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U. S. DOT CROSSING INVENTORY FORM A. Revision Date (MM/DD/YYYY) PAGE 2 D. Crossing Inventory Number (7 char.) 1 Part III: Highway or Pathway Traffic Control Device Information 1. Are there 2. Types of Passive Traffic Control Devices associated with the Crossing Signs or Signals? 2.A. Crossbuck2.B. STOP Signs (RI -1) 2.C. YIELD Signs (R1-2) 2.D. Advance Warning Signs (Check all that apply;include count) ElNone Assemblies (count) (count) (count) ❑ w10-1 ❑ W10-3 ❑ W10-11 ElYes ElNo ❑ W10-2 ❑ W10-4 ❑ W10-12 2.E. Low Ground Clearance Sign 2.F. Pavement Markings 2.G. Channelization 2.H. EXEMPT Sign 2.1. ENS Sign (1-13) (W10-5) Devices/Medians (R15-3) Displayed ❑ Yes (count J ❑ Stop Lines ❑Dynamic Envelope ❑ All Approaches ❑ Median ❑ Yes ❑ Yes ❑ No ❑ RR Xing Symbols ❑ None ❑ One Approach ❑ None ❑ No ❑ No 2.1. Other MUTCD Signs ❑ Yes ❑ No 2.K. Private Crossing 21. LED Enhanced Signs (List types) Signs (if private) Specify Type Count Specify Type Count ❑ Yes ❑ No Specify Type Count 3. Types of Train Activated Warning Devices at the Grade Crossing (specify count of each device for all that appty) 3.A. Gate Arms 3.8. Gate Configuration 3.C. Cantilevered (or Bridged) Flashing Light 3.D. Mast Mounted Flashing Lights 3.E. Total Count of (count) Structures (count) (count of masts) Flashing Light Pairs ❑ 2 Quad ❑ Full (Barrier) Over Traffic Lane ❑ Incandescent ❑ Incandescent ❑ LED Roadway ❑ 3 Quad Resistance ❑ Back Lights Included ❑ Side Lights Pedestrian ❑ 4 Quad ❑ Median Gates Not Over Traffic Lane ❑ LED Included 3.F. Installation Date of Current 3.G. Wayside Horn 3.H. Highway Traffic Signals Controlling 3.1. Bells Active Warning Devices: (MM/YYYY) Crossing (count) ❑ Not Required Yes Installed on (MM/YYYY) ❑ Yes ❑ No ❑ 3.1. Non -Train Active Warning 3.K. Other Flashing Lights or Warning Devices ❑ Flagging/Flagman ❑Manually Operated Signals ❑ Watchman ❑ Floodlighting ❑ None Count Specify type 4.A. Does nearby Hwy 4.B. Hwy Traffic Signal 4.C. Hwy Traffic Signal Preemption 5. Highway Traffic Pre -Signals 6. Highway Monitoring Devices Intersection have Interconnection ❑ Yes ❑ No (Check all that apply) Traffic Signals? ❑ Not Interconnected ❑ Yes - Photo/Video Recording ❑ For Traffic Signals ❑ Simultaneous Storage Distance * ❑ Yes — Vehicle Presence Detection ❑ Yes ❑ No ❑ For Warning Signs ❑ Advance Stop Line Distance * ❑ None Part IV: Physical Characteristics 1. Traffic Lanes Crossing Railroad ❑ One-way Traffic 2. Is Roadway/Pathway 3. Does Track Run Down a Street? 4. Is Crossing Illuminated? (Street ❑ Two-way Traffic Paved? lights within approx. 50 feet from Number of Lanes ❑ Divided Traffic ❑ Yes El No ❑ Yes E3 No nearest rail) ❑ Yes ❑ No 5. Crossing Surface (on Main Track, multiple types allowed) Installation Date * (MM/YYI / 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? 7. Smallest Crossing Angle 8. Is Commercial Power Available? ❑ Yes ❑ No If Yes, Approximate Distance (feet) ❑ 0'-29* ❑ 30° — 59° ❑ 60" - 90° ❑ Yes ❑ No Part V: Public Highway Information 1. Highway System 2. Functional Classification of Road at Crossing 3. Is Crossing on State Highway 4. Highway Speed Limit ❑ (0) Rural ❑ (1) Urban System? MPH ❑ (01) Interstate Highway System ❑ (1) Interstate ❑ (5) Major Collector ❑ Yes ❑ No ❑ Posted ❑ Statutory 5. Linear Referencing System (LRS Route ID) ❑ (02) Other Nat Hwy System (NHS) ❑ (2) Other Freeways and Expressways ❑ (03) Federal AID, Not NHS ❑ (3) Other Principal Arterial ❑ (6) Minor Collector 6. LRS Milepost ❑ (08) Non -Federal Aid ❑ (4) Minor Arterial ❑ (7) Local 7. Annual Average Daily Traffic (AADT) 8. Estimated Percent Trucks 9. Regularly Used by School Buses? 10. Emergency Services Route Year AADT % ❑ Yes ❑ No Average Number per Day ❑ 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. FORM FRA F 6180.71 (Rev. 3/15) OMB approval expires 01/31/2026 Page 2 OF 2