Form FRA F 6180.57 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
J. Other motor vehicle
K. Pedestrian
M. Other (specify)

F. Bus
G. School bus
H. Motorcycle

Code

14. Vehicle Speed
15. Direction (geographical)
(est. mph
1. North 2. South 3. East 4. West
at impact)
16. Position 1. Stalled or stuck on crossing 4. Trapped on crossing by traffic
2. Stopped on crossing
3. Moving over crossing

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

Code

18. Position of Car Unit in Train

Code

19. Circumstance

5. Blocked on crossing by gates

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

2. Rail equipment

3. Both

Public

Code

Private

Rail Equipment Involved

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

PM

10. State
Abbr.

9. County

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
EMU Locomotive(s)
DMU Locomotive(s)

Code

Code

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

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. EMU

A. Spec. MoW Equip.

E. DMU

Code

3. Commuter Train-Pulling 7. Yard/switching B. Passenger Train-Pushing
8. Light loco(s)

4. Work train

1. Gates
2. Cantilever FLS
3. Standard FLS

29. Number
of Cars

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

Code

3. Rain

4. Fog

2. Yard

3. Siding

5. Sleet

4. Industry

Code

31. Time Table Direction
1. North
2. South

Code

(See reverse side for
instructions and codes)

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
38. Highway
User's
Age

39. Highway User's Gender
1. Male
2. Female

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

Code

40. Highway User Went Behind or in Front of Train
and Struck or was Struck by Second Train Code
1. Yes

2. No

3. Unknown

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

Code

44. Driver was
Killed

Casualties to:

Injured

46. Highway-Rail Crossing Users

1. Killed

41. Highway User
1.
2.
3.
4.

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

3. Uninjured

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

49. Railroad Employees

54. Narrative Description

5. Other (specify)
6. Went around/thru
temporary barricade
(if yes, see instructions)
7. Went thru the gate
8. Suicide/Attempted suicide

Yes
Yes

51. Is a Rail Equipment Accident/
Incident Report Being Filed?
2. No

(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. 08/10)

Code

48. Total Number of Vehicle Occupants
(including driver)

53b. Special Study Block

No
No

Code

7. Other (specify)
8. Not obstructed

1. Yes
Video Taken?
Video Used?

Code

Code

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

52. Passengers on Train
53a. Special Study Block

Dry
Wet
Snow/slush
Ice
Sand, Mud, Dirt, Oil, Gravel
Water (Standing, Moving)

Code
5. Vegetation
6. Highway vehicles
Code

2. Injured

A.
B.
C.
D.
E.
F.

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

Code

Code

3. East
4. West

34. Roadway Conditions

33. Signaled Crossing Warning

Code(s)
35. Location of Warning

6. Snow

26. Track Number or Name

Code

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
1. Main

C. Commuter Train-Pushing

28. Number of
Locomotive Units

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

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

OMB approved 6/6/2018, Approval expires 6/30/2021

Code

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. 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.