Incident Report Form 1284 - BC Safety Authority

ACCIDENT/INCIDENTREPORTING REGULATIONS for BC RAILWAYSNote:1. Interpretation comments are in bracketed italics under the identifiedrequirement.2. These requirements are based on the Province of BC, Railway SafetyAdopted Provisions Regulations pertaining to the adopted matter from theCanadian Transportation Accident Investigation and Safety Board Act.3. This regulation applies to all railways operating in British Columbia that areoperating under, or hold a provincially issued Operating Permit.1. Short Title(1) These regulations may be cited as the British Columbia Safety Authority’sRailway Accident and Incident Reporting Requirements.2. Interpretation2. (1) in these requirements:“collision” means an impact, other than an impact associated with normaloperating circumstances, between rolling stock or between rolling stock andanother object;“dangerous goods” means any product, substance or organism included by itsnature or by the Transportation of Dangerous Goods Regulations (Canada) inany classes listed in the schedule to the Transportation of Dangerous Goods Act(Canada), and includes the dangerous materials listed in Schedule 1 of theDangerous Bulk Materials Regulations (Canada);“derailment” means an accident whereby one or more wheels of rolling stockleave the rails, other than by reason of an explosion or a collision;“grade crossing collision” means a collision that occurs at any railway crossingbetween rolling stock and any other crossing user;“railway company” means a company that operates rolling stock involved in areportable railway accident or incident;“reportable railway accident” means an accident resulting directly from theoperation of a railway where:(a) a person sustains a serious injury or is killed as a result of;(i) being on board or getting on or off the rolling stock, or(this includes the any person in or on station, guideways or right ofways of commuter railways)

(ii)coming into contact with any part of the rolling stock orits contents; or(b)the rolling stock:(i) is involved in a grade crossing collision;(ii) is involved in a collision or a derailment and is carryingpassengers;(iii) is involved in a collision or derailment and is carryingdangerous goods, or is known to have last containeddangerous goods the residue of which has not beenpurged from the rolling stock;(iv) sustains damage that affects its safe operation, or(v) causes or sustains a fire or explosion, or causesdamage to the railway, that poses a threat to the safetyof any person, property or the environment.“reportable railway incident” means an incident resulting directly from theoperation of rolling stock where;(a) a risk of a collision occurs;(b)(c)(d)(e)(f)(g)(h)an unprotected main track switch is left in an abnormal position;a railway signal displays a less restrictive indication than requiredfor the intended movement of rolling stock;an unprotected overlap of operating authority occurs;the movement of rolling stock exceeds the limits of its authority;there is runaway rolling stock;any crew member whose duties are directly related to the safeoperation of the rolling stock is unable to perform the crewmember’s duties as a result of a physical incapacitation that posesa threat to any person, property or the environment, orany dangerous goods is released on board or from the rolling stock,“risk of collision” means a situation where rolling stock comes so close to beinginvolved in a collision that a threat to the safety of any person, property or theenvironment exists;“rolling stock” means every description of equipment that is designed or modifiedfor movement on its wheels along a line of railway or guideway and withoutlimiting the generality of the forgoing, includes any locomotive, modified industrialequipment or construction wheeled power unit or combination of road/rail

equipment and railway car that is so designed or modified; (Adapted from theCanada Transportation Act)“serious injury” means an injury that is likely to require admission to a hospital;(this includes any injury that requires transportation to a hospital for treatment by a registeredmedical practitioner)“special situation” means any situation or condition that the British ColumbiaSafety Authority (BCSA) has reasonable grounds to believe could if leftunattended, induce an accident or incident; and“track operator” means the company that operates the track on which areportable railway accident or incident takes place.3. MANDATORY REPORTINGReportable Railway Accidents and Incidents(1) Subject to subsection (5), where a reportable railway accident or incidenttakes place, the railway company, the track operator and any crewmember aboard rolling stock involved in the accident or incident shallreport to the BCSA as much of the information listed in subsection (2) as isavailable, as soon as possible and by the quickest means available.(2) The report referred to in subsection (1) shall contain the followinginformation:(a) the train number and direction;(b)(c)(d)(e)(f)(g)the names of the railway company and of the track operator;the names of the crew members;the date and time of the accident or incident;the location of the accident or incident by reference to a mileageand sub-division location and, where applicable, the trackdesignation in a yard;(commuter railways shall reference the track section numbers and the nearestpassenger station as applicable)the number of crew members, passengers and other persons thatwere killed or sustained a serious injury;a description of the accident or incident and the extent of anyresulting damage to the rolling stock, the railway, a commoditypipeline, the environment and other property;

(h)(i)(j)a summary description of any dangerous goods contained in orreleased from the rolling stock;in the case of a reportable accident, the anticipated arrival time ofwreck-clearing equipment, and(commuter railways shall include the anticipated arrival time of the local firstresponder emergency services personnel and coroner’s representatives asapplicable)the name, location and title of the person making the report.(3) In addition to the reporting requirements set out in subsection (1), theperson making the report shall, on a form approved by the BCSA, submitto the BCSA within 30 days after the accident or incident all theinformation listed in subsection (2), unless otherwise exempted by theBCSA pursuant to subsection (4).(4) The BCSA may exempt a person from submitting the information referredto in subsection (3) where the BCSA has gathered the information throughits own investigation of the accident or incident.(5) Where any person required to do so pursuant to subsection (1) makes areport to the BCSA, no other person referred to in that subsection isrequired to make a report.4. Voluntary ReportingGeneralAny person having knowledge of an accident, incident or special situationassociated with the operation of rolling stock may report to the BCSA anyinformation that the person believes is relevant.5. Confidential Reporting(1) The BCSA may establish a confidential reporting unit that shall haveexclusive authority to receive and examine in confidence any verbal orwritten report made pursuant to section 4.(2) Where a report is made to the BCSA, other than a report concerning areportable accident or incident made by a person referred to in subsection3 (1), no person shall release the identity of the person making the reportor any information that could reasonably be expected to reveal theperson’s identity, unless the person making the report authorizes, inwriting, its release.

6. Preservation of Evidence Respecting Reportable Accidents andIncidents(1) Subject to subsection (2) and (3), where a reportable accident or incidenttakes place, the owner, operator and any crew member shall, to the extentpossible, and until otherwise instructed by the BCSA or except asotherwise required by law, preserve and protect any evidence relevant tothe reportable accident or incident, including evidence contained indocuments as defined in subsection 19 (16) of the CanadianTransportation Accident Investigation and Safety Board Act.(2) Subsection (1) shall not be construed as preventing any person fromtaking necessary measures to ensure the safety of any person, property orthe environment.(3) Where evidence relevant to a reportable accident or incident has to beinterfered with pursuant to subsection (2), the person directing,supervising or arranging the interference shall, to the extent possible inthe circumstances, and prior to the interference, record the evidence bythe best means available.(4) Where any person required to do so pursuant to subsection (1) preservesand protects evidence relevant to a reportable accident or incident, noother person referred to in that subsection is required to preserve orprotect that evidence.7. Reporting Procedures(1) To report railway accidents or incidents as soon as possible, as referred toin subsection 3. (1), telephone 1-866-566-7233, this telephone number isopen 24 hours a day, 7 days a week throughout the year.(2) To submit the report form referred to in subsection 3.(3), the report shall be forwarded in 30 days to:Railway Safety ManagerBC Safety Authority505 Sixth Street, Suite 200New Westminster BCV3L 0E1or Email to: bcsa.railway@safetyauthority.caor Fax to: 778 396 2035

RAILWAY ACCIDENT/INCIDENT REPORTFORMReporting Railway or Track Operator: _________________________________________________________________Address of Railway or Track Operator: ________________________________________________________________Telephone #: _______________________Cell #: ________________________ Fax #: ______________________E-Mail Address: _________________________________________________Date: _____________________________Date and Time of Accident: ___________________________________ Date Reported:_________________________Weather conditions and Temperature: ________________________________________________________________(Check box or fill in appropriate information)This Report is for: A Reportable AccidentA Reportable IncidentEvent Location: (Mileage, sub-division, track designation, track section, nearest station, etc.)_________________________________________________________________________________Train Designation or Identification: (Train Number or Movement Number)_________________________________________________________________________________General Description of Accident/Incident: (Use additional sheets if necessary)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Type of Railway OperationCommon Carrier Industrial CommuterStreet Car Heritage Other: (describe) ________________Type of Rolling Stock OperationPulling Pushing Rolling Free StationaryFRM-1284-00 (2011-01-06)

Type of railway ActivityPassenger Train Freight Train Mixed Train Work TrainYard MovementOther: (Describe) __________________________________________________Direction of TravelNorth South East WestInbound Outbound Yard StoppedNames of Train CrewConductor: ___________________________________Engineman: ___________________________________Trainman: ___________________________________ Yard Switchman: ___________________________________Hostler: _____________________________________ Other: (Describe): ___________________________________Type of AccidentInjury or Death Collision Crossing Collision Train CollisionDerailment Property Damage Fire/Explosion ThreatDamages (Use additional sheets if necessary)Freight cars describe types & car ID numbers & number damaged: ________________________________________________________________________________________________________________________________________Passenger cars describe types & car ID numbers & number damaged: ______________________________________________________________________________________________________________________________________Locomotives describe types & engine numbers & number damaged: _______________________________________________________________________________________________________________________________________Other rolling stock describe type & equipment umbers & number damaged: _________________________________________________________________________________________________________________________________Track & infrastructure (Describe): __________________________________________________________________________________________________________________________________________________________________Other damages (Describe): ________________________________________________________________________________________________________________________________________________________________________FRM-1284-00 (2011-01-06)

Dangerous Goods (Use additional sheets if necessary)Number of Dangerous Goods Cars DamagedNumber of Dangerous Goods Cars RupturedNumber of Dangerous Goods Cars LeakingNames of Dangerous Goods Involved: __________________________________________________________________Names of Dangerous Goods Released: __________________________________________________________________Grade Crossing AccidentsName of Crossing: _________________________________________________________________________________Sub-Division & Mileage of Crossing, or: _______________________________________________________________Geographic Location: ______________________________________________________________________________Type of Crossing ProtectionSignals Gates Stop Signs FlaggedHighway User InvolvedCar Light Truck Heavy Truck Heavy Truck/TrailerPassenger Bus Passenger Van Industrial Equipment Farm EquipmentMotor Cycle Bi-Cycle Pedestrian Other (Describe): __________Action by Train CrewRinging Bell Sounding Whistle Emergency Braking Engine Lights OnAction by Crossing UserStopped Foul Stopped on Crossing Moving Over Crossing Other (Describe): _________OutcomeTrain was Struck Car was Struck Train Derailed Other (Describe): _________Estimated Cost of DamageRailway Damage Costs $FRM-1284-00 (2011-01-06)

Non-Railway Damage Costs $CausesIdentify the Primary Cause: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Identify Contributing Factors: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Corrective ActionsDescribe Corrective Action Taken: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Report Submitted by:Name: _____________________________________________Title: ______________________________________________Signature: ______________________________________________Date: ______________________________________________Forward the completed reported, within 30 days of the event, to:Postal Address: Railway Safety Manager,BC Safety Authority,505 Sixth Street, Suite 200New Westminster BCV3L 0E1or E-Mail to: bcsa.railway@safetyauthority.caFRM-1284-00 (2011-01-06)