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

SIGNAL AND SURFACE DETAILS

  • 37. Train Detection Type

  • 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

  • 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

  • 57. FRA Official Cause

  • 58. Date 6180.83 Signed by Railroad

  • 59. Failure Date

  • 60. Failure Time

  • 60a. Time Zone

  • 61. Repair Date

  • 62. Repair Time

  • 62a. Time Zone

INVOLVED TRAIN INFORMATION

  • 63. Train Symbol

  • 64. Train Type

  • 64a. If "Other" Train type

  • 65. Passenger Equipment

  • 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

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