Railroad & Utility Emergency Contact Information Form

If you have more than three emergency contacts, you will not be able to use this form. If you cannot or choose not to use this form, please mail an original and two copies of your contact information to: Iowa Utilities Board, 1375 E. Court Ave., Des Moines, IA 50319-0069.

Items marked with an asterisk (*) are required fields. Please note: Information filed via this form will be open for public inspection.

The emergency contact information lists are being updated approximately once each month. Once the new list is posted, please review your information to verify that it has been submitted and input correctly.

Filing Status *

Original Filing

Revised Filing

Company Name *

Business Address *

City *

State *

Zip Code *

Information in this area will not be published in the contact lists.

This information is for internal use only.

Name of person to contact with questions about this form *

Business Phone *

E-mail Address *

Type of Company

Emergency Contacts

Emergency Contact 1

Name *

Primary Phone *

After-hours Phone

Mobile/Cell

Other Info

Emergency Contact 2

Name

Primary Phone

After-hours Phone

Mobile/Cell

Other Info

Emergency Contact 3

Name

Primary Phone

After-hours Phone

Mobile/Cell

Other Info

Leave this field blank

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Railroad & Utility Emergency Contact Information Form