Major Rail Accident/Incident Report continued ... page 2 of 3
Major Rail Accident/Incident Report(to be reported within 2 hours)* /
Page 2 of 3 Corporate Forms Management Form F3222 ES (Feb 2005)
This information is required to be:
telephoned to 1300 139 959
and then confirm information by
faxing form to (07) 3253 4917 or
Email:
1. / Accident/Incident Reference number (allocated by TMR)2. / Reporting Officer’s name
3. / Title
4. / Organisation
5. / Contact phone number
6. / Time reported to TMR (24 hour clock) / 7. / Date reported to TMR
: / / / /
Nature of Accident/Incident
8. / Time of Accident/
Incident (24 hour clock) / 9. / Date of Accident/Incident
: / / / /
10. / Location
Defined Interstate Rail Network (DIRN)?
No Yes
11. / Accident/Incident category
12. / Description of Accident/Incident (if insufficient space attach a separate sheet)
13. / Extent of damage
14. / Actions taken or planned
15. / Type of train/vehicle
16. / Railway Manager
17. / Railway Operator
18. / Number of injuries/fatalities
No. of Fatality / No. of Serious injury / No. of Minor injury / Gender
M/F/
unknown / Age
0-5, 6-15,
16-24, 25-39,
40-59, 60+
Passengers
Public
Employees
Trespasser
Contractor
Volunteer
19. / Dangerous Goods involved?
No
Yes / ► / Type/Class
On train External
20. / Response to Accident/Incident
Organisations advised/in attendance
Police / Fire
WH&S / Ambulance
Others / ► / Give details
21. / Alcohol and/or drug test requested Yes No
No. Conducted / No. Positive / Time of test
Alcohol
Drug
Privacy Disclaimer – Department of Transport and Main Roads collects the information on this form in accordance with the Transport Infrastructure Act 1994. Personal information such as your name and phone number is collected in case further information is required about the accident/incident. The information on this form is accessible only by authorised government staff (or its agents) who may be required to disclose it to other government bodies, other state or territory rail safety regulators, or other railways. Your personal information will not be disclosed to any other third party without your consent or unless required to do so by law.
Office Use Only
Entered by (initials) ______Date _____/ _____/ _____
Validated by (initials) ______Date _____/ _____/ _____
Page 2 of 3 SSA Multimedia Services Form F3222 ES (May 2010)
What is a Major Rail Accident/IncidentMajor Accident / An unplanned, uncontrolled event that has resulted in or is likely to result in a fatality or serious injury or significant property damage.
Note: A major accident/incident includes those accidents referred to as Serious Incidents in the Transport Infrastructure Act 1994 and may also be referred to as occurrences.
Major Incident / An unplanned, uncontrolled event which under different circumstances could lead to a Major Accident.
Major Accident/Incident is one or more of the following types
· An accident or incident that has caused significant property damage, serious injury or death.
· A running line derailment.
· A running line collision between rolling stock.
· A collision at a railway crossing between rolling stock and either a road vehicle or a person.
· A fire or explosion on or in rail infrastructure or rolling stock that affects the safe carrying out of the railway operations or has endangered 1 or more persons.
· A terrorist attack or an act or event suspected to be a terrorist attack.
· An accident or incident involving an inadequacy in the safety management system for the railway operations that could have caused significant property damage, serious injury or death.
· Another accident or incident that is likely to generate intense public interest or concern.
Guidelines for Completing Form
No. / Category / Description
10 / Location / Provide all known details where possible including nearest station, nearest town, line and kms. Did the accident/incident happen on the DIRN?
11 / Accident/Incident category / Choose the most appropriate category from page 3 of this form. For detailed guidance on occurrence categories, please refer to the ‘Guideline for the Top Event Classification of Notifiable Occurrences, Occurrence Classification – Guideline One (OC-G1), Version 1’. This guideline is available on the TMR website*.
15 / Type of train/vehicle / Type of train e.g. passenger – suburban, passenger – non-suburban, freight, track machines, tourist & heritage or other. Type of vehicle (level crossing accidents) e.g. car, bus, light freight vehicle, heavy freight vehicle, farm machinery, articulated combination, motorcycle, bicycle or other.
16 / Railway Manager / Name of the person or organisation accredited to manage the railway.
17 / Railway Operator / Name of the person or organisation accredited to operate rolling stock on the railway.
18 / Number of injuries/fatalities
Passenger / A person travelling or intending to travel on a train. (For further guidance refer to the section 1.7.5 of the ‘OC-G1, Version 1’ which is available on the TMR website*).
Public / Any other person affected by a railway occurrence. (For further guidance refer to the section 1.7.7 of the ‘OC-G1, Version 1’ which is available on the TMR website*).
Employee / A person employed directly by a railway organisation. (Section 1.7.2 of the ‘OC-G1, Version 1’ which is available on the TMR website*).
Trespasser / A person on railway premises and whether intentionally or negligently, is in a place they have no right or authority to be or for the purpose of carrying out unauthorised activities. (For further guidance refer to the section 1.7.6 of the ‘OC-G1, Version 1’ which is available on the TMR website*).
Contractor / A person and any employee of that person, who has a contract of service to carry out work for a railway organisation and is carrying out that work. (Section 1.7.3 of the ‘OC-G1, Version 1’ which is available on the TMR website*).
Volunteer / A person who undertakes railway work for a railway organisation on a voluntary or unpaid basis and is carrying out that work. (Section 1.7.4 of the ‘OC-G1, Version 1’ which is available on the TMR website*).
Fatality / A person who dies within 30 days of a railway occurrence, from injuries sustained in that occurrence.
Serious injury / A person admitted to hospital as a result of injuries sustained in a railway occurrence who does not die within 30 days of the occurrence.
Minor injury / A person injured and requiring medical attention as a result of a railway occurrence but not admitted to hospital and who does not die within 30 days of the occurrence.
* http://www.transport.qld.gov.au/resources/file/eb2da84f39c768d/Pdf_occurence_classification_guideline_one.pdf
Accident/Incident Category1 / Derailment / 8 / Load Irregularity
1.1 / Running Line Derailment / 8.1 / Door open
1.2 / Yard Derailment / 8.2 / Out of gauge
2 / Collision / 8.3 / Load shift
2.1 / Running Line Collision / 8.4 / Uneven distribution of load
2.1.1 / Between trains / 8.5 / Loose load fastening
2.1.2 / With rolling stock / 8.6 / Other load irregularity
2.1.3 / With person not on a level crossing / 9 / Dangerous Goods
2.1.4 / With animal / 9.1 / On train
2.1.5 / With infrastructure / 9.2 / Off train
2.1.6 / With road vehicle not on a level crossing / 10 / Safeworking Rule or Procedure Breach
2.1.7 / With obstruction / 10.1 / Wayside signalling system procedure/rule breach
2.1.7.1 / Natural object / 10.2 / In - cab signalling system procedure/rule breach
2.1.7.2 / Railway related object / 10.3 / Token based system procedure/rule breach
2.1.7.3 / Other object / 10.4 / Communication based system procedure/rule breach
2.1.8 / Other running line collision / 10.5 / Track work procedure/rule breach
2.2 / Yard Collision / 10.6 / Other safeworking rule or procedure breach
2.2.1 / Between trains / 11 / Track and Civil Infrastructure Irregularity
2.2.2 / With rolling stock / 11.1 / Broken rail
2.2.3 / With person not on a level crossing / 11.1.1 / Detected during train operation
2.2.4 / With animal / 11.1.2 / Maintenance inspection detected
2.2.5 / With infrastructure / 11.2 / Buckled track
2.2.6 / With road vehicle not on a level crossing / 11.3 / Spread track
2.2.7 / With obstruction / 11.4 / Points irregularity
2.2.7.1 / Natural object / 11.5 / Track Obstruction
2.2.7.2 / Railway related object / 11.5.1 / Natural object
2.2.7.3 / Other object / 11.5.2 / Railway-related object
2.2.8 / Other yard collision / 11.5.3 / Other object
3 / Level Crossing Occurrence / 11.6 / Civil infrastructure irregularity
3.1 / Collision with Road Vehicle / 11.7 / Other Track infrastructure irregularity
3.1.1 / At crossings with active warning device / 12 / Rolling stock Irregularity
3.1.2 / At crossings with passive warning device / 12.1 / Train parting
3.1.3 / At unprotected level crossings / 12.2 / Wheel/axle failure
3.2 / Collision with person / 12.3 / Defective bearing
3.2.1 / At crossings with active warning device / 12.4 / Faulty passenger train door
3.2.2 / At crossings with passive warning device / 12.5 / Braking system
3.2.3 / At unprotected level crossings / 12.6 / Other rolling stock irregularity
3.3 / Level crossing equipment failure/defect / 13 / Electrical Infrastructure Irregularity
3.4 / Level crossing equipment damage/interference / 13.1 / Overhead traction supply
3.5 / Near miss with road vehicle / 13.2 / Other electrical infrastructure irregularity
3.5.1 / At crossings with active warning device / 14 / Fire
3.5.2 / At crossings with passive warning device / 14.1 / On train
3.5.3 / At unprotected level crossings / 14.1.1 / Rolling stock
3.6 / Near miss with person / 14.1.2 / Train operations
3.6.1 / At crossings with active warning device / 14.2 / Lineside fires
3.6.2 / At crossings with passive warning device / 14.2.1 / Safety related infrastructure
3.6.3 / At unprotected level crossings / 14.2.2 / Other lineside fires
3.7 / Other level crossing occurrence / 14.3 / Station/terminal fires
4 / Signals Passed at Danger / 15 / Explosion
4.1 / Driver misjudged / 16 / Suspected Suicide or Attempted Suicide
4.2 / Completely missed while running / 16.1 / Suspected suicide
4.3 / Starting against signal / 16.1.1 / Struck by train
4.4 / Signal restored as train approached / 16.1.2 / Other suspected suicide
4.5 / Other signal passed at danger / 16.2 / Attempted Suicide
5 / Proceed Authority Exceeded / 16.2.1 / Struck by train
5.1 / Driver misjudged / 16.2.2 / Other attempted suicide
5.2 / Completely missed while running / 17 / Alcohol or drugs Irregularity
5.3 / Other proceed authority exceeded / 18 / Train Warning and Enforcement System Irregularity
6 / Signalling And Other Proceed Authority System Irregularities / 18.1 / Warning system irregularity
6.1 / Wayside signalling system irregularities / 18.2 / Enforcement system irregularity
6.2 / In-cab signalling system irregularities / 19 / Communications System Failure
6.3 / Token system irregularities / 20 / Railway network security
6.4 / Communications based train authority system irregularities / 20.1 / Railway trespass
6.5 / Other signalling or proceed authority system irregularity / 20.1.1 / Near miss
7 / Slip, Trip or Fall / 20.1.2 / Other railway trespass
7.1 / To/from train / 20.2 / Alleged Assault
7.2 / Between platform and train / 20.2.1 / On a train / 20.2.2 / On a platform
7.3 / On train / 20.2.3 / Other alleged assault
7.4 / On track / 20.3 / Terrorism/Sabotage
7.5 / On/from platform/concourse / 20.3.1 / Terrorist act / 20.3.2 / Terrorist threat
7.6 / On/from escalator/lift / 20.3.3 / Other terrorism/sabotage
7.7 / On/from stairs/ramps / 20.4 / Vandalism
7.8 / From structure / 20.4.1 / Object projected at train / 20.4.2 / Graffiti
7.9 / Caught in train doors / 20.4.3 / Other vandalism
7.10 / Other slip trip or fall / 20.5 / Theft
20.6 / Other railway network security
21 / Runaway
Page 3 of 3 SSA Multimedia Services Form F3222 ES (V01 May 2010)