Form FRAF6180.83 Highway-Rail Grade Crossing Warning System Activation Fa

HIGHWAY-RAIL GRADE CROSSING WARNING SYSTEM ACTIVATION FAILURE REPORT
DEPARTMENT OF TRANSPORTATION

OMB No. 2130-0534

FEDERAL RAILROAD ADMINISTRATION (FRA)

Each railroad shall submit a report of each activation failure to FRA within 15 days after the failure occurs. Copies of this form may be obtained
from the Federal Railroad Administration, Office of Safety, 1120 Vermont Avenue, N.W., Stop 25, Washington, DC 20590.
An activation failure means the failure of an active highway-rail grade crossing warning system to indicate the approach of a train at least 20
seconds prior to the train’s arrival at the crossing, or to indicate the presence of a train occupying the crossing, unless the crossing is provided with
an alternative means of active warning to highway users of approaching trains. (This failure indicates to the motorist that it is safe to proceed across
the railroad tracks when, in fact, it is not safe to do so.)
A train means one or more locomotives, with or without cars.
Name of Railroad

Mail to:
Federal Railroad Administration
Regional Administrator

RR Code

Region/Division (Optional)
Reporting Employee (Signature/Title)

Date Signed

DOT/AAR Crossing Number

CLASSIFICATION
Current Active Warning Devices (Check all that apply)
1

Gates

2

Cantilevered Flashing Lights

7

Other (Describe)

3

Flashing Lights

4

Wig Wags

5

Hwy. Traffic Signals

6

Bell

LOCATION
Street/Road

City

County/Parish

State

RR Mile Post

CORRECTIVE ACTION
Repairs Completed

Failure Reported/Discovered
Date (mm/dd/yy)

Date (mm/dd/yy)

Time
AM

Cause of Failure Code
01
02
03
04
05
06
07
08
09
10
11
12
13
14

PM

Time
AM

PM

Comments if Applicable:

Sand, Rust, or Other Deposit On Rail
Failure of Relay
Crosses, Grounds, Foreign Current, or Open Circuits
Apparatus Broken, Defective, or Out of Adjustment
Lightning / Power Surge
Vandalism
Errors in Connections or Adjustments
Design Error
Directional Lockout of Stick Circuit or Interlocking Relay
Commercial Power Failure
Railroad Power Failure (Primary Battery or RR Power Lines)
Failure of Electronic Device
Interference
Other, Miscellaneous (Please explain in comments section.)

This collection of information is mandatory under 49 CFR 234, and is used by FRA to monitor activation failures of highway-rail grade crossing warning systems
throughout the country. Public reporting burden is estimated to average 15 minutes 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 2130-0534.

FORM FRA F 6180.83 (Rev. 04/98)

OMB approval expires 09/30/2006