Form FRAF6180.83 Highway-Rail Grade Crossing Warning System Activation Fa

HIGHWAY-RAIL GRADE CROSSING WARNING SYSTEM ACTIVATION FAILURE REPORT
OMB Approval No.: 2130-0534
Public reporting burden for this information collection is estimated to average 10 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 2130-0534. 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 Ave., S.E., Washington D.C. 20590.

Each railroad shall submit a report of each activation failure to FRA within 15 days after the failure occurs. Copies of this form may be obtained from
the Federal Railroad Administration's web site at www.fra.dot.gov
An activation failure means the failure of an active highway-rail grade crossing warning system to indicate the approach of a train at least 20 seconds prior to the
train's arrival at the crossing, or to indicate the presence of a train occupying the crossing, unless the crossing is provided with an alternative means of active
warning to highway users of approaching trains. (This failure indicates to the motorist that it is safe to proceed across the railroad tracks when, in fact, it is not safe
to do so.)
A train means one or more locomotives, with or without cars.
Name of Railroad

Mail to:

RR Code

Region/Division (Optional)

Federal Railroad Administration
Regional Administrator

Reporting Employee (Signature/Title)

Date Signed

DOT Crossing Number

Yes

Accident/Incident Involved?

No

(Defined in 49 CFR Section 225.5)

CLASSIFICATION
Current Active Warning Devices (Check all that apply)
1

Gates

7

Other (Describe)

2

3

Cantilevered Flashing Lights

4

Flashing Lights

Wig Wags

5

6

Hwy. Traffic Signals

Bell

LOCATION
Street/Road

County/Parish

City

State

RR Mile Post

CORRECTIVE ACTION
Failure Reported/Discovered
Date (mm/dd/yy)

Repairs Completed
Time

Date (mm/dd/yy)
AM

Cause of Failure Codes (Primary & Secondary Required)
1 Power
a Commercial
b Railroad
c Batteries
d Chargers/Transformers
e Power Surge
f Lightning (Fuses, Arresters)
g Loose Connections/Frayed Wires
h Other

3 Equipment
a Relays
b Motion Detector
c Constant Warning Time Device
d Other Train Detection (e.g. AFO)
e Shunts/Couplers
f Crossing Controller
g Lamps
h Cable, Wiring Harness, or Grounds
i Other

2 Rail
a Rusty
b Contaminants on Rail
c Contaminants on Train Wheels
d Broken Rail
e Shorted Rail
f Track Connections
g Other

4 Human Factor
a Interference
b Vandalism
c Design
d Testing
e Maintenance Procedures
f Communications Procedures
g Adjustments
h Other

FRA F 6180.83 Rev: 01/17/2017

Time

PM

AM
Provide a Brief Explanation of Failure:

OMB approval expires 01/31/2020

PM