Information
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Audit Title
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Milepost / DOT No.
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Conducted on
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Prepared by
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Location
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Personnel
ACTIVATION FAILURE REPORT
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1. Inspector Name
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2. Inspector No.
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3. Region
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4. AF No.
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5. CCM No.
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6. 96 Report No.
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7. Report Date
INVESTIGATION
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8. FRA Informal Investigation
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9. FRA Formal Investigation
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10. Invalid Report
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11. Accident Occurred
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12. Accident Investigated
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13. Violation (Check if a violation is recommended)
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14. FRA Investigation Date
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15. FRA Accident No.
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16. Violation No.
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17. Railroad 6180.57 No.
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18. Railroad Name
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19. Railroad Code
GRADE CROSSING
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20. DOT Crossing Number
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21. Milepost
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22. City
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23. State
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24. County
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25. Subdivision
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26. Division
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27. Train Direction
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28. Controlled BY
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29. No. Of Tracks
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30. Quiet Zone
RAILROAD TEST / INSPECTION
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31. Monthly
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32. Quarterly
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33. Annual
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34. Relay
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35. Insulation Resistance Test
METHOD(S) OF OPERATION
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36. Method of Operation
- Advanced Train Control System
- Automatic Train Control
- Automatic Train Stop
- Automatic Cab Signals
- Traffic Control
- Interlocking
- Automatic Block Signal
- Current of Traffic
- Time Table / Train Orders
- Track Warrant Control
- Direct Traffic Control
- Yard Limits
- Special Instructions
- Other than Main Track Rules
- Positive Train Control
- Block Register Territory
- Restricted Limits
SIGNAL AND SURFACE DETAILS
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37. Train Detection Type
- AC/DC
- DC
- Harmon AFTAC
- Harmon EMD
- Harmon HXP 1
- Harmon HXP 1 w/CTU
- Harmon HXP 3
- Harmon HXP 3R
- Harmon HXP 3R2
- Harmon MAD
- Harmon PMD 1
- Harmon PMD 2
- Harmon PMD 3R
- Harmon PMD 3R2
- Harmon SXT 1
- Interlocking Relays
- Island Only
- Island Only w/Manual Control
- Loop Detection
- Safetran GCP 300
- Safetran GCP 3000
- Safetran GCP 3000 D2
- Safetran 400
- Safetran 4000
- Safetran MS 2000
- Safetran MS 350
- Safetran MS 585
- Safetran MS 590
- Safetran MS 600
- Wheel Counting
- Other
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37a. If "Other" Train Detection Type in Box 37
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38. Failed Component
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39. MAX Authorized Highway Speed (MPH)
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40. Speed in Area of Crossing
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41. Intersecting Angle
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42. No. Of Highway Lanes
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43. Divided Hwy
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44. Crossing Surface
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45. Side Lights
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46. Four Quadrant Gates
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47. Gates
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48. Flashing Lights
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49. Bell
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50. Hwy Preemption
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51. Wig Wag
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52. Traffic Signal Only
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53. Cantilevers
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54. Interconnected With Another Railroad
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55. Other
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55a. If "Other" Warning Device
CAUSE AND REPAIR
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56. Railroad Reported Cause
- 1a - Power Commercial
- 1b - Power Railroad
- 1c - Power Batteries
- 1d - Power Chargers / Transformers
- 1e - Power Surge
- 1f - Power Lightning (Fuses/Arrestors)
- 1g - Power Loose Connections/Frayed Wire
- 1h - Power Other
- 2a - Rail Rusty
- 2b - Rail Contaminates on Rail
- 2c - Rail Contaminates on Train Wheel
- 2d - Rail Broken Rail
- 2e - Rail Shorted Rail
- 2f - Rail Track Connections
- 2g - Rail Other
- 3a - Equipment Relays
- 3b - Equipment Motion Detector
- 3c - Equipment Constant Warning Time
- 3d - Equipment Other Train Detection
- 3e - Equipment Shunts/Couplers
- 3f - Equipment Crossing Controller
- 3g - Equipment Lamps
- 3h - Equipment Cable, Wiring Harness...
- 3i - Equipment Other
- 4a - Human Factor Interference
- 4b - Human Factor Vandalism
- 4c - Human Factor Design
- 4d - Human Factor Testing
- 4e - Human Factor Maintenance Procedures
- 4f - Human Factor Communications Procedures
- 4g - Human Factor Adjustments
- 4h - Human Factor Other
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57. FRA Official Cause
- 1a - Power Commercial
- 1b - Power Railroad
- 1c - Power Batteries
- 1d - Power Chargers / Transformers
- 1e - Power Surge
- 1f - Power Lightning (Fuses/Arrestors)
- 1g - Power Loose Connections/Frayed Wire
- 1h - Power Other
- 2a - Rail Rusty
- 2b - Rail Contaminates on Rail
- 2c - Rail Contaminates on Train Wheel
- 2d - Rail Broken Rail
- 2e - Rail Shorted Rail
- 2f - Rail Track Connections
- 2g - Rail Other
- 3a - Equipment Relays
- 3b - Equipment Motion Detector
- 3c - Equipment Constant Warning Time
- 3d - Equipment Other Train Detection
- 3e - Equipment Shunts/Couplers
- 3f - Equipment Crossing Controller
- 3g - Equipment Lamps
- 3h - Equipment Cable, Wiring Harness...
- 3i - Equipment Other
- 4a - Human Factor Interference
- 4b - Human Factor Vandalism
- 4c - Human Factor Design
- 4d - Human Factor Testing
- 4e - Human Factor Maintenance Procedures
- 4f - Human Factor Communications Procedures
- 4g - Human Factor Adjustments
- 4h - Human Factor Other
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58. Date 6180.83 Signed by Railroad
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59. Failure Date
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60. Failure Time
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60a. Time Zone
- EST
- EDT
- CST
- CDT
- MST
- MDT
- PST
- PDT
- AKST
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61. Repair Date
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62. Repair Time
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62a. Time Zone
- EST
- EDT
- CST
- CDT
- MST
- MDT
- PST
- PDT
- AKST
INVOLVED TRAIN INFORMATION
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63. Train Symbol
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64. Train Type
- Freight Train
- Passenger Train
- Commuter Train
- Work Train
- Single Car
- Cut of Cars
- Yard/Switching
- Light Loco(s)
- Maintenance/Inspection
- Spec. MoW Equipment
- Other
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64a. If "Other" Train type
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65. Passenger Equipment
- N/A
- Amtrak
- Commuter
- Light Rail
- Push-Pull
- MU
- ACELA
- TALGO
- Tourist\Excursion
- Other
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65a. If "Other" Passenger Equipment
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66. Involved Train Speed (MPH)
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67. Loads
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68. Empties
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69. No. of cars
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70. Length
ADDITIONAL DETAILS
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71. Synopsis
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72. Describe the Circumstances on How the AF was Reported and the Railroad's Action
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73. Description of the Failure and Description of the Cause of Repair
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74. FRA Action Taken
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75. Other Applicable Comments
