FRA F 3 Annual Inspection Report

OMB No. 2130-0505

Form No. 3

Annual Inspection Report

Date of
Owner __________________________
Inspection ____________ Operator ________________________

Locomotive Initials ______________
Locomotive No. ________________

Instructions: Non-complying conditions shall be repaired and this report approved before locomotive is returned to service. Where condition is called for, enter either: (1) Good – No defects
which could be discovered by a reasonable inspection; (2) Fair – Functioning less than optimally but safe and suitable and not in violation of the regulations; or (3) Poor – Not in compliance with
the regulations. In any case N/A means – not applicable.

Boiler hydrostatically tested to ___________ psi, at a water temperature of ______________ degrees F.
Was boiler washed? __________
Were steam gauge siphon pipe(s) cleaned? ____________
Were water gauge and valve passages cleaned? _________
Were steam leaks repaired? ___________
Were gauge cock passages cleaned? __________
Were tubular water glasses renewed? ___________
Were all washout plugs removed and inspected? __________
Were fusible plugs removed, cleaned & inspected? ______
Were arch tubes, circulators, siphons and water bar tubes
Flexi caps removed on (date) ___________
cleaned and inspected? _______________________
Were all air brake gauges tested? ___________
Thickness of arch tubes ________; Water bar tubes _______
Main reservoir hydro ________ psi, hammer ________
Dry pipe thickness________; Circulator thickness _________
NDE ________, Drilled __________
Were water column passages cleaned and inspected? ______
Were brake cylinders tested for leakage? ___________
Was boiler entered and inspected? _____________________
Was main reservoir tested for leakage? ___________
Were drilled flexible staybolt telltale holes tested? ________
Were air compressor(s) orifice tested? ___________
Were staybolts hammer tested? __________
Condition of driving gear. ___________
Were all broken staybolts replaced? __________
Condition of running gear. ___________
Were longitudinal lap seams inspected? __________
Condition of draft system and draw gear. ___________
Was smoke box entered and inspected? _________
Condition of spring/equalizing system. ___________
Safety relief valves pop at _____ psi _____ psi _____ psi
Condition of brake equipment. ___________
Were injectors tested and in good condition? __________
Condition of tender running gear. ___________
Was feedwater pump tested and in good condition? __________ Was tender tank entered and inspected? ___________
Were all steam gauges tested? __________
_______________________________________________
INSPECTOR

The above work has been performed and the report is
approved. ___________________________________
OFFICER IN CHARGE

_______________________________________________
INSPECTOR

Locomotive Air Brake Cleaning, Testing and Inspection Record
EQUIPMENT

SERVICE
PERIOD

AIR COMPRESSOR
ORIFICE TEST

92 service day

AIR GAUGES

92 service day

MAIN RESERVOIR
LEAKAGE

92 service day

BRAKE CYLINDER
LEAKAGE

92 service day

FILTERS

Annual
Inspection

DIRT COLLECTORS

Annual
Inspection

MAIN RESERVOIR
HYDRO, HAMMER, NDE

Annual
Inspection

BRAKE VALVES

368 service days
or second

Previous
Inspection

Current
Annual
Date

Inspection
Date

Inspection
Date

Inspection
Date

Inspection
Date

Notes

Public reporting burden for this information collection is estimated to average 30 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 2130-0505. 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.

FRA Form No. 3

(01/09)

Expires 09/39/2021