1.Physical Act

2.Location - Parts I, II, and III

3.Event

4.Tools, Machinery, Appliances, Structures, Surfaces (etc.)

5.Probable Reason for Injury/Illness

When selecting circumstance codes, use a COMBINATION THAT BEST IDENTIFIES the key factors without duplicating information identified by another code. The narrative portion of the report is to be used to provide additional information concerning those items that cannot be adequately described on the coded portions of the form. Reference the FRA Guide for Preparing Accident/Incident Reports, chapter 6 and appendix F FOR more information. Use FRA Form 6180.55a. and Insert the circumstance code in the appropriate item (5j, 5k, 5l, 5m, and 5n).

Type of Circumstance

Form F6180.55a Item Entry

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All Circumstance Codes

Physical Act

5j

What was the person doing when hurt?

Part I
Did A/I occur on or near rail right of way?

Part II
If A/I involved rail equipment, select code that best describes type of equipment involved

Codes

Location

5k

Part III
Select the code that best identifies the location of the person whose injury/illness is being reported

Codes

Event

5l

Select one of these Event codes

Codes

Tools, Machinery, Appliances, Structures, Surfaces (etc.)

5m

Select one of these Result codes

Codes

Probable Reason for Injury / Illness

5n

Select one of these Cause codes

Codes