Information
-
Audit Title
-
Milepost / DOT No.
-
Conducted on
-
Prepared by
-
Location
-
Personnel
ACTIVATION FAILURE REPORT
-
1. Inspector Name
-
2. Inspector No.
-
3. Region
-
4. AF No.
-
5. CCM No.
-
6. 96 Report No.
-
7. Report Date
INVESTIGATION
-
8. FRA Informal Investigation
-
9. FRA Formal Investigation
-
10. Invalid Report
-
11. Accident Occurred
-
12. Accident Investigated
-
13. Violation (Check if a violation is recommended)
-
14. FRA Investigation Date
-
15. FRA Accident No.
-
16. Violation No.
-
17. Railroad 6180.57 No.
-
18. Railroad Name
-
19. Railroad Code
GRADE CROSSING
-
20. DOT Crossing Number
-
21. Milepost
-
22. City
-
23. State
-
24. County
-
25. Subdivision
-
26. Division
-
27. Train Direction
-
28. Controlled BY
-
29. No. Of Tracks
-
30. Quiet Zone
RAILROAD TEST / INSPECTION
-
31. Monthly
-
32. Quarterly
-
33. Annual
-
34. Relay
-
35. Insulation Resistance Test
METHOD(S) OF OPERATION
-
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
-
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
-
37a. If "Other" Train Detection Type in Box 37
-
38. Failed Component
-
39. MAX Authorized Highway Speed (MPH)
-
40. Speed in Area of Crossing
-
41. Intersecting Angle
-
42. No. Of Highway Lanes
-
43. Divided Hwy
-
44. Crossing Surface
- Asphalt
- Asphalt / Timber
- Concrete
- Gravel
- Rubber
- Wood
- Other
-
44a. If "Other" Crossing Surface in Box 44
-
45. Side Lights
-
46. Four Quadrant Gates
-
47. Gates
-
48. Flashing Lights
-
49. Bell
-
50. Hwy Preemption
-
51. Wig Wag
-
52. Traffic Signal Only
-
53. Cantilevers
-
54. Interconnected With Another Railroad
-
55. Other
-
55a. If "Other" Warning Device
CAUSE AND REPAIR
-
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
-
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
-
58. Date 6180.83 Signed by Railroad
-
59. Failure Date
-
60. Failure Time
-
60a. Time Zone
- EST
- EDT
- CST
- CDT
- MST
- MDT
- PST
- PDT
- AKST
-
61. Repair Date
-
62. Repair Time
-
62a. Time Zone
- EST
- EDT
- CST
- CDT
- MST
- MDT
- PST
- PDT
- AKST
INVOLVED TRAIN INFORMATION
-
63. Train Symbol
-
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
-
64a. If "Other" Train type
-
65. Passenger Equipment
- N/A
- Amtrak
- Commuter
- Light Rail
- Push-Pull
- MU
- ACELA
- TALGO
- Tourist\Excursion
- Other
-
65a. If "Other" Passenger Equipment
-
66. Involved Train Speed (MPH)
-
67. Loads
-
68. Empties
-
69. No. of cars
-
70. Length
ADDITIONAL DETAILS
-
71. Synopsis
-
72. Describe the Circumstances on How the AF was Reported and the Railroad's Action
-
73. Description of the Failure and Description of the Cause of Repair
-
74. FRA Action Taken
-
75. Other Applicable Comments
