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VI (816) 329-3840
Regional Administrator
Federal Railroad Administration
Department of Transportation Building
901 Locust Street - Suite 464
Kansas City, MO 64106
FRA Guide for Preparing Accident/Incident Reports
APPENDIX G – Continued
Appendix G - 2 FRA Regional Offices
REGION OFFICE PHONE
VII (916) 498-6540
Regional Administrator
Federal Railroad Administration
801 I Street - Suite 466
Sacramento, CA 95814
VIII (360) 696-7536
Regional Administrator
Federal Railroad Administration
500 Broadway, Suite 240
Vancouver, WA 98660
FRA HEADQUARTERS
Office of Safety Analysis (RRS-22) (202) 493-6287
Federal Railroad Administration
U.S. Department of Transportation
West Building 3rd Floor, Room W33-437
1200 New Jersey Avenue, SE
Washington, DC 20590
For updates to FRA Regional Offices, Contact Information, refer to: www.fra.dot.gov/us/content/3, and
click on "regional offices".
FRA Guide for Preparing Accident/Incident Reports
Appendix H - 1 Forms
APPENDIX H
Forms
Form FRA F 6180.54 Rail Equipment Accident/Incident Report
Form FRA F 6180.55 Railroad Injury and Illness Summary
Form FRA F 6180.55a Railroad Injury and Illness Summary
(Continuation Sheet)
Form FRA F 6180.56 Annual Railroad Report of Employee Hours and
Casualties, by State
Form FRA F 6180.57 Highway-Rail Grade Crossing Accident/Incident
Report
Form FRA F 6180.78 Notice to Railroad Employee Involved in Rail
Equipment Accident/Incident Attributed to Employee
Human Factor
Employee Statement Supplementing Railroad Accident
Report
Form FRA F 6180.81 Employee Human Factor Attachment
Form FRA F 6180.97 Initial Rail Equipment Accident/Incident Record
Form FRA F 6180.98 Railroad Employee Injury and/or Illness Record
Form FRA F 6180.107 Alternative Record for Illnesses Claimed to be
Work-Related
Form FRA F 6180.150 Highway User Injury Inquiry Form
1. Name of Reporting Railroad 1b. Railroad Accident/Incident No.
3. Name of Railroad or Other Entity Responsible for Track Maintenance (single entry)
7. Type of Accident/
Incident (single
entry in code box)
8. Cars Carrying
HAZMAT
14. Milepost (to
nearest tenth)
9. HAZMAT Cars
Damaged/Derailed
Code
17. Temperature (F)
(Specify if minus)
1a. Alphabetic Code
18. Visibility (single entry)
2b. Railroad Accident/Incident No. 2. Name of Other Railroad or Other Entity with Consist Involved 2a. Alphabetic Code
3a. Alphabetic Code 3b. Railroad Accident/Incident No.
4. U.S. DOT Grade Crossing Identification Number 5. Date of Accident/Incident 6. Time of Accident/Incident
AM PM month day year
1. Derailment
2. Head on collision
3. Rear end collision
4. Side Collision
5. Raking collision
6. Broken train collision
7. Hwy-rail crossing
8. RR grade crossing
9. Obstruction
10. Explosion-detonation
11. Fire/violent rupture
12. Other impacts
13. Other
(describe in
narrative)
10. Cars Releasing
HAZMAT
11. People
Evacuated
12. Subdivision
13. Nearest City/Town 15. State
Abbr.
16. County
o
F 1. Dawn 3. Dusk
2. Day 4. Dark
Code 19. Weather (single entry)