FRA F 6180.96 Inspection Report

DEPARTMENT OF TRANSPORTATION

INSPECTION REPORT

FEDERAL RAILROAD ADMINISTRATION (FRA)

Inspector's Name

Inspector's Signature

OMB No. 2130-0509

Inspector's ID No.

Date

Report No.
yyyy

R/C

Railroad/Company Name & Address

Division

mm

dd

RR/Co. Representative (Receipt Acknowledged)
Name

RR/Co.
Code

Subdivision

Title
Signature

From:
City

Codes

Codes

Destination City & County

From Latitude:

State

City

From Longitude:

County

County

To Latitude:

Mile Post:

From ______________ To ______________

Inspection Point:

To Longitude:

Activity
Code:
Units:

Item

Initials/Milepost

Equipment/Track #

Type/Kind

49 CFR/USC

Defect Code

Subrule

Speed

Class

Train #/Site

SNFR *

RCL ** # of Occ. ***

Activity Code

Description

Latitude:

Violation Recommended

Yes

No

Written Notification to
FRA of Remedial Action is:

Required

Optional

Item

Initials/Milepost

Equipment/Track #

Type/Kind

Railroad
Action Code

49 CFR/USC

Defect Code

Subrule

Longitude:
Date (mm/dd/yyyy)
Speed

Class

Train #/Site

____/____/____
SNFR *

Comments on back?

RCL ** # of Occ. ***

Activity Code

Description

Latitude:

Violation Recommended

Yes

No

Written Notification to
FRA of Remedial Action is:

Required

Optional

Item

Initials/Milepost

Equipment/Track #

Type/Kind

Railroad
Action Code

49 CFR/USC

Defect Code

Subrule

Longitude:
Date (mm/dd/yyyy)
Speed

Class

Train #/Site

____/____/____
SNFR *

Comments on back?

RCL ** # of Occ. ***

Activity Code

Description

Latitude:

Violation Recommended

Yes

No

Written Notification to
FRA of Remedial Action is:

Required

Optional

Source Code

File Number

Railroad
Action Code

Longitude:
Date (mm/dd/yyyy)

____/____/____

Comments on back?

I.D.(s) of Accompanying Inspector(s)
_______, _______, _______, _______, _______, _______, _______, _______, _______, _______

Activity Code
Activity Code Hours
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 2130-0509. All responses to this collection of information are mandatory. 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 Avenue, SE, Washington, D.C. 20590.
* SNFR - Special Notice for Repairs

Form FRA F 6180.96 (Revised 10/02)

FRA COPY

OMB approval expires 01/31/2019

** RCL - Remote Control Locomotive

*** # of Occ. - Number of Occurrences

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