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HIGHWAY -RAIL GRADE CROSSING <br />DEPARTMENT OF TRANSPORTATION ACCIDENT /INCI DENT REPORT <br />FEDERAL RAILROAD ADMINISTRATION (FRA) OMB Approval No 2130 -0500 <br />Name Of <br />Alphabetic Code <br />RR AccidenVlncident No <br />1. Reporting Railroad Amtrak ATK <br />1a. ATK <br />1b. 010579A <br />2. Other Railroad Involved in Train Accident/incident Atchison Topeka & Santa Fe Rvvy Co. ATSE <br />2a ATSE <br />2b. 31019102 <br />3. Railroad Responsible for Track Maintenance Atchison Topeka & Santa Fe Rwy Co. ATSE <br />3a. ATSE <br />3b. 31019102 <br />4. U.S. DOT -AAR Grade Crossing ID No 026702V <br />15 . Date of Accident/ lncident 01/05/79 <br />6. Time of AccidenVlncident 09:15 AM <br />7. Nearest Railroad Station <br />8. Division <br />9. County <br />10. State <br />Code <br />SANTA ANNA <br />ORANGE <br />Abbr. 06 <br />CA <br />11. City (if in a city) SANTA ANNA <br />12. Highway Name or No SANTA ANNA BLVD ❑✓ Public �Pnvete <br />Highway User Involved <br />Rail Equipment Involved <br />13. Type C Truck - trailer F. Bus J. Other Motor Vehicle Code <br />17. Equipment 4. Car(s) (moving) 8. Other (specify) <br />Code <br />1. Train (unitspulling) 5. Car(s) (standing) A. Train pulling- RCL <br />A. Auto D. Pick -up truck G. School Bus K. Pedestrian <br />2. Train (unitspushing) 6. Light loco(s) (moving) B. Train pushing- RCL <br />A <br />1 <br />B. Truck E. Van H. Motorcycle M. Other (specify) <br />3. Train (standing) 7. Light loco(s) (standing) C Train standing- RCL <br />14. Vehicle Speed <br />15. Direction (geographical) Code <br />18. Position of Car Unit in Train <br />(est mph at impact) 25 <br />1. North 2. South 3. East 4. West 1 1 <br />2 <br />16. Position 1. Stalled on crossing 3. Moving over crossing Code <br />19. Circumstance 1. Rail equipment struck highway user <br />Code <br />2. Stopped on Crossing 4. Trapped 1 3 <br />2. Rail equipment struck by highway user <br />2 <br />20a. Was the highway user and /or rail equipment involved Code <br />20b. Was there a hazardous materials release by <br />Code <br />in the impact transporting hazardous materials? <br />1. Highway User 2. Rail Equipment 3. Both 4. Neither 4 <br />1. Highway User 2. Rail Equipment 3. Both 4. Neither <br />20c. State the name and quantity of the hazardous materials released, if any <br />21. Temperature <br />22. Visibility (single entry) Code <br />23. Weather (single entry) <br />Code <br />(specify ifminus) 49 'F <br />1. Dawn 2. Day 3. Dusk 4. Dark 1 2 <br />1. Clear 2. Cloudy 3. Rain 4. Fog 5. Sleet 6. Snow <br />2 <br />24. Type of Equipment A. Spec. MoW Equip <br />25. Track Type Used by Rail Code <br />26. Track Number or Name <br />Consist 1. Freight train 4. Work train 7. Yard /Switching <br />Equipment Involved <br />(single entry) 2. Passenger train 5. Single car 8. Light loco(s) Code <br />3. Commuter train 6. Cut of cars 9. Main /inspect car 1 2 <br />1. Main 2. Yard 3. Siding 4. Industry 1 <br />MAIN <br />27. FRA Track <br />28. Number of <br />29. Number of <br />30. Consist Speed (Recorded if available) Code <br />31. Time Table Direction <br />Code <br />Class <br />Locomotive <br />Cars <br />R. Recorded <br />2 <br />Units 1 <br />4 <br />E. Estimated 40 mph E <br />1. North 2. South 3. East 4. West <br />3 <br />32. Type of 1. Gates 4. Wig wags 7 Crossbucks 10. Flagged by crew <br />33. Signaled Crossing <br />34. Whistle Ban <br />Code <br />Crossing 2. Cantilever FLS 5. Hwy traffic signals 8. Stop signs 11. Other (specify) <br />Warning <br />1. Yes <br />Warning 3. Standard FLS 6. Audible 9. Watchman 12. None <br />20 see warn min (1); <br />2. No <br />3. Unknown <br />Code(s) 1 01 1 <br />35. Location of Warning Code <br />36. Crossing Warning Interconnected Code <br />37. Crossing Illuminated by Street <br />Code <br />1. Both Sides <br />with Highway Signals <br />Lights or Special Lights <br />2. Side of Vehicle Approach 1 <br />2 <br />2 <br />3. O osite Side of Vehicle A roach <br />1. Yes 2. No 3. Unknown <br />1. Yes 2. No 3. Unknown <br />38. Driver's <br />39. Driver's Code <br />40. Driver Drove Behind or in Front of Train Code <br />41. Driver <br />Code <br />Age <br />Gender <br />and Struck or was Struck by Second Train <br />1. Drove around or thru the gate 4. Stopped on crossing <br />1. Male <br />1. Yes 2. No 3. Unknown <br />2. Stopped and then proceeded 5. Other (specify) <br />1 <br />2 <br />1 <br />1 <br />2. Female <br />3. Did not stop <br />42. Driver Passed Standing Code <br />43. View of Track Obscured by (primary obstruction) <br />Code <br />Highway Vehicle <br />1. Permanent Structure 3. Passing Train 5. Vegetation 7. Other (specify) <br />1. Yes 2. No 3. Unknown 2 <br />2. Standing railroad equipment 4. Topography 6. Highway Vehicles 8. Not Obstructed <br />8 <br />44. Driver was Code <br />45. Was Driver in the Vehicle? <br />Code <br />Casualties to <br />Killed <br />Injured <br />1. Killed 2. Injured 3. Uninjured <br />1. Yes 2. No <br />3 <br />1 <br />47. Highway Vehicle Property Damage <br />48. Total Number of Highway -Rail Crossing <br />Users <br />46. Highway -Rail Crossing Users <br />0 <br />0 <br />(est dollar damage) $900 <br />(include driver) 1 <br />49. Railroad Employees <br />0 <br />0 <br />50. Total Number of People on Train <br />(include passengers and crew) <br />51. Is a Rail Equipment Accident / <br />Incident Report Being Filed <br />Code <br />52. Passengers on Train <br />0 <br />0 <br />1. Yes 2. No <br />1 <br />53a. Special Study Block 53b. Special Study Block <br />54. Narrative Description <br />55. Typed Name and Title <br />56. Signature 57. Date <br />FORM FRA F 6180.57 * NOTE THAT ALL CASUALTIES MUST BE REPORTED ON FORM FRA F 6180.55A <br />19E -40 <br />