for Google Chrome, Mozilla Firefox and Microsoft Edge.