Form Fra F 6180 55A PDF Details

In the realm of railroad operations, maintaining comprehensive and accurate records of injuries and illnesses is paramount for ensuring workplace safety and regulatory compliance. The Department of Transportation's Federal Railroad Administration (FRA) mandates the use of the FRA F 6180 55A form, known as the Railroad Injury and Illness Summary Sheet Continuation Sheet, to meticulously document such incidents. This form serves as a critical tool for the reporting railroad to compile detailed reports on every injury and illness occurring within its operations. It captures a wide array of information, including the reporting railroad's name and code, the month and year of the report, and detailed specifics about each accident or illness such as the numbers, types, and outcomes. Additionally, it includes data on drug and alcohol testing, days away from work, and even optional geographical coordinates of the incident location. The narrative section allows for a brief description of the circumstances surrounding each event. Importantly, the form is designated under OMB Approval No. 2130-0500 and is a component of the railroad's accident report, which is protected under 49 U.S.C. 20903, ensuring that these reports are not used adversely in litigation or for other damages related to reported incidents. This multi-faceted approach to documentation underscores the federal commitment to both transparency and privacy, enhancing safety oversight while safeguarding against the misuse of sensitive information.

QuestionAnswer
Form NameForm Fra F 6180 55A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesfra form 6180 55 fillable, fra 6180 55a form fillable, fra 6180 55, fra form 6180 55 address

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DEPARTMENT OF TRANSPORTATION RAILROAD INJURY AND ILLNESS SUMMARY

 

 

 

 

 

 

SHEET ____ OF ____

FEDERAL RAILROAD ADMINISTRATION (FRA)

 

 

 

 

 

(Continuation Sheet)

 

 

 

 

 

 

 

OMB Approval No.: 2130-0500

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Name of Reporting Railroad

 

 

 

 

 

 

 

 

 

 

 

2. Alphabetic Code

 

3. Report Month

 

 

4. Report Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5a.

 

 

5b.

5c.

 

5d.

 

 

 

 

 

 

 

 

 

 

 

5e.

 

5f.

 

5g.

Accident/Injury Number

Day

Time

 

County

 

 

 

 

 

 

 

 

 

 

 

State

 

Type

 

Age

 

 

 

 

of Day

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Person/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Job Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5h.

 

5i.

5j.

 

5k.

 

5l.

 

5m.

 

 

5n.

5o.

 

5p.

5q.

 

 

5r.

Drug/

 

Injury

Physical

 

Location

 

Event

 

Result

 

 

Cause

Number of

 

Number of

Exposure to

Special Case

Alcohol Test

Illness

Act

 

 

 

 

 

 

 

 

 

 

 

Days Away

 

Days

Hazmat

 

 

Codes

A

D

Code

 

 

 

 

 

 

 

 

 

 

 

 

From Work

 

Restricted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5s. Latitude (optional)

 

 

 

 

 

 

 

 

5t.

Longitude (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5u. Narrative (Up to 250 Characters)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5a.

 

 

5b.

5c.

 

5d.

 

 

 

 

 

 

 

 

 

 

 

5e.

 

5f.

 

5g.

Accident/Injury Number

Day

Time

 

County

 

 

 

 

 

 

 

 

 

 

 

State

 

Type

 

Age

 

 

 

 

of Day

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Person/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Job Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5h.

 

5i.

5j.

 

5k.

 

5l.

 

5m.

 

 

5n.

5o.

 

5p.

5q.

 

 

5r.

Drug/

 

Injury

Physical

 

Location

 

Event

 

Result

 

 

Cause

Number of

 

Number of

Exposure to

Special Case

Alcohol Test

Illness

Act

 

 

 

 

 

 

 

 

 

 

 

Days Away

 

Days

Hazmat

 

 

Codes

A

D

Code

 

 

 

 

 

 

 

 

 

 

 

 

From Work

 

Restricted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5s. Latitude (optional)

 

 

 

 

 

 

 

 

5t.

Longitude (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5u. Narrative (Up to 250 Characters)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5a.

 

 

5b.

5c.

 

5d.

 

 

 

 

 

 

 

 

 

 

 

5e.

 

5f.

 

5g.

Accident/Injury Number

Day

Time

 

County

 

 

 

 

 

 

 

 

 

 

 

State

 

Type

 

Age

 

 

 

 

of Day

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Person/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Job Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5h.

 

5i.

5j.

 

5k.

 

5l.

 

5m.

 

 

5n.

5o.

 

5p.

5q.

 

 

5r.

Drug/

 

Injury

Physical

 

Location

 

Event

 

Result

 

 

Cause

Number of

 

Number of

Exposure to

Special Case

Alcohol Test

Illness

Act

 

 

 

 

 

 

 

 

 

 

 

Days Away

 

Days

Hazmat

 

 

Codes

A

D

Code

 

 

 

 

 

 

 

 

 

 

 

 

From Work

 

Restricted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5s. Latitude (optional)

 

 

 

 

 

 

 

 

5t.

Longitude (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5u. Narrative (Up to 250 Characters)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: This report is part of the reporting railroad's accident report pursuant to the accident reports statute and, as such shall not " be admitted as evidence or used for any purpose in any suit or action for damages growing out of any matter mentioned in said report . . . ." 49 U.S.C. 20903.

See 49 C.F.R. 225.7 (b).

FORM FRA F 6180.55a (Revised March 2003)