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pdfU.S. DOT CROSSING INVENTORY FORM
DEPARTMENT OF TRANSPORTATION
OMB No. xxxx-xxxx
FEDERAL RAILROAD ADMINISTRATION
Instructions: For a new Public highway vehicle at-grade crossing, complete or provide data for Parts I-V. For a Private highway vehicle at-grade crossing, complete or provide
data for Parts I-IV. For all Pedestrian crossings, complete or provide data for Parts I-IV as appropriate. For all grade separated crossings, complete or provide data for Part I
only. For changes in data, Items A, B, C, D, and Part I, 1-3, must be provided.
A. Revision Date
(MM/DD/YYYY)
B. Reporting Agency
Railroad
State
Other
Transit
____ /_____ /_________
C. Reason for Update (Select only one)
Closed
Change
New
In Data
Crossing
Re-Open
Date Change
Operating RR
Only
Transfer
Abandoned
D. DOT Crossing Inventory
Number ( 7 char.)
Out-Service/
Inactive
Quiet Zone
Update
Admin.
Correction
Part I: Location and Classification Information
1. Primary Operating Railroad (Code – max. 4 char. or name)
4. City/Municipality (max. 16 char.)
In
2. State (2 char.)
3. County (max 20 char.)
6. Highway Type & No. (max. 26 char.)
5. Street/Road Name & Block Number (max. 26 char.)
Near
(Block Number)
7. Do Other Railroads Operate a Separate Track at Crossing?
If Yes, Specify RR (max. 16 char.)
Multiple Forms Filed
Yes
No
8. Do Other Railroads Operate Over Your Track at Crossing?
If Yes, Specify RR (max. 16 char.)
_________________ , ________________ , _________________ , _________________
Yes
No
________________ , _________________ , ________________ , _______________
9. Railroad Division or Region (max. 14 char.) 10. Railroad Subdivision or District (max. 14 char.) 11. Branch or Line Name (max. 15 char.)
12. RR Milepost
(prefix)
(nnnn.nnn)
(suffix)
13. Line Segment (max. 16 char.) 14. Nearest RR Timetable Station (max. 15 char.) 15. Parent RR (max. 4 char.) 16. Crossing Owner (If applicable, RR or Company Name)
(Optional)
17. Crossing Type
Public
18. Crossing Purpose
Highway Vehicle
Private
(If applicable)
21. Type of Train Service (check all that apply)
Freight
Transit
19. Crossing Position 20. Public Access
(If Private Crossing)
At Grade
Pathway, Ped., Other
RR Under
Yes
Station, Ped.
RR Over
No
Intercity
Passenger
Commuter
22. Average Passenger
Train Count Per Day
Light Rail Shared
Less than one per day
Tourist/Other
Number
per day __________
23. Type of Development – Primary Purpose of Crossing
Open Space
Residential
Farm (Field to Field)
Commercial
24. Is there an Adjacent Crossing with a Separate Number?
Yes
27. Latitude in decimal degrees
No
24 hr
Partial
Chicago Excused
RR Yard
Date Established _________________
29. Lat/Long Source
28. Longitude in decimal degrees
(max. 10 char.,WGS84 std nn.nnnnnnn)
(4 char.)
Recreational
Institutional
25. Quiet Zone (FRA Provided)
If Yes, Provide Crossing Number __________________
26. HSR Corridor ID
Industrial
(max. 11 char., WGS84 std nn.nnnnnnn)
Actual
30.A. Railroad Use (max. 20 char.)
31.A. State Use (max. 20 char.)
30.B. Railroad Use (max. 20 char.)
31.B. State Use (max. 20 char.)
30.C. Railroad Use (max. 20 char.)
31.C. State Use (max. 20 char.)
30.D. Railroad Use (max. 20 char.)
31.D. State Use (max. 20 char.)
Estimated
32. Narrative (max. 100 char.)
33. Emergency Notification Telephone No. (Posted)
34. Railroad Contact (Telephone No.)
35. State Contact (Telephone No.)
Part II: Railroad Information
1. Estimated Average Number of Daily Train Movements
1.A. Total Day Thru Trains
1.B. Total Night Thru Trains
(6 PM to 6 AM)
(6 AM to 6 PM)
1.C. Total Day Switching
Trains (6 AM to 6 PM)
1.D. Total Night Switching
Trains (6 PM to 6 AM)
1.E. Check if Less Than
One Movement Per Day
How many trains per week?
2. Year of Train Count Data (YYYY)
3. Speed of Train at Crossing
3.A. Maximum Timetable Speed (mph) ____________
3.B. Typical Speed Range Over Crossing (mph)
4. Type and Number of Tracks
If Other, Specify:
Main
__________
Other
__________
5. Train Detection (Main Track Only)
Siding
RR Yard
Transit
(check all that apply)
Spur/Lead
Industry
FORM FRA F 6180.71 (Rev. 10/11)
WYE
Other
___________
Storage
Constant Warning Time
DC
Motion Detection
Other
AFO
None
PTC
OMB approval expires xx/xx/xxxx
From _____________ to _____________
6. Is Track Signaled?
Yes
No
7. Event Recorder Monitoring Device
Yes
No
PAGE 1 OF 2
U.S. DOT CROSSING INVENTORY FORM
A. Revision Date (MM/DD/YYYY)
D. Crossing Inventory Number ( 7 char.)
PAGE 2
Part III: Highway Traffic Control Device Information
2. Type of Passive Traffic Control Devices at Crossing – Signs (Specify number of each)
1. No Signs or Signals
2.A. Crossbuck
2.B. Stop Signs (R1-1)
Assemblies (count)
Check if this applies
2.C. Yield Signs (R1-2)
2.D. Advance Warning Signs (Check all that apply, Count optional)
W10-1 ___________
W10-11 __________
W10-3 _________
W10-4 _________
W10-2 ___________
2.F. Pavement Markings
Stop Lines
None
2.E. Low Ground Clearance Sign
(W10-5)
No
Yes
2.H. Exempt (R15-3)
2.G. Channelization Devices
All Approaches
None
RR Xing Symbols
One Approach
2.J. Other Signs (Specify MUTCD type)
Number ___________ Specify Type (max. 10 char.) ______________________
Yes
Median
W10-12 __________
2.I. ENS Sign Displayed (I-13)
No
Yes
No
2.K. Private Crossing 2.L. LED Enhanced Signs (List types – Max. 32 char.)
Signs (if Private)
Number ___________ Specify Type (max. 10 char.) ______________________
Yes
No
Number ___________ Specify Type (max. 10 char.) ______________________
3. Type of Active Warning Devices at Crossing – Train Activated Devices (Specify number of each for all that apply)
Roadway ________
Pedestrian _______
2 Quad
Full (Barrier) Resistance
3 Quad
Full Entrance Closure
4 Quad
Median Gates
3.F. Original Installation Date of Current Active
Warning Devices: (MM/YYYY)
_____ / ________
3.D. Post-Mounted Flashing Light 3.E. Total number
of Flashing
Assemblies (# of posts) _________
Light Pairs
Incandescent
LED
3.C. Cantilevered (or Bridged) Flashing Light Structures
3.A. Gates Arms (Count) 3.B. Gate Configuration
(Count)
Over Traffic Lane ____________
Incandescent
Not Over Traffic Lane _________
LED
Backlights
Included
3.G. Automated Wayside Horn
3.H. Highway Traffic Signals
Controlling Crossing
Installed on
Yes
Yes
No
(MM/YYYY) _____ / _______
3.K. Special Active Warning [WD-5]
Manually Operated Signals
Flagging/Flagman
Watchman
Floodlighting
3.I. Wigwags (number)
3.J. Bells (number)
3.L. Other Flashing Lights or Warning Devices
Number __________ Specify type (max. 26 char.) __________________
5. Highway Traffic Pre-Signals 6. Monitoring Devices
4.A. Does Nearby Hwy 4.B. Hwy Traffic Signal 4.C. Hwy Traffic
(Check all that apply)
Intersection have
Interconnection
Signal Preemption
Yes
No
Traffic Signals?
Not Interconnected
Yes – Photo/Video
Simultaneous
Enforcement
For Traffic Signals
Storage
Distance
___________
Advanced
Yes – Vehicle Presence
Yes
No
For Warning Signs
Stop Line Distance __________
Detection
7. Crossing Warning Device
WD Code (FRA Calc.)
Part IV: Physical Characteristics
One-way Traffic 2. Is Roadway Paved? 3. Does Track Run Down a Street? 4. Is Crossing Illuminated? (street lights within
1. Traffic Lanes Crossing Railroad
approx. 50 feet from nearest rail)
Two-way Traffic
Number of
Lanes______________
5 Crossing Surface (on main track, multiple types allowed)
1. Timber
2. Asphalt
Yes
Divided Traffic
No
No
Yes
Installation Date (MM/YYYY) _____ / _______
3. Asphalt and Timber
4. Concrete
Width _______________
5. Concrete and Rubber
No
Yes
6. Rubber
7. Metal
Length _______________
8. Unconsolidated
9. Composite
10. Other (Specify) _________________________________________________________________
7. Smallest Crossing Angle
6. Intersecting Roadway within 500 feet?
Yes
No
If Yes, Approximate Distance (feet) _____________
0 - 29
30 - 59
8. Is Commercial Power Available?
Yes
60 - 90
No
Part V: Public Highway Information
1. Highway System
2. Functional Classification of Road at Crossing
(01) Interstate
(02) Nat. Hwy System (NHS)
(0) Rural
(1) Urban
Yes
(5) Major Collector
(1) Interstate
4. Highway Speed Limit
3. Is Crossing on State
Highway System?
_____________ MPH
No
Posted
Statutory
(03) Federal Aid, Not NHS
(2) PA-Other Freeway/Expressway
(6) Minor Collector
(3) Principal Arterial - Other
(7) Local Access
(08) Non-Federal Aid
6. LRS Milepost (Optional - 7 char.)
(4) Minor Arterial
7. Estimated Average Daily Traffic
Year ________ ADT ____________
5. Linear Referencing System (LRS Route ID) (Optional - 32 char.)
8. Estimated Percent
9. Regularly Used by School Buses?
Commercial Trucks
_____________ %
Yes
Number per Day ________
10. Regularly used by Hazmat
Vehicles?
Yes
No
11. Regular Emergency
Services Route
Yes
No
This information is not recorded in the database:
Submitted By ____________________
Organization ____________________
Phone________________
Date _________
Public reporting burden for this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. According to the Paperwork Reduction Act of 1995, a federal agency may not conduct or sponsor, and a person is
not required to respond to, nor shall a person be subject to a penalty for failure to comply with, a collection of information unless it displays a currently valid OMB control number. The valid OMB control
number for this information collection is 2130-0017. Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden to: Information
Collection Officer, Federal Railroad Administration, 1200 New Jersey Ave., SE, MS-25, Washington, D.C. 20590.
FORM FRA F 6180.71 (Rev. 10/11)
OMB approval expires x/xx/xxxx
PAGE 2 OF 2
File Type | application/pdf |
File Title | Visio-Form 71 Draft7-Final Updated 20120914.vsd |
Author | DHudock |
File Modified | 2012-10-17 |
File Created | 2012-09-14 |