State of Louisiana by iOqX2NNn

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                             Louisiana Uniform Crash Report – Form 3112
                                                                                                                      75


                                                 State of Louisiana
                                     Uniform Motor Vehicle Traffic Crash Report
                                                    DPSSP 3112
                                     Railroad Grade Crossing Crash Supplement

The Railroad Grade Crossing Crash Supplement is provided to report additional data for crashes involving a motor
vehicle and a railroad train, AT A PUBLIC CROSSING. It is also used for a crash involving a streetcar and a motor
vehicle, as well as a streetcar and a pedestrian. THIS FORM IS USED AS A SUPPLEMENT to the DPSSP 3105
Uniform Motor Vehicle Traffic Crash Report, NOT IN PLACE OF IT.

NOTE: Mark the appropriate block at the top of the form to indicate whether the form is being used to document a
crash involving a railroad train or a streetcar.

Copy the (58) Pre-printed Computer Number onto the             156. Set of Tracks
supplement form from page one of the crash report.
                                                               Enter the number of complete sets of tracks at the
59. Page Number                                                crossing.
Enter the next consecutive page number.                        157. Track Speed Limit
60. Local Agency Use                                           Enter the maximum track speed limit in effect at the time
                                                               of the crash. This information may be posted by signage
(See item A., page 3)
                                                               or obtained from the railroad or streetcar company.
152. Train
                                                               158. Train in Motion
Check here if crash involves a railroad train.
                                                               Mark a Y for Yes or an N for No to indicate whether the
153. Streetcar                                                 train was in motion at the time of the crash.
Check here if crash involves a streetcar.                      159. Crossing Type
154. DOT Crossing Number                                       Mark an X in the appropriate data block to identify
                                                               whether the roadways leading up to the grade crossing
Each grade crossing is assigned a unique identification        were publicly or privately owned.
number composed of six digits and one letter. This
number is usually attached to the signal mast or painted       160. Surface
on nearby railroad fixed equipment. If the number is not
                                                               Enter the letter from the choices provided that best
readily visible at the crossing, a representative of the
                                                               describes the roadway surface at the crossing.
railroad company or the Louisiana Department of
Transportation and Development can help obtain the             161. Estimated Speed of Train Before Braking
number. The Railroad Unit telephone number is 225-379-
                                                               Based on physical evidence, including data recorder
1573. It is MANDATORY that this number be entered.
                                                               information, as well as witness statements, you should
    NOTE: If the Streetcar block is marked, DO NOT             enter the estimated speed of the train before any braking
    enter a DOT crossing number.                               attempts to avoid collision were employed.
155. Train ID Number/Consist Number                            162. Company Operating RR Train or Street Car
Enter the Train ID Number found on the number boards           Enter the Name, Address, City, State and Zip Code of
of the lead locomotive. In lieu of this number, the            the company that is operating the train or streetcar using
Consist Number is a unique number assigned to a                the procedures and format previously described in this
particular train on a specific trip by the railroad company.   manual.
This number may be obtained from a railroad
                                                               163. Company Owning Tracks
crewmember. If the locomotive has no ID number posted
on the number boards, the consist number should be used        Enter the Name, Address, City, State and Zip Code of
in this data section. The engineer should be able to           the company that owns the railroad tracks using the
provide this information. Streetcars may not have an ID        procedures and format previously described in this
or consist number available. If this is the case, the          manual. If the company operating the train is the same
investigating officer should enter “Not Available” or          company that owns the tracks, enter “Same” in the first
“N/A” in the spaces provided.                                  four data blocks of this section.




                                  Louisiana Uniform Crash Report – Form DPSSP 3112
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             175                                                              140




Entries 140 through 175 are shown on page 73.




                           Louisiana Uniform Crash Report – Form 3112
                                                                                                                          77


164. Engineer’s Name, Address, Date of Birth, and
Personal and Injury Information
                                                               171. YES/NO Boxes
Enter the requested information for the engineer of the
                                                               For the following mandatory warning devices on the train,
train, using the format previously outlined in this manual.
                                                               you should mark a Y for Yes or an N for No to answer the
It is NOT necessary to ask for the engineer’s motor
                                                               questions:
vehicle driver’s license.
                                                                   Headlight Functional
                                                                   Ditch Lights Functional
165. Engineer’s Certification Number
                                                                   Horn Functional
Enter this number in the appropriate data block. Note:
DO NOT enter the motor vehicle driver’s license number             Bell Functional
of the engineer.
                                                                   Event Data Recorder Equipped
                                                               172. Data Recorder Speed
166. Conductor’s Name, Address, Date of Birth, and
                                                               If able to determine the speed of the train from the Data
Personal and Injury Information
                                                               Recorder, enter this speed in the appropriate set of blocks.
Enter the requested information for the conductor of the       If the Speed Results are Pending, then mark a Y for Yes
train, using the format previously outlined in this manual.    and leave the Data Recorder Speed block blank.
It is NOT necessary to ask for the conductor’s driver’s
license.
    NOTE: Additional occupants of the train/streetcar          173. Side Impact
    should be listed on the DPSSP 3108 Additional              Information in this data section should be completed
    Occupant Supplement. The train’s manifest may be           ONLY if the crash involved the highway user colliding
    a source document for this information.                    with the side of the train or the train backing into a
                                                               highway user on the crossing.
167. Warning Devices, Advance Warning Devices and
Active Warning Devices Functional                              174. Impact Information
Mark an “X” in the data blocks provided to indicate            Mark a “Y” for Yes or an “N” for No to indicate whether
which warning devices were in place at the crossing and        this crash involved a side impact. Enter the appropriate
their operating condition. You should mark all the blocks      information to document the No. of Cars from Lead
that apply.                                                    Engine, Type Railcar Struck and the Railcar Number
                                                               of the Struck Railcar.
168. Highway User
Enter the letter in the data block that best describes the     175. Hazardous Materials
movement of the highway user at the time of the crash. If      Mark a “Y” for Yes or an “N” for No to indicate whether
the crash involved a train or streetcar and a pedestrian,      the railcar struck was carrying Hazardous Materials. If
this block should be left blank.                               yes, then enter the four-digit identification number in the
                                                               blocks labeled DOT Placard #. Also mark a “Y” for Yes
169. Train Information
                                                               or an “N” for No in the blocks labeled Car Loaded and
Enter the Make, Type, Lead Engine # and Serial                 Leaking.
Number of the lead engine in the train consist. Further,
enter the total Number of Engines and Number of Cars           140. Investigating Officer’s Initial
in the consist. This information can be gathered with the      The lead investigator who signed on page #1 should
help of a railroad company representative.                     initial this and all additional forms that are attached to the
                                                               original report.
170. Distance Traveled after Impact
Document the distance the train traveled after impact. If
the engineer applied significant braking and immediately
brought the train to a stop, enter the distance in the data
blank provided. Indicate the distance in feet or tenths of a
mile. If the engineer did not immediately bring the train
to a stop but continued to the next crossing or station,
enter “moved” in the blank provided.



                                 Louisiana Uniform Crash Report – Form DPSSP 3112
78


                                             References


     1.   Manual on Classification of Motor Vehicle Traffic Accidents (ANSI D161 – 1996), 1996,
          American National Standards Institute, Itasca, Illinois 60143-3201.

     2.   Guideline for Minimum Uniform Crash Criteria (MUCC), Second Edition 2003, National
          Association of Governors Highway Safety Representatives, National Highway Traffic Safety
          Administration, Washington. D.C. 20590, http://www-nrd.nhtsa.dot.gov/pdf/nrd-
          30/NCSA/MMUCC/.

     3.   Data Element Dictionary (ANSI D20.1 – 1979), 1980, American National Standards Institute,
          Itasca, Illinois 60143-3201.

     4.   Forms for Accident / Incident Recordkeeping and Reporting (DOT/FRA/RRS-22), 1997, Federal
          Railroad Administration, Washington, D.C. 20590.

     5.   The Traffic Collision Investigation Manual (Volume 1), 2001, Northwestern University Center
          for Public Safety, Evanston, Illinois 60204.




                              Louisiana Uniform Crash Report – Form 3112

								
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