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.
Question | Answer |
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Form Name | Form Fra F 6180 55A |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | fra form 6180 55 fillable, fra 6180 55a form fillable, fra 6180 55, fra form 6180 55 address |
DEPARTMENT OF TRANSPORTATION RAILROAD INJURY AND ILLNESS SUMMARY |
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SHEET ____ OF ____ |
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FEDERAL RAILROAD ADMINISTRATION (FRA) |
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(Continuation Sheet) |
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OMB Approval No.: |
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1. Name of Reporting Railroad |
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2. Alphabetic Code |
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3. Report Month |
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4. Report Year |
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5a. |
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5b. |
5c. |
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5d. |
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5e. |
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5f. |
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5g. |
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Accident/Injury Number |
Day |
Time |
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County |
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State |
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Type |
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Age |
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of Day |
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Person/ |
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Job Code |
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5h. |
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5i. |
5j. |
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5k. |
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5l. |
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5m. |
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5n. |
5o. |
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5p. |
5q. |
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5r. |
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Drug/ |
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Injury |
Physical |
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Location |
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Event |
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Result |
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Cause |
Number of |
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Number of |
Exposure to |
Special Case |
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Alcohol Test |
Illness |
Act |
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Days Away |
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Days |
Hazmat |
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Codes |
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A |
D |
Code |
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From Work |
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Restricted |
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5s. Latitude (optional) |
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5t. |
Longitude (optional) |
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5u. Narrative (Up to 250 Characters) |
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5a. |
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5b. |
5c. |
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5d. |
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5e. |
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5f. |
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5g. |
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Accident/Injury Number |
Day |
Time |
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County |
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State |
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Type |
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Age |
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of Day |
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Person/ |
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Job Code |
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5h. |
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5i. |
5j. |
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5k. |
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5l. |
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5m. |
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5n. |
5o. |
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5p. |
5q. |
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5r. |
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Drug/ |
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Injury |
Physical |
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Location |
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Event |
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Result |
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Cause |
Number of |
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Number of |
Exposure to |
Special Case |
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Alcohol Test |
Illness |
Act |
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Days Away |
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Days |
Hazmat |
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Codes |
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A |
D |
Code |
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From Work |
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Restricted |
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5s. Latitude (optional) |
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5t. |
Longitude (optional) |
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5u. Narrative (Up to 250 Characters) |
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5a. |
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5b. |
5c. |
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5d. |
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5e. |
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5f. |
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5g. |
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Accident/Injury Number |
Day |
Time |
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County |
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State |
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Type |
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Age |
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of Day |
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Person/ |
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Job Code |
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5h. |
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5i. |
5j. |
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5k. |
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5l. |
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5m. |
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5n. |
5o. |
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5p. |
5q. |
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5r. |
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Drug/ |
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Injury |
Physical |
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Location |
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Event |
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Result |
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Cause |
Number of |
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Number of |
Exposure to |
Special Case |
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Alcohol Test |
Illness |
Act |
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Days Away |
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Days |
Hazmat |
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Codes |
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A |
D |
Code |
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From Work |
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Restricted |
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5s. Latitude (optional) |
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5t. |
Longitude (optional) |
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5u. Narrative (Up to 250 Characters) |
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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)