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FORM FRA F 6180.71 (Rev. 3/15) OMB approval expires 8/31/2019 Page 2 OF 2 U. S. DOT CROSSING INVENTORY FORM A. Revision Date (MM/DD/YYYY) PAGE 2 D. Crossing Inventory Number (7 char.) Part III: Highway or Pathway Traffic Control Device Information 1. Are there Signs or Signals?  Yes  No 2. Types of Passive Traffic Control Devices associated with the Crossing 2.A. Crossbuck Assemblies (count) 2.B. STOP Signs (R1-1) (count) 2.C. YIELD Signs (R1-2) (count) 2.D. Advance Warning Signs (Check all that apply; include count)  None  W10-1 ________  W10-3 ________  W10-11 __________  W10-2 ________  W10-4 ________  W10-12 __________ 2.E. Low Ground Clearance Sign (W10-5)  Yes (count_______)  No 2.F. Pavement Markings 2.G. Channelization Devices/Medians 2.H. EXEMPT Sign (R15-3)  Yes  No 2.I. ENS Sign (I-13) Displayed  Yes  No  Stop Lines  RR Xing Symbols Dynamic Envelope  None  All Approaches  One Approach  Median  None 2.J. Other MUTCD Signs  Yes  No 2.K. Private Crossing Signs (if private)  Yes  No 2.L. LED Enhanced Signs (List types) Specify Type _______________ Specify Type _______________ Specify Type _______________ Count __________ Count __________ Count __________ 3. Types of Train Activated Warning Devices at the Grade Crossing (specify count of each device for all that apply) 3.A. Gate Arms (count) Roadway _____ Pedestrian _____ 3.B. Gate Configuration 3.C. Cantilevered (or Bridged) Flashing Light Structures (count) 3.D. Mast Mounted Flashing Lights (count of masts) _________ 3.E. Total Count of Flashing Light Pairs  2 Quad  3 Quad  4 Quad  Full (Barrier) Resistance  Median Gates Over Traffic Lane _____ Not Over Traffic Lane _____  Incandescent  LED  Incandescent  Back Lights Included  LED  Side Lights Included 3.F. Installation Date of Current Active Warning Devices: (MM/YYYY) ______/___________  Not Required 3.G. Wayside Horn 3.H. Highway Traffic Signals Controlling Crossing  Yes  No 3.I. Bells (count)  Yes  No Installed on (MM/YYYY) ______/__________ 3.J. Non-Train Active Warning  Flagging/Flagman Manually Operated Signals  Watchman  Floodlighting  None 3.K. Other Flashing Lights or Warning Devices Count ___________ Specify type ______________________ 4.A. Does nearby Hwy Intersection have Traffic Signals?  Yes  No 4.B. Hwy Traffic Signal Interconnection  Not Interconnected  For Traffic Signals  For Warning Signs 4.C. Hwy Traffic Signal Preemption 5. Highway Traffic Pre-Signals  Yes  No 6. Highway Monitoring Devices (Check all that apply)  Yes - Photo/Video Recording  Yes – Vehicle Presence Detection  None  Simultaneous  Advance Storage Distance * ____________ Stop Line Distance * ____________ Part IV: Physical Characteristics 1. Traffic Lanes Crossing Railroad  One-way Traffic  Two-way Traffic Number of Lanes _______  Divided Traffic 2.Is Roadway/Pathway Paved?  Yes  No 3.Does Track Run Down a Street?  Yes  No 4.Is Crossing Illuminated? (Street lights within approx. 50 feet from nearest rail)  Yes  No 5.Crossing Surface (on Main Track, multiple types allowed) Installation Date * (MM/YYYY) _______/__________ Width * ______________ Length * _______________  1 Timber  2 Asphalt  3 Asphalt and Timber  4 Concrete  5 Concrete and Rubber  6 Rubber  7 Metal  8 Unconsolidated  9 Composite  10 Other (specify) ________________________________________________________ 6.Intersecting Roadway within 500 feet?  Yes  No If Yes, Approximate Distance (feet) _________________ 7.Smallest Crossing Angle  0° – 29°  30° – 59°  60° - 90° 8.Is Commercial Power Available? *  Yes  No Part V: Public Highway Information 1. Highway System  (01) Interstate Highway System  (02) Other Nat Hwy System (NHS)  (03) Federal AID, Not NHS  (08) Non-Federal Aid 2. Functional Classification of Road at Crossing  (0) Rural  (1) Urban  (1) Interstate  (5) Major Collector  (2) Other Freeways and Expressways  (3) Other Principal Arterial  (6) Minor Collector  (4) Minor Arterial  (7) Local 3. Is Crossing on State Highway System?  Yes  No 4. Highway Speed Limit ___________ MPH  Posted  Statutory 5. Linear Referencing System (LRS Route ID) * 6. LRS Milepost * 7.Annual Average Daily Traffic (AADT) Year _______ AADT _____________ 8.Estimated Percent Trucks ___________________ % 9.Regularly Used by School Buses?  Yes  No Average Number per Day ___________ 10.Emergency Services Route  Yes  No Submission Information - This information is used for administrative purposes and is not available on the public website. Submitted by __________________________________ Organization _______________________________________ Phone _______________ Date _____________ Public reporting burden for this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. According to the Paperwork Reduction Act of 1995, a federal agency may not conduct or sponsor, and a person is not required to, nor shall a person be subject to a penalty for failure to comply with, a collection of information unless it displays a currently valid OMB control number. The valid OMB control number for information collection is 2130-0017. Send comments regarding this burden estimate or any other aspect of this collection, including for reducing this burden to: Information Collection Officer, Federal Railroad Administration, 1200 New Jersey Ave. SE, MS-25 Washington, DC 20590. 11/27/2017 967948R 8 3 0 1 8 2 8 8 8 8 0 0 0 0 0 8 0 0 8 8 2 8 88 8 8 10 284201410 8 25 8 8 8 8 8 30 8 8 2014 000200 05 8 Appendix C - U.S. DOT Crossing Inventory Forms Quiet Zone Evaluation New Brighton, Minnesota C4 Spack Consulting