FRA F 6180.57 Highway-Rail Grade Crossing Accident/Incident Report

HIGHWAY-RAIL GRADE CROSSING
ACCIDENT/INCIDENT REPORT

DEPARTMENT OF TRANSPORTATION
FEDERAL RAILROAD ADMINISTRATION (FRA)

OMB No. 2130-0500

1. Name of Reporting Railroad

1a. Alphabetic Code

1b. Railroad Accident/Incident No.

2. Name of Other Railroad or Other Entity Filing for Equipment Involved in Train Accident/Incident

2a. Alphabetic Code

2b. Railroad Accident/Incident No.

3. Name of Railroad or Other Entity Responsible for Track Maintenance

3a. Alphabetic Code

3b. Railroad Accident/Incident No.

(single entry)

5. Date of Accident/Incident

4. U.S. DOT Grade Crossing Identification Number

month

day

6. Time of Accident/Incident

year

AM
8. Subdivision

7. Nearest Railroad Station

11. City (if in a city)

12. Highway Name or Number
Highway User Involved

A. Auto
B. Truck

4.
5.
6.
7.
8.

17. Equipment

14. Vehicle Speed
(est. mph
at impact)
16. Position

F. Bus
G. School bus
H. Motorcycle

Public

Code

Private

Rail Equipment Involved

13. Type
C. Truck-trailer
D. Pick-up truck
E. Van

PM

10. State
Abbr.

9. County

J. Other motor vehicle
K. Pedestrian
M. Other (specify)

Code

15. Direction (geographical)

1. Train (units pulling)
2. Train (units pushing)
3. Train (standing)

Code

18. Position of Car Unit in Train

Code

19. Circumstance

Car(s) (moving)
Car(s) (standing)
Light loco(s) (moving)
Light loco(s) (standing)
Other (specify)

A.
B.
C.
D.
E.

Train pulling – RCL
Train pushing – RCL
Train standing – RCL
MU Locomotive(s)
DMU Locomotive(s)

Code

1. North 2. South 3. East 4. West

20a. Was the highway user and/or rail equipment involved
in the impact transporting hazardous materials?
1. Highway user

2. Rail equipment

3. Both

Code

1. Rail equipment struck highway user 2. Rail equipment struck by highway user

1. Stalled on crossing 2. Stopped on crossing 3. Moving over crossing 4. Trapped

20b. Was there a hazardous materials release by

Code

1. Highway user

4. Neither

2. Rail equipment

Code

3. Both

4. Neither

20c. State here the name and quantity of the hazardous material released, if any.
21. Temperature (Specify if minus)

22. Visibility

F

1. Dawn

24. Type of Equipment
Consist
(single entry)

1. Freight Train

3. Dusk

Code

1. Clear

5. Single Car

9. Maint./inspect. Car

D. MU

A. Spec. MoW Equip.

E. DMU

8. Light loco(s)

1. Gates
2. Cantilever FLS
3. Standard FLS

29. Number
of Cars

4. Wig wags
5. Hwy. traffic signals
6. Audible

1. Main

C. Commuter Train-Pushing

28. Number of
Locomotive Units

38. Driver's
Age

39. Driver's Gender
1. Male
2. Female

42. Driver Passed Standing
Highway Vehicle
1. Yes 2. No 3. Unknown

Code

Code

2. No

46. Highway-Rail Crossing Users
49. Railroad Employees

3. Unknown

1. Killed

1.
2.
3.
4.

Code

Drove around the gate
Stopped and then proceeded
Did not stop
Stopped on crossing

31. Time Table Direction
1. North
2. South

Code
2. Injured

3. Uninjured

47. Highway Vehicle Property Damage
(est. dollar damage)
50. Total Number of People on Train
(include passengers and train crew)

34. Quiet Zone
1. Yes
2. No
3. Unknown

Code

Code

5. Other (specify)
6. Drove around or thru
temporary barricade/closure
7. Drove thru the gate
8. Suicide/Attempted suicide

Code

7. Other (specify)
8. Not obstructed

45. Was Driver in the Vehicle?
1. Yes 2. No

Code

48. Total Number of Highway-Rail Crossing Users
(include driver)
51. Is a Rail Equipment Accident/
Incident Report Being Filed?
1. Yes

53a. Special Study Block

Code

3. East
4. West

Code
5. Vegetation
6. Highway vehicles

52. Passengers on Train

54. Narrative Description

4. Industry

41. Driver Action
Code

43. View of Track Obscured by (primary obstruction)
1. Permanent structure
3. Passing train
2. Standing railroad equipment 4. Topography
Injured

26. Track Number or Name

37. Crossing Illuminated by Street
Lights or Special Lights
1. Yes
2. No
3. Unknown

Code

44. Driver was
Killed

Casualties to:

3. Siding

Code

6. Snow

(See reverse side for
instructions and codes)

40. Driver Drove Behind or in Front of Train
and Struck or was Struck by Second Train
1. Yes

2. Yard

5. Sleet

Code

36. Crossing Warning Interconnected
with Highway Signals
1. Yes
2. No
3. Unknown

Code

1. Both sides
2. Side of vehicle approach
3. Opposite side of vehicle approach

4. Fog

33. Signaled Crossing Warning

Code(s)
35. Location of Warning

Code

3. Rain

30. Consist Speed (Recorded speed,
if available)
R - Recorded
MPH
E - Estimated

10. Flagged by crew
11. Other (specify)
12. None

7. Crossbucks
8. Stop signs
9. Watchman

2. Cloudy

25. Track Type Used by Rail
Equipment Involved

Code

3. Commuter Train-Pulling 7. Yard/switching B. Passenger Train-Pushing
4. Work train

23. Weather (single entry)

4. Dark

2. Passenger Train-Pulling 6. Cut of cars

27. FRA Track
Class (1-9, X)
32. Type of
Crossing
Warning

(single entry)
2. Day

Code

2. No

53b. Special Study Block
(Be specific, and continue on separate sheet if necessary)

55. Typed Name & Title

56. Signature

57. Date

NOTE: This report is part of the reporting railroad's accident report pursuant to the accident reports statute and, as such shall not “be admitted as evidence or used for any purpose in any suit
or action for damages growing out of any matter mentioned in said report...." 49 U.S.C. 20903. See 49 C.F.R. 225.7 (b).

FORM FRA F 6180.57 (Rev. 06/07)

* NOTE THAT ALL CASUALTIES MUST BE REPORTED ON FORM FRA F 6180.55A

OMB approval expires XX/XX/200X

DRAFT 06/03/07

INSTRUCTIONS FOR COMPLETING BLOCK 33
Only if Types 1 - 6, Item 32 are indicated, mark in Block 33 the status of the warning devices at the crossing at the time of the accident,
using the following codes:
1. Provided minimum 20-second warning.
2. Alleged warning time greater than 60 seconds.
3. Alleged warning time less than 20 seconds.
4. Alleged no warning.
5. Confirmed warning time greater than 60 seconds.
6. Confirmed warning time less than 20 seconds.
7. Confirmed no warning.
If status code 5, 6, or 7 was entered, also enter a letter code explanation from the list below:
A. Insulated rail vehicle.
B. Storm/lightning damage.
C. Vandalism.
D. No power/batteries dead.
E. Devices down for repair.
F. Devices out of service.
G. Warning time greater than 60 seconds attributed to accident-involved train stopping short of the crossing, but within track
circuit limits, while warning devices remain continuously active with no other in-motion train present.
H. Warning time greater than 60 seconds attributed to track circuit failure (e.g., insulated rail joint or rail bonding failure, track
or ballast fouled, etc.).
J. Warning time greater than 60 seconds attributed to other train/equipment within track circuit limits.
K. Warning time less than 20 seconds attributed to signals timing out before train’s arrival at the crossing/island circuit.
L. Warning time less than 20 seconds attributed to train operating counter to track circuit design direction.
M. Warning time less than 20 seconds attributed to train speed in excess of track circuit’s design speed.
N. Warning time less than 20 seconds attributed to signal system’s failure to detect train approach.
P. Warning time less than 20 seconds attributed to violation of special train operating instructions.
R. No warning attributed to signal system’s failure to detect the train.
S. Other cause(s). Explain in Narrative Description.

This collection of information is mandatory under 49 CFR 225, and is used by FRA to monitor national rail safety by tracking – on a continual
basis – all rail accidents/incidents above a stipulated dollar threshold. Public reporting burden is estimated to average 2 hours per response,
including the time for reviewing instructions, searching existing databases, gathering and maintaining the data needed, and completing and
reviewing the collection of information. The information collected is a matter of public record, and no confidentiality is promised to any
respondent. Please note that an agency may not conduct or sponsor, and a person is not required to respond to a collection of information
unless it displays a currently valid OMB control number. The OMB control number for this collection is 2130-0500.