/ PB95-916201

NTSB/HAR-95/01

NATIONAL

TRANSPORTATION

SAFETY

BOARD

WASHINGTON, D.C. 20594

HIGHWAY ACCIDENT REPORT

COLLISION OF AMTRAK TRAIN NO. 88 WITH

ROUNTREE TRANSPORT AND RIGGING VEHICLE

ON CSX TRANSPORTATION, INC., RAILROAD

NEAR INTERCESSION CITY, FLORIDA

NOVEMBER 30, 1993

6558
Abstract: This report explains the November 30, 1993, collision of National Railroad Passenger 

Corporation (Amtrak) train 88 with a Rountree Tranport and Rigging, Inc., overdimension/low-clearance 

vehicle, which was fouling a grade crossing on a private access road to an electricity generating plant 

complex near Intercession City, Florida. Six people sustained serious injuries and 53 people sustained 

minor injuries from this accident. The total estimated damage exceeded $14 million. 

 From its investigation of this accident, the Safety Board identified safety issues in the following 

areas: State permitting requirements and procedures, management oversight, oversize move coordination 

between highway and railroad operators, emergency notification procedures, wreck clearing coordination 

between railroad and pipeline operators, vehicle escort procedures, and lounge car seat support design. 

 The Safety Board made safety recommendations to the American Association of State Highway 

Transportation Officials, the American Gas Association, the American Public Gas Association, the 

American Petroleum Institute, the Interstate Natural Gas Association of America, the Association of 

American Railroads, the American Short Line Railroad Association, the Central Florida Pipeline 

Corporation, the National Railroad Passenger Corporation, the Osceola County (Florida) Emergency 

Management Division, the State of Florida Division of Emergency Management, the CSX Transportation 

Corporation, the Specialized Carriers and Rigging Association, the International Association of Chiefs of 

Police, the National Sheriffs Association, and the National Committee on Uniform Traffic Laws and 

Ordinances.

The National Transportation Safety Board is an independent Federal agency dedicated to promoting aviation, railroad, highway, marine, pipeline, and hazardous materials safety. Established in 1967, the agency

is mandated by Congress through the Independent Safety Board Act of 1974 to investigate transportation

accidents, determine the probable causes of the accidents, issue safety recommendations, study

transportation safety issues, and evaluate the safety effectiveness of government agencies involved in

transportation. The Safety Board makes public its actions and decisions through accident reports, safety

studies, special investigation reports, safety recommendations, and statistical reviews. 

Information about available publications may be obtained by contacting: 

National Transportation Safety Board 

Public Inquiries Section, RE-51 

490 L'Enfant Plaza, S.W. 

Washington, D.C. 20594 

(202) 382-6735

Safety Board publications may be purchased, by individual copy or by subscription, from: 

National Technical Information Service 

5285 Port Royal Road 

Springfield, Virginia 22161 

(703) 487-4600
 

NTSB/HAR-95/01 PB95-916201 

National Transportation 

Safety Board

Washington, D.C. 20594

HIGHWAY ACCIDENT REPORT 

COLLISION OF AMTRAK TRAIN NO. 88 WITH 

ROUNTREE TRANSPORT AND RIGGING, INC., VEHICLE 

 ON CSX TRANSPORTATION, INC., RAILROAD 

 NEAR INTERCESSION CITY, FLORIDA 

NOVEMBER 30, 1993 

Adopted: May 16, 1995 

Notation 6558 

CONTENTS

EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

INVESTIGATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

The Accident 1

Events Following the Collision .............................

Emergency Response ..............................

Pipeline Operator Actions ...........................

7

7

7

Injuries ............................................ 8

Damage ........................................... 8

Truck ....................................... 8

Train ........................................ 8

Pipeline ...................................... 9

Vehicle and Pipeline System Information .......................

Rountree Vehicle .................................

Train ........................................

Pipeline ......................................

9

9

11

11

Personnel Information ..................................

Amtrak Crew ...................................

Rountree Crew ..................................

Hours of Service .................................

12

12

12

13

14

14

14

Toxicological Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rountree Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Amtrak Crew . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accident Site Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Kissimmee Utility Authority (KUA) Power Road . . . . . . . . . . . . . . . . .

Track, Wayside, and Crossing Signals . . . . . . . . . . . . . . . . . . . . . . 

Pipeline Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14

14

15

15

Carrier Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

CFPL Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Rountree Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

CSXT Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Amtrak Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Oversize Move Permits and Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Regulatory Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

iii
State Permitting Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Local Permits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Escort Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The CSXT Application Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rountree Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Previous CSXT Permits Granted to Rountree . . . . . . . . . . . . . . . . . . . . . . . . .

The Intercession City Move . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postaccident Revisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.

16

17

17

17

17

18

18

20

23

Medical and Pathological Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Survival Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Postaccident Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Lounge Car Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Emergency Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Postaccident Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CSXT Emergency Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CFPL Emergency Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

State Plans and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Past Accidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.

. 26

26

. 28

28

29

29

30

Tests and Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Speed Recorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Sight Distance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Stopping Distance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Track . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Crossing Signals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Radio Test (Dispatcher) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Time-Distance Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Grade Crossing Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Railroad-Highway Crossing Inventory and Numbering System . . . . . . . . . . .

Other State Crossing Safety Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

State Escort Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

The Accident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Pretrip Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . 

. .

37

37

38

38

iv

32

32

33

33

33

33

33

33

34

34

34

35

35
Problems at the Site .................................. 39

Postaccident Activities ................................ 39

Rountree Oversight of Oversize Moves ........................... 40

Grade Crossing Flagging Arrangements ...................... 40

Route Selection ..................................... 40

Work Schedule ..................................... 41

Oversize Move Coordination ................................. 42

State Permitting Requirements and Procedures ...................... 44

Emergency Notification Procedures ............................. 45

Wreckage Clearing Coordination ............................. 46

On-scene Problems ................................ 46

Risk Identification ................................. 41

Overdimension Vehicle Escorts ............................... 48

Lounge Car Seat Design .................................... 48

CONCLUSIONS ...................................... 50

Findings ....................................... 50

Probable Cause ................................... 51

RECOMMENDATIONS ................................... 52

APPENDICES

Appendix A - Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Appendix B - Injury Information . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .

Appendix C - Railroad/Highway Grade Crossings on the Rountree Route . . . 

Appendix D - CSXT Permits Issued to Rountree . . . . . . . . . . . . . . . . . . . . . . . . 

Appendix E - Section 11-703 of the Uniform Vehicle Code. . . . . . . . . . . . . . . . .

Appendix F - States Requiring Notification to Railroad(s) of Travel Over . . . .

Railroad/Highway Grade Crossing(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

57

59

61

63

69

71

v

vii 

 EXECUTIVE SUMMARY 

 On November 30, 1993, a 184-foot-long vehicle consisting of a truck-tractor and modular 

transporter operated by Rountree Transport and Rigging (Rountree), Inc., was en route to deliver 

an 82-ton turbine to a Kissimmee Utility Authority (KUA) electricity generating plant under 

construction near Intercession City, Florida. The private access road to the plant facility crosses 

over a single railroad track owned by CSX Transportation, Inc. (CSXT). Because of the 

configuration of the truck and the profile of the roadway, the cargo deck of the transporter began 

to bottom out on the roadway surface as the vehicle moved across the tracks and began down the 

descending grade. To gain sufficient clearance, the Rountree crew shimmed the transporter 

while the cargo deck was on the tracks. About 12:40 p.m, they had finished raising the cargo 

deck and were preparing to move the vehicle when the lights and bells at the grade crossing activated. The crossing gates descended, striking the turbine. Seconds later, National Railroad 

Passenger Corporation (Amtrak) train number 88, the Silver Meteor, carrying 89 passengers, 

struck the side of the cargo deck and the turbine. The locomotive and the first four cars of the 

eight-car consist derailed, carrying the turbine and parts of the Rountree vehicle with them. 

 No deaths resulted from this accident. Responders evacuated 59 people to five local 

hospitals, where 15 were admitted for further treatment. Six people sustained serious injuries 

and 53 suffered minor injuries, mostly abrasions, lacerations, and contusions. The Rountree 

vehicle and the turbine were destroyed, and the locomotive and the first three railcars were 

damaged extensively. Total damage from the accident exceeded $14 million. 

 The National Transportation Safety Board determines that the probable cause of the 

accident was the failure of Rountree Transport and Rigging, Inc. to notify CSXT in advance of 

its intent to cross the railroad track at the accident grade crossing and to ensure through CSXT 

that it was safe to do so. Contributing to the accident were deficiencies in the permitting 

processes of the CSXT and the Florida Department of Transportation that resulted in a lack of 

appropriate guidance for permitting officials, oversize, low-clearance vehicle operators, and 

escort personnel. 

 From its investigation of this accident, the Safety Board identified safety issues in the 

following areas: Rountree oversight of oversize moves, oversize move coordination, pipeline 

notification and hazard identification and avoidance, permitting procedures, and lounge car seat 

support design. 

 The Safety Board issued recommendations to the American Association of State Highway 

Transportation Officials, the American Gas Association, the American Public Gas Association, 

the American Petroleum Institute, the Interstate Natural Gas Association of America, the Association of American Railroads, the American Short Line Railroad Association, the Central Florida 

Pipeline Corporation, the National Railroad Passenger Corporation, the Osceola County (Florida) 

Emergency Management Division, the State of Florida Division of Emergency Management, the 

CSX Transportation Corporation, the Specialized Carriers and Rigging Association, the International Association of Chiefs of Police, the National Sheriffs Association, and the National 

Committee on Uniform Traffic Laws and Ordinances. 

 1 

 INVESTIGATION 

The Accident

 About 11:25 p.m. on November 29, 1993, a 184-foot-long vehicle operated by Rountree 

Transport and Rigging (Rountree), Inc. left Tampa, Florida, to deliver an 82-ton turbine to the 

Kissimmee Utility Authority's (KUA's) Cane Island Project, an electricity-generating plant under 

construction near Intercession City, Osceola County, Florida. The weather was clear and dry. 

The vehicle consisted of a truck-tractor and a modular transporter comprising three cargo deck 

sections totaling 67 feet in length to accommodate the 14-foot-high by 14-foot-wide by 57-footlong turbine (figure 1). Four Rountree employees comprised the vehicle crew: a driver and a 

tiller operator on the rig, and an equipment supervisor and regional manager in separate vehicles 

accompanying the rig. 

 A utility truck with a raised bar to measure the clearance of overhead utility wires preceded the Rountree vehicle en route. In addition, two off-duty Florida Highway Patrol (FHP) 

officers in marked cruisers provided escort service for the vehicle. The route from the Port of 

Tampa to the KUA facility selected by the Rountree regional manager traversed 13 highway/railroad crossings (figure 2) in two CSX Transportation, Inc. (CSXT) area divisions. A CSXT 

maintenance-of-way employee accompanied the vehicle to flag1

 seven crossings in the immediate 

Tampa area. No flagman accompanied the Rountree vehicle after the seventh crossing. The convoy traversed the next crossing at Pasco County Road 535 without incident and without a CSXT 

employee protecting the crossing. 

 The ninth crossing, near Zephyrhills, has a cantilevered light support over the crossing. 

Rountree had arranged for personnel from the CSXT Vitis subdivision signals department to 

remove the support and protect the vehicle's transit across the grade crossing. The Rountree 

vehicle traversed three more crossings without a CSXT employee protecting the crossing before 

reaching the crossing at the KUA Power Road. 

 When not making turns or avoiding obstructions, the vehicle operated at a reported top 

speed of 10 to 15 mph in the city, and about 22 mph in rural areas. The equipment supervisor 

reported encountering no problems on the trip from Tampa to Intercession City. 

 About 10:59 a.m.2

 on November 30, 1993, as the Rountree vehicle and its convoy were 

turning off U.S. Route 17/92 onto Old Tampa Highway, about 1/2 mile from the access road 

 

 1 When the vehicle approaches a crossing, the flagman contacts the CSXT train dispatcher to determine if it is 

safe for the vehicle to cross the track. If the dispatcher determines that no train movements will be affected, he 

grants authorization to the flagman for the track between two milepost areas that include the crossing, and restricts 

all train movement into this area. The section of track is closed to train traffic until the flagman relinquishes his 

authority back to the train dispatcher. Additional information about track movement restrictions appears later in this 

report under Amtrak Operations. 

 2

 Most of the times in this narrative are based on a videotape of portions of the move.
240 210 180 150 120 90 60 30 0

1 0

Approximate Scale in Feet

 North Old Tampa Highway

Side View of Crossing (Above)

OAbout 34 feet north of Old Tampa Highway, the grade of KUA Power Road begins an

ascent that continues for about 120 feet and

that averages 3.8 percent.

Q About 35 feet north of the CSXT tracks,

the KUA Power Road begins a 4.4 percent

descent.

0 As the tractor of the 184-foot-long Rountree vehicle began its descent, its cargo deck,

which had a 24-inch clearance, began to

bottom out at.the high point in the road.

Overhead View of Crossing

Figure l.--Rountree vehicle on KUA Power Road grade crossing.

2
LEGEND

Figure 2.--Route of the Rountree vehicle from Tampa to Intercession City.
4 

to the KUA plant, the Rountree regional manager said two men whom he believed to be 

KUA employees helped him pull a street sign 

out of the ground to allow the load to get by. 

He stated one of the men told him, "You got a 

train at 1 o'clock," which led him to believe 

that KUA personnel were in contact with 

CSXT and that a train was due at 1 p.m. at the 

KUA Power Road crossing. The KUA 

employees deny telling the Rountree regional 

manager any information about the arrival time 

of the train. (Figure 3 shows a timeline of 

precollision events.) 

 The Rountree crew first tried to turn 

left from Old Tampa Highway onto KUA 

Power Road, but had to abandon the effort 

because guy wires to a utility pole blocked 

the passage of the vehicle. Backing the unit 

onto Old Tampa Highway took about 15 minutes. They then drove east about 2 1/2 miles, 

turned the vehicle around, and drove back to 

attempt a right turn onto KUA Power Road. 

When the Rountree vehicle began the turn onto the private access road, the FHP escort 

officers parked their vehicles on the Old 

Tampa Highway shoulder, where they computed their time and mileage and waited to be 

paid by Rountree. 

 Before going into the turn, the equipment supervisor had the crew raise the rear 

tower3

 to keep the turbine level while the 

front of the cargo bed was on the ascending 

grade of the crossing. As the unit moved 

forward, the cargo deck began to bottom out 

on the roadway north of the track. The equipment supervisor said that because the tiller unit 

was not aligned with the rest of the vehicle 

after the turn, he believed that backing off 

the track would be more difficult and take 

 

 3

 A device on each of the cargo bed support dollies that enables crews to lower the cargo deck for loading and 

unloading or to raise the cargo deck to clear humps, dips, or obstacles. With both towers fully raised, the maximum 

clearance of a loaded cargo bed is about 24 inches. 

DATE/TIME EVENT 

Nov. 29

 11:00 a.m. Rountree crew oversees offloading of 

turbine from barge onto vehicle. 

 11:25 p.m. Vehicle departs Port of Tampa en 

route to Intercession City. 

Nov. 30 

 11:12 a.m. Vehicle attempts first turn onto KUA 

Power Road; is blocked by guy wires. 

 11:31 a.m. Amtrak train departs Tampa en route 

to New York City. 

 12:08 p.m. Amtrak train departs Lakeland for its 

next stop, Kissimmee, which is 43 

miles away. 

 12:25 p.m. Vehicle turns onto KUA Power Road, 

is proceeding across track when the 

front of the cargo bed begins to drag 

on the pavement. 

 12:29 p.m. Rountree crew lowers cargo deck to 

shim the load. 

 12:32 p.m. According to Rountree regional manager, KUA employee tells him "only 

25 minutes left" [before the train].* 

Rountree manager tries to call Orlando trainmaster, but gets no answer. 

 12:37:17 p.m. Rountree manager tries a CSXT tollfree number, gets a menu recording, 

and hangs up in frustration. 

 12:39:15 p.m. He tries the toll-free number again, is 

listening to the menu for 32 seconds 

when he hears the train whistle blow. 

 12:40:06 p.m. Amtrak train 88 broadsides the cargo 

deck and turbine. The locomotive and 

four cars derail. 

 * The KUA employee denys making this statement. 

 Figure 3. Precollision timeline.
 5 

and take longer than shimming4 the cargo deck in place. He decided to adjust the cargo deck, which 

he estimated would take 6 minutes, while the vehicle straddled the live mainline track. 

 The Rountree regional manager said that while his crew was shimming the cargo deck, 

one of the KUA employees approached, looked at his watch, and said, "Only 25 minutes left." 

In later interviews, the KUA employees deny saying this. 

 The Rountree regional manager said he interpreted the KUA employee's statement to 

mean the time of the next train at the crossing, so he "double-timed" to his vehicle to call CSXT 

via his mobile telephone and have the train stopped. He said he did not have a CSXT emergency 

number and that the CSXT passage application form that he had been given for the trip did not 

list any telephone numbers. He was trying other CSXT telephone numbers that he knew, 

including a toll-free number, when he heard a train whistle blow. About 12:40 p.m., just as the 

driver and tillerman had climbed back aboard the vehicle to move it, the crossing lights and bells 

activated. Within seconds, the gates descended, hitting the turbine. 

 The Rountree equipment supervisor started to run toward the train, waving his arms 

to get it to stop. He yelled into his portable two-way radio for the driver to bail out of the truck 

cab. When the tillerman saw the crossing gate arms strike the turbine, he realized a train was 

coming. He was jumping from his position when the collision occurred. The Rountree regional 

manager, who had started to run toward the vehicle, saw people running from the unit, so he 

turned and ran back away from the crossing. 

 Meanwhile, the engineer and assistant engineer were in the operating compartment of the 

National Railroad Passenger Corporation's (Amtrak's) train 88, the Silver Meteor, which was 

en route from Tampa to New York City, New York. Train 88 was approaching railroad milepost 

(MP) A-816 at an engineer-reported speed of 79 mph when the engineer, who was at the control 

stand, reported that through the trees he saw "a big blue obstacle5

 on the crossing." When the 

grade crossing came into clear view and he saw the track blocked, he placed the train brakes in 

emergency and he and the assistant engineer exited the cab through the auxiliary engine 

compartment access door. 

 Amtrak train 88 struck the left side of the cargo deck and the turbine. The locomotive 

and the first four cars of the eight-car consist derailed, carrying the turbine and parts of the 

Rountree vehicle with it. The turbine came to rest partly atop the second railroad car. The locomotive and other wrecked cars came to rest over or near two buried high-pressure liquid product 

lines operated by Central Florida Pipeline Corporation (CFPL).6 (See figure 4.) 

 

 4 The clearance of a cargo deck can be increased by adding temporary spacers, or shims. A more complete explanation of shimming appears later in this report. 

 5

 The turbine was covered with blue tarps. 

 6

 At 12:42 p.m., one pipeline was transporting unleaded gasoline at a calculated pressure of 500 pounds per 

square inch guage (psig), and the other was transporting aviation jet fuel at a calculated pressure of 300 psig.
Figure 4.--Aerial shot taken by Orlando-Sentinel photographer about 2 p.m.

Routes of pipelines are superimposed. Arrow points to CFPL pipeline marker.

6
 7 

Events Following the Collision 

Emergency Response.--At 12:45 p.m., a resident called the Osceola County Communications Center (911) and reported a "train derailment at 6030 Old Tampa Highway." Eight 

rescue and fire units initially responded. The Osceola battalion fire chief assumed responsibility 

as incident commander (IC) and established a command post (CP) and triage area near Old Tampa Highway when he arrived on scene at 12:52 p.m. He radioed area hospitals to activate their 

disaster plans and requested medical evacuation (Medivac) helicopters. He directed responders 

to begin efforts to extricate the crewmembers trapped in the locomotive and to conduct a sweep 

of each railroad car to identify, classify, and tag patients. No fire resulted from the accident. 

 Responders evacuated all passengers from the train by 1:37 p.m. Osceola Fire Rescue 

personnel had to remove the roof hatch of the overturned locomotive to extricate the trapped engineer and assistant engineer. By 3:15 p.m., response personnel had transported 59 injured to 

area hospitals, where 15 were admitted for further treatment. The emergency responders included 24 paramedics, 29 emergency medical techncians (EMTs), and 18 firefighters. 

 Photographs taken by area newspapers about 2 p.m. show that tape denoting an investigation area had been strung along the treeline, within a few feet of pipeline markers that had not 

been knocked over by the derailing train. 

Pipeline Operator Actions.--At 1:50 p.m., about 1 hour after the accident, an off-duty 

CFPL operator who had seen a television report on the derailment alerted the CFPL Port of 

Tampa station operator.7

 After verifying the location of the derailment, CFPL shut down the 

pumps on both pipelines at 1:54 p.m., monitored the pressure in the lines for 2 hours to ensure 

that neither were leaking, and alerted their customers to open their valves so that as much 

product as possible could be drained from the lines. This reduced the pressure in the lines to the 

lowest level possible, about 5 pounds per square inch guage (psig). 

 About 2 p.m., a CFPL maintenance man from Plant City, Florida, and a CFPL field engineer from Tampa proceeded to the accident site. When the CFPL personnel arrived on scene 

shortly after 3 p.m., the IC indicated that he did not know about the active pipelines at the site 

and gave the CFPL employees permission to check on them. Some pipeline markers near the 

KUA Power Road were intact, but other markers had been either damaged or destroyed. The 

CFPL field engineer placed marker flags along the pipeline routes. He then briefed CSXT onscene personnel on the pipelines' locations, and depths, and the hazardous materials they were 

transporting. He said he advised CSXT personnel that the pipelines were still under some 

pressure and that they would need to keep railcars and heavy equipment off the pipelines. 

 The IC said that he met with CSXT and CFPL personnel at the CP, asked that they work 

together during wreckage clearing, and advised them that they should report back to him should 

 

 7 The CFPL subsequently was notified by the Florida one-call system at 3:03 p.m. Additional information 

 about postaccident emergency notification and actions appears later in this report under Survival Factors. 
8 

any problems arise. When the CFPL field engineer asked a CSXT representative why CSXT

hadn't notified CFPL about the derailment, the CSXT employee said that he did not know.

Injuries.--Table 1 is based on the injury criteria8

of the International Civil Aviation Organization, 

which the Safety Board uses in accident reports

for all transportation modes. An injury table

based on the Abbreviated Injury Scale (AIS) of 

the Association for the Advancement of 

Automotive Medicine is shown in Appendix B. 

Damage.--The Rountree vehicle and the turbine were destroyed, and the locomotive and the first 

three railcars were damaged extensively. Rountree estimated the replacement cost of the tractor 

and transporter at $400,000. KUA valued the turbine at $10.5 million. Amtrak estimated the 

damage to rolling stock at $3 million. CSXT estimated the damage to track and signals at 

$15,000. CFPL estimated that its costs for pipe replacement and emergency response was 

$120,000 and its loss of commerce while the pipeline was out of service was $200,000. Total 

damage estimates including cleanup costs exceeded $14 million. The KUA reported that they

incurred $156,816 in costs for the construction delay. 

Truck.--Inspections revealed no defect attributable to the collision. Damage to the tractor 

and transporter precluded any mechanical function inspections. Maintenance records and interviews with maintenance personnel indicated that the vehicle had been maintained in compliance 

with the Federal Motor Carrier Safety Regulations. The crew reported that they had not experienced any mechanical problems on the trip from Tampa and that they had not stopped on the 

railroad tracks because of a mechanical malfunction. 

Train.--Upon striking the turbine, the locomotive nose, which contained a toilet and the 

event recorder, was crushed 12 inches. The locomotive came to rest on its left side about 28 feet 

north of the track line and about 364 feet east of the point of initial impact. Investigators found 

the automatic brake handle in the emergency position. The locomotive fuel tanks were breached, 

and diesel fuel was leaking. In the lounge car, investigators found four pedestal seats broken 

from their bases and five tables bent toward the front of the train. Safety Board investigators 

found that the pedestal seats had separated at the weld area where the pedestal was connected 

to the base. Amtrak's General Manager of Mechanical Standards and Compliances later stated 

that the pedestal seat should have collapsed or buckled along the pedestal support rather than 

separating from the base. 

 

 8

 Title 49 Code of Federal Regulations (CFR) 830.2 defines fatal injury as "Any injury which results in death 

within 30 days of the accident" and serious injury as an injury that "(1) Requires hospitalization for more than 48 

hours, commencing within 7 days from the date the injury was received; (2) results in a fracture of any bone (except 

simple fractures of fingers, toes, or nose); (3) causes severe hemorrhages, nerve, muscle, or tendon damage; 

(4) involves any internal organ; or (5) involves second or third degree burns, or any burn affecting more than 

5 percent of the body surface." 

Injury

Type

Rountree 

Crew (4) 

Train 

Crew 

(10) 

Passengers 

(89) 

Total 

(103) 

Fatal 0 0 0 0 

Serious 1 2 3 6 

Minor 0 3 50 53 

None 3 5 36 44

Table 1. Injuries from accident.
 9 

Pipeline.--The CFPL elected to install new pipeline sections in the accident area because 

replacement was more expeditious and cost about the same as performing an instrumented inspection to determine whether the pipelines sustained internal damage.9

 The pipeline company 

excavated both pipelines and found no visible damage to the exterior of the pipes. 

Vehicle and Pipeline System Information 

Rountree Vehicle

 Tractor.--The Rountree power unit was a 1990 Peterbilt 3-axle conventional cab 

truck-tractor equipped with a sleeper berth. The unit had a diesel engine, an 18-speed manual 

transmission, and a gross vehicle weight rating (GVWR) of 58,000 pounds. All axles were 

equipped with standard S-cam air-mechanical brakes. 

 Modular Transporter.--The modular transporter (figure 5) was typical of units 

used by the heavy rigging industry to move oil drilling rigs, earth-moving equipment, heavy 

transformers, power-generating components, and the like. The manufacturer estimates that about 

100 units of this type are in operation throughout the United States. The transporter in the Intercession City accident was a 1992 Trail King with a load-carrying capacity of 110 tons. The 

transporter had 10 axles, which were equipped with standard S-cam air-mechanical brakes. The 

cargo bed was supported by two jeep dollies,10 one forward and one aft. 

 The tongue section of the front jeep dolly connected to the tractor's fifth wheel. The dolly 

frame articulated between two sets of tandem axles. Each gooseneck had a hydraulic tower, 

which crews used to lower the cargo deck for loading and unloading or to raise it to clear humps 

or dips in the road surface or low roadside obstacles. When unloaded, with both towers fully 

raised, and without shims, the cargo bed had a maximum ground clearance of about 48 inches. 

When loaded, the maximum clearance decreased to about 24 inches because of flexure in the 

deck frame and suspension compression in both dolly axles. When operating on the highway, 

 the clearance of the loaded cargo bed fluctuated between 6 and 8 inches. 

 The basic cargo deck section was 31 feet long with a 28-foot platform. For longer 

cargos, crews added one or two extension sections, which were 20 feet long with an 18-foot 

platform, and 16 feet long with a 14-foot platform respectively. The accident vehicle was 

operating with all three sections for a total cargo deck length of 67 feet. 

 The rear jeep dolly unit had three separate sections; the tiller operator's position was at the 

back of the third section. The first section, a short dolly, had one set of tandem axles. When 

 

 9 The CFPL's launch point for an internal inspection device is Tampa. 

 10 The heavy hauling/rigging industry uses the term jeep dolly to denote various configurations of long-frame, 

or "wing", dollies and short-frame dollies when they are combined to accommodate the weight of a load. A jeep dolly 

unit is usually positioned at each end of the cargo bed.
Enlarged Below

Peterbilt Tractor and Modular Transport Trailer

Normal travel configuration: Hydraulic tower is in the extended position; no shims are used at goose

neck/bed connection.

Pivot Point ’

Set-down mode: Hydraulic tower is in the retracted position. The goose neck pivots, leaving an

opening for the placement of shims.

Modified travel configuration: Hydraulic tower is in extended position. The shims change the position

of the goose neck, which provides increased ground clearance.

**For illustration Only, Not Drawn to Scale**

Figure 5. Drawings show how the front goose neck is shimmed to increase clearance.

To raise the cargo bed at the rear of the vehicle, crews shim the rear goose neck.
 11 

crews connected or "pinned" the tandem axles to the bed with a tow bar, these axles tracked the 

cargo bed during forward movement. For turning or backing, the tow bar had to be disconnected 

and these axles steered either by the tiller operator or by remote control by a person on the 

ground. The second section had nonsteerable tandem axles mounted on a long (wing) dolly. The 

third section, the tiller, was a wing dolly with a set of tandem axles that could be steered from 

the tiller position or by remote control from the ground. 

 Crews could increase the ground clearance of the cargo deck by adding shims at one or 

both of the goose neck connections. Using the hydraulic towers, crews lowered the cargo deck 

either onto the ground or onto cribbing so that the weight of the deck and its cargo was removed 

from the goose necks. Crews then pivoted the goose neck to create a gap at the connection to 

the cargo deck, and inserted a shim into this gap. 

 The transporter had seven articulation points, three to the front of the cargo deck and 

four to the rear. Forward movement did not require much coordination among crewmembers. 

Rearward movement of more than a few feet required the full coordination of the 3-person crew. 

To move the transporter backwards usually required that it be reconfigured, such as disconnecting the rear dolly tow bar. Thus, the company always planned major move routes to maximize forward movements and minimize rearward movements. 

 Train.--Table 2 shows the consist of 

Amtrak train 88 on the day of the accident. 

 Locomotive.--The locomotive 

unit, Amtrak No. 306, was built by General 

Motors Electro-Motive Division. It was equipped with a 3000-hp engine, 2 four-wheel 

trucks, and a 1,800-gallon fuel tank. On-board 

equipment included a 97-channel radio, 26L 

airbrake equipment, a Barco Bach-Simpson 

speed recorder, and an over-speed-limit control 

with a warning whistle. Records indicate the 

unit was last inspected on November 23, 1993. 

 Car Information.--The lounge 

and sleeper cars were Pullman Standard 

Heritage Class, and the other six cars were 

Amtrak Amfleet Class. 

 

 Pipeline.--The two CFPL pipelines along the CSXT right-of-way include a 6-inchdiameter welded steel pipeline that transports jet fuel from the CFPL terminal at the Port of 

Tampa to the Orlando, Florida, Municipal Airport, and a 10-inch-diameter welded steel pipeline 

that transports petroleum products from Tampa to Taft, Florida. The 6-inch pipeline was constructed of 6 5/8-inch outside diameter (OD), 0.219 wall thickness (WT) steel pipe manufactured 

Consist 

Position

Unit 

Number

Unit/ 

Car Type

1 306 Locomotive 

2 1174 Mail 

3 1168 Bag/Mail 

4 2452 Sleeper 

5 3107 Lounge 

6 25021 Coach 

7 25055 Coach 

8 25099 Coach 

9 25019 Coach 

Table 2. Consist of train.
12 

to the American Petroleum Institute (API) Standard for 5L X42 line pipe, and the 10-inch line 

was constructed of 10 3/4-inch OD, 0.206 WT steel pipe manufactured to the API Standard for 

5L X60 line pipe. The 6-inch-diameter pipeline is buried 22 to 30 inches deep about 55 feet 

south of the track and the 10-inch-diameter pipeline is buried 34 to 36 inches deep about 30 feet 

north of the track. 

Personnel Information

Amtrak Crew.--Amtrak train 88 had five operating crewmembers and five on-board 

service personnel. The operating crew included an engineer, assistant engineer, conductor, and 

two assistant conductors. The on-board service personnel included a lead service attendant and 

four other attendants. Amtrak personnel records indicate that each crewmember was qualified 

to operate on the CSXT. 

 The operating crewmembers were headquartered at the Amtrak Jacksonville, Florida, 

terminal. Before coming on duty on November 30 in Tampa, the crewmembers had been offduty in compliance with the provisions of the Hours of Service Act. On November 29, 1993, 

they arrived at Tampa on train 87 at 6:03 p.m., whereupon they went off duty at 6:18 p.m. The 

operating crewmembers came on duty at Tampa at 11:01 a.m. on November 30, 1993. 

 The engineer was hired by Amtrak on July 14, 1989. He had his last physical on June 

16, 1993. His engineer certification was issued on July 7, 1993, and his last rules examination 

was on September 22, 1993. The assistant engineer was hired on August 20, 1986. His last rules 

examination was on August 25, 1993, his last physical was on November 15, 1993, and his 

engineer certification was issued November 21, 1993. The conductor was hired on October 28, 

1989, his last physical was April 21, 1993, and his last rules examination was August 31, 1993. 

 One assistant conductor, who was hired on August 20, 1986, had his last physical on 

August 30, 1991, and took his last rules examination on August 5, 1993. The other assistant 

conductor was hired and had his last physical on January 25, 1993, and took his last rules 

examination on February 20, 1993. 

 The on-board service (OBS) crew also came on duty at Tampa. When the accident occurred, 

two OBS employees were in the lounge car, one was in a sleeper car, and two were 

in different coaches. Amtrak personnel records indicate that OBS crewmembers had received 

training in emergency evacuation procedures. Two employees took the training in August 1993, one 

in January 1985, and one in May 1987. The personnel file for the fifth employee did not 

indicate a training date. 

Rountree Crew.--Operating the transporter required a minimum crew of three: a tractor 

driver, a tiller operator, and an equipment supervisor. On the day of the accident, the regional 

manager was in charge of the move and accompanied the modular unit in a separate vehicle. The 

crew used two-way radios to communicate with each other and with escort personnel. Crewmembers acquired their expertise through on-the-job-training under the supervision of 

experienced operators and company officials. 
 13 

 The driver, age 51, had a valid Florida class A commercial vehicle driver's license with 

multi-trailer and tanker endorsements, and a valid medical examiner's certificate dated December 

4, 1992, indicating he was physically qualified to drive commercial vehicles in interstate commerce. 

Both his license and his medical examiner's certificate restricted him to driving with corrective 

lenses. His driving record for the 36 months before the accident showed no convictions 

for violations. He had been a truckdriver for Rountree since 1986 and a professional truck driver 

for almost 28 years. He had regularly driven the accident tractor for about 1 year. 

 The tiller operator, age 46, had a valid Florida class A commercial vehicle driver's 

license and a valid medical examiner's certificate dated December 3, 1992, indicating he was 

physically qualified to drive commercial vehicles in interstate commerce with no restrictions. He 

had been a truck driver for Rountree since 1987. His driving record for the 36-month-period before the accident showed he had been convicted of careless driving while operating a commercial 

vehicle following an accident in Lake County, Leesburg, Florida, on September 2, 1992. 

 The equipment supervisor, age 31, had been employed by Rountree for 7 1/2 years, 

during which he was a mechanic for 2 years and then supervisor of the transporter operation and 

maintenance for 5 1/2 years. On moves involving the transporter, he accompanied the unit in 

a separate vehicle. Prior to joining Rountree, he had been employed as a truck mechanic. 

 The regional manager, age 56, had been employed by Rountree for 30 years, during 

which he worked as a dispatcher, terminal manager, and regional manager. He had been the 

regional manager for 11 months before the accident. 

 Hours of Service.--Federal regulations prohibit a driver in interstate commerce from 

driving more than 10 hours and from driving after having been on duty more than 15 hours since 

his last 8 hours off duty. 

 Rountree crew service.--The tiller operator stated that on November 29, he, the 

equipment supervisor, and the truckdriver assembled the Rountree vehicle and oversaw the 

loading of the turbine at the Port of Tampa from about 9:00 a.m. to about 5:30 p.m., with a 1- 

hour break for lunch. They then returned to their motel rooms and remained off duty for about 

4 1/2 hours until 10:00 p.m., when they reported back at the Tampa pier to begin the trip to 

Intercession City. The tiller operator's duty status record showed he was on duty-not driving 

from 10 p.m. on November 29 until the time of the accident, 12:40 p.m. on November 30, a 

total of 14 hours, 40 minutes. From the time the driver and tiller operator began work at 9 a.m. 

on November 29 until the accident, they had been on duty about 20 hours since their last 8 hours 

or more off duty. 

 Investigators found no duty status records (daily logs) for the truckdriver's accident trip 

after the accident. The truckdriver stated he did not recall any of the events associated with the 

accident trip. 

 Postaccident actions.--A Rountree official advised the Safety Board that in order 

to ensure compliance with State and Federal hours-of-service regulations, the company will have 
14 

a second crew available to relieve the regular crew on future moves to prevent hours-of-service 

violations. 

Toxicological Tests 

 Rountree Employees.--The injured truck driver was taken to Orlando Regional Medical 

Center, where technicians obtained blood and urine samples for medical reasons at 3:59 p.m., 

3 hours and 19 minutes after the accident. The medical center tested the blood sample for the 

presence of alcohol and found none. The medical center also tested the urine sample for the 

presence of five drugs (cocaine, amphetamines, cannabinoids, opiates and phencyclidines). The 

results of the drug test were negative. 

 The following day, about 25 hours after the accident, Rountree required the three other 

employees to submit urine samples for drug testing. The results of the drug tests were negative. 

Amtrak Crew.--Amtrak did not have the operating crew toxicologically tested after the 

accident because 49 Code of Federal Regulations (CFR) 219.201(b) provides as an exception that 

"no test shall be required in the case of a collision between railroad rolling stock and a motor 

vehicle or other highway conveyance at a rail/highway grade crossing." 

Accident Site Information 

 

Kissimmee Utility Authority (KUA) Power Road.--At the accident site, the CSXT right-ofway is in a general east-west direction and extends 100 feet on both sides of the track centerline. 

Property owned by the KUA borders the right-of-way on the north; Old Tampa Highway borders 

the right-of-way on the south and essentially parallels the CSXT track in the accident area. To 

access its new combustion turbine power plant, KUA and CSXT entered into an agreement on 

April 26, 1993, which provided for KUA to construct, use, and maintain a private road from 

Old Tampa Highway across CSXT's track and right-of-way to the power plant, and for CSXT 

to install active warning devices at the grade crossing created by the planned roadway. The 

private road was opened for use on August 5, 1993. 

 The north-south KUA Power Road has two 12-foot-wide asphalt lanes with 5-foot-wide 

gravel shoulders. The CSXT track are about 122 feet north of the junction of the KUA Power 

Road with Old Tampa Highway. The plant facility gate is about 325 feet north of the track. 

 To cross the track at grade, the KUA Power Road was constructed with an ascent that 

averages 3.8 percent beginning about 34 feet north of the north edgeline of Old Tampa Highway 

and that extends about 120 feet from a point about 34 feet north of the Old Tampa Highway 

edgeline to a point about 35 feet north of the track, the highest point of the roadway. The 

roadway then begins an average 4.4 percent descending grade for about 105 feet back to the 

approximate level of the surrounding terrain. The KUA Power Road grade crossing is assigned 

Department of Transportation/American Association of Railroads (DOT/AAR) No. 643879-N. 
 15 

Track, Wayside, and Crossing Signals.--The grade crossing is at railroad MP A-816.27 

in the Lakeland Subdivision of the CSXT Jacksonville Division. CSXT maintains the track to 

meet or exceed Class 4 Federal Railroad Administration (FRA) Track Safety Standards. Passenger trains operate at a maximum authorized speed of 79 mph. 

 In the accident area, the track is constructed of continuous welded rail and from an 

eastbound engineer's perspective has a 1-degree right hand curve and a 0.07 percent ascending 

grade. The north rail is superelevated about 3 inches above the south rail. A whistle post designating the point at which an eastbound train must begin sounding a crossing warning signal is 

2,160 feet in advance of the KUA Power Road crossing, on the engineer's side of the track. 

 The crossing was equipped with flashing red lights, gates, and an audible device (bell), 

which were installed by October 21, 1993. A Harmon Electronic motion detector 3,317 feet west 

of the KUA Power Road crossing activates the crossing signal equipment for eastbound trains. 

Pipeline Markers.--In the area of the grade crossing, 3-foot-high white markers were 

spaced along both mainlines. At the top of each of the pipeline markers was a 10-inch-diameter 

circular black and yellow sign that was imprinted with a red-lettered warning to call the toll-free 

telephone number indicated on the sign should an emergency arise. 

Carrier Information.--Following an overview of each of the primary parties in this accident, 

this report will discuss the operations of Rountree and CSXT as they pertain to oversize and 

low-clearance vehicle move permitting and procedures. Additional information related to emergency response operations and procedures appears later in this report. 

CFPL Operations.--CFPL is owned by GATX Terminals Corporation, a part of GATX, 

Inc. CFPL operates two hazardous liquid mainlines, which lay predominantly in (CSXT) railroad 

rights-of-way between Tampa and Orlando. The dispatcher at Hemlock Pump Station, which is 

near the Port of Tampa and is the CFPL control center, controls the CFPL system by means of 

remotely operated valves at its pump stations in Tampa, Auburndale, Intercession City, 

Kissimmee, and Taft. 

 Rountree Operations.--Rountree is authorized by the Interstate Commerce Commission 

to operate as a common carrier by motor vehicle over irregular routes in 13 southeastern States, 

transporting commodities that because of their size or weight require special handling or 

equipment. Rountree operates 54 tractors (47 owned and 7 leased), and 150 trailers of various types, 

including flat beds, lowboys, drop necks and steer dollies. 

 Rountree's principal place of business is in Jacksonville, Florida, where it domiciles 25 

full-time drivers and 7 independent contractor/drivers at its terminal. The company also has terminals in Orlando, Florida, and Fort Lauderdale, Florida, which have 2 and 4 full-time employee drivers respectively. 

 
16 

CSXT Operations.--The accident occurred in the Lakeland subdivision of the CSXT 

Jacksonville division. Other CSXT divisions and subdivisions traversed while the Rountree 

vehicle was en route to Intercession City are listed in Appendix C. In the Tampa area, territorial 

assignments for maintenance-of-way personnel in subdivisions of the Fertilizer Business Unit and 

Jacksonville divisions overlap. The single track that passes through Intercession City carries two 

scheduled Amtrak passenger trains and about six freight trains daily. While on the CSXT system, Amtrak crews are subject to both Amtrak's Manual of Instruction for Transportation Department Employees and CSXT's operating rules. 

Amtrak Operations.--Train 88, the Silver Meteor, is a regularly-scheduled Amtrak 

 revenue run originating daily in Tampa, Florida, with a final destination of New York City, 

New York. The Amtrak schedule lists the following departure times for train 88: Tampa, 11:30 

a.m.; Lakeland, 12:03 p.m., Kissimmee, 12:45 p.m. Between Tampa and Kissimmee the CSXT 

Special Instructions list nine locations where the maximum authorized speed is restricted to 40 

to 75 mph. 

 Amtrak operating crews receive special notices, bulletins, or messages about events that 

affect the movement of their train. Such information items typically identify areas having temporary 

speed restrictions, areas where railroad personnel are working on or near the track, 

and areas where the train dispatcher has granted temporary control to a flagman. The notices do 

not necessarily advise Amtrak crews why a given area, or zone, is under a flagman's control. 

For example, the notices do not advise train crews that a flagman has been granted control of 

a zone for the purpose of protecting the crossing movement of an oversize vehicle. Crews cannot 

move a train into a zone that is under a flagman's authority without first contacting him, usually 

by radio, and obtaining permission to do so. 

Oversize Move Permits and Procedures 

Regulatory Requirements.--The State of Florida Uniform Traffic Control Section 316, 

"Moving Heavy Equipment at Railroad Grade Crossings," requires that operators of certain 

types of highway vehicles with low ground clearance notify railroads of each intended crossing 

at grade (see appendix E). The statute further states "... a reasonable time shall be given to the 

railroad to provide proper protection at the crossing." Officials for Rountree and CSXT both 

advised the Safety Board that their company was not aware of this requirement before the 

accident. Neither Federal nor State of Florida regulations specifically require that rail carriers 

provide protection at crossings. 

State Permitting Procedures.--The State of Florida requires that motor carriers obtain 

a permit to operate vehicles exceeding maximum height, width, length, or weights on any Statemaintained highway. 

 To obtain an overdimension/overweight permit, operators must first submit an Overload 

Permit Request (OPR) to the Permit Section of the Florida Department of Transportation 
 17 

(FDOT) State Maintenance Office in Tallahassee, Florida. Applicants must provide the following 

information on the OPR form: name and address of operator; description of the load, including 

dimensions, axle spacings, and weights; number and size of tires on each axle; and an exact 

description of the route, including Federal, State, and County road numbers and city streets. 

Applicants must also include a map showing the route along State-maintained highways. 

 The permit section personnel then perform a design analysis of the highway structures, 

including bridges and box culverts, on the requested route. If they identify a problem with the 

route, the OPR is denied and the applicant must select and file a different route. The process 

continues until the permit section determines that the proposed route is satisfactory, at which 

time it assigns a "Move Request Number" to the OPR. Operators can file and the permit section 

can approve an OPR well in advance of the move. The operator then contacts the FDOT permit 

section shortly before the move to obtain the actual permit. 

 When the FDOT issues permits, it does not advise applicants that Florida law requires 

operators of certain low-clearance vehicles to provide railroads with advance notification of the 

applicant's intent to travel over grade crossings. An FDOT Permit Section official stated that 

if any terms or conditions of a permit are violated, the permit is invalid. The FDOT Permit 

Section issues about 90,000 permits per year. 

Local Permits.--In addition to the FDOT permit, carriers must obtain permits from city 

and/or county agencies if the movement of the oversize vehicle might impact a structure(s) 

within their jurisdictions. For the Intercession City move, Rountree obtained permits from the 

City of Tampa and Hillsborough, Pasco, and Polk Counties. 

Escort Requirements.--The FDOT requires an off-duty police escort for any vehicle and 

cargo more than 16 feet high. Before the Intercession City accident, escort officers were only 

required to obtain advance approval to perform the escort and to radio the FHP dispatcher at the 

onset of the trip, when they began escorting the overdimension load. The two off-duty FHP 

escort officers hired for the Intercession City trip had accompanied overdimension Rountree vehicles on previous occasions. They did not nor did FHP procedures require them to inspect the move 

permits issued to Rountree by the FDOT or other local agencies. (Information about postaccident 

changes to FDOT escort requirements appears later in this report.) 

Other Requirements.--Figure 6 lists other typical FDOT restrictions. For the Intercession 

City trip, Rountree had to trim some trees along the route. 

The CSXT Application Process.--To provide the railroad with a means of protecting train 

movements, CSXT issues Right-of-Way: Passage application form to over-dimension vehicle 

operators routing their moves over at-grade crossings. A fee assigned to the passage form covers 

the carrier's costs of providing a flagman. In the case of all passage forms issued to Rountree, 

CSXT charged $200 per move. 

 The passage application form indicates the date, time, and affected location(s) of the 
18 

planned move. By signing the form, the 

applicant agrees to schedule the movement 

when it will not interfere with train operations, 

and to provide 24-hour notice of the move. 

Based on the route shown on the application, CSXT annotates it with the names and 

telephone numbers of subdivision supervisors 

who will be affected by the move. The motor 

carrier is to contact all CSXT supervisors listed 

on the passage form to confirm the date and to 

arrange for needed assistance. 

 Rountree Procedures.--The regional 

manager selects the trip route for the modular 

unit. After defining the correct highway 

designations for the route, he advises his supervisor, a Rountree vice president, who then 

calculates the anticipated weight on each axle 

of the combination. The vice president is 

responsible for filing the OPR with and obtaining the move request number from the 

FDOT Permit Section. The regional manager 

is responsible for procuring and complying 

with city or county permit requirements, as 

well as arranging for passage over grade 

crossings. 

Previous CSXT Permits Granted to Rountree.--CSXT records indicate that prior to the 

Intercession City load, CSXT prepared four Right-of-way: Passage forms to Rountree to transport seven loads of turbine generators and accessories to various points in Florida between 

October 1, 1992 and March 9, 1993. Copies of three application forms issued to Rountree 

appear in Appendix D. 

 CSXT prepared the first Rountree application form post facto after finding an overdimension Rountree vehicle carrying a turbine engine stuck under the grade crossing cantilever signal 

on Faulkenburg Road in the Tampa area on October 1, 1992. A CSXT signals supervisor for 

the Tampa area overheard a radio report of the fouled crossing and proceeded to the scene even 

though the grade crossing was not in his territory. He asked the Rountree employee in charge 

of the move11 for his Right-of-Way: Passage application. The Rountree regional manager replied 

that he didn't have a permit to cross the track, and had never obtained one before. 

 

 11 The regional manager who later would be in charge of the Intercession City move. 

Permittee is responsible for verifying all vertical 

and horizontal clearances on the route. 

Permit is usually valid for only one trip and

remains in effect for a limited number of days. 

Permit is valid from origin to destination on

State-maintained roads only. 

Movement is prohibited when visibility is less 

than 1,000 feet. 

Requirements for size and placement of warning 

flags, signs, and warning lights are specified.

Requirements for law enforcement escort are

specified. 

Overhead utilities must be contacted if height 

exceeds 16 feet. Utilities may require a line crew

to be in attendance. 

Mover shall be responsible and liable for

accidents, damages, and injuries. 

Certain overwidth/overlength units are 

prohibited from operating on certain highways

during rush hours.

Figure 6. Common Florida move restrictions. 
 19 

 After making arrangements to raise the cantilever signal support so that Rountree crews 

could get the vehicle off the track, the signals supervisor transported the Rountree manager to 

the CSXT Tampa office where the CSXT project engineer prepared a Right-of-Way: Passage

application for Rountree's Faulkenburg Road crossing transit. When asked if Rountree's regional 

manager mentioned where the load was going, the signals supervisor stated, "No, he didn't 

really tell me where it was going....I thought there was a power plant (in or near) Zephyrhills12, 

and I really didn't ask him where it was going."13

 On October 2, 1992, the CSXT Tampa office prepared the second right-of-passage 

application for Rountree to transport three overdimension loads from Tampa on October 5, 6, 

and 7, 1992. The route for the load to be moved on October 5 ends at Highway 301; the routes 

for the loads to be moved on October 6 and 7 end at Faulkenberg Road. The actual destinations 

of the loads were Umatilla, Florida, Dade City, and Umatilla, respectively. 

 The CSXT signals supervisor reported that shortly after his initial contact with the 

regional manager, about 3 a.m. one morning14 he received a telephone call at home from the 

Rountree regional manager reporting that the CSXT flagman for a CSXT-permitted load had not 

arrived at the pier in Tampa and that Rountree was going to proceed without flagging protection. 

The signals supervisor told the regional manager not to move without a flagman, traveled to the 

pier, and flagged for Rountree only to the end of his territory in the Tampa area. He did not see 

a CSXT flagman from the adjoining territory meet the vehicle. The Tampa supervisor did not 

ask if the vehicle was going over any other tracks outside his territory, and the Rountree regional 

manager did not offer any such information. The Tampa supervisor later stated that he 

"... assumed that he [the Rountree regional manager] wasn't crossing the railroad anymore." 

 The signals supervisor stated that during one of his conversations with the Rountree 

regional manager: 

I told him time and time again, don't go across the track unless you have 

somebody from the railroad there protecting it.... He said, 'it don't take me but 

about a minute to get across the tracks.' I explained to him . . . even at [a] 

protected crossing where you have crossing signals, the crossing signals is set for 

30 seconds warning time. If a train is approaching and you're going across the 

track that 30 seconds will not give you time to get cleared. You cannot clear the 

track. 

 

 12 Zephyrhills was in the Vitis subdivision of the Jacksonville subdivision, outside the signals supervisor's 

territory. The actual destination for the load was Dade City, Florida. 

 13 The Safety Board determined that in the case of this trip, the Faulkenburg Road crossing was the last highway-rail crossing on the route. However, Rountree crossed some tracks that were unprotected by CSXT and that 

were beyond the last point specified on the permits on at least two subsequent trips. 

 14 Although the signals supervisor could not recall the date, examination of the permits indicate this incident 

probably occurred on October 7, 1992.
20 

 On October 29, 1992, the CSXT Tampa office issued the third permit to Rountree to 

transport two overdimension loads on November 3 and 4, 1992. The permit itself does not list 

the load routes, but refers to two attachments, which are written on Rountree notepaper. Again, 

the last points indicated do not show the actual load destinations, Dade City and Umatilla. The 

first attachment showing the November 3 route ends at East Broadway and includes the notation 

"Your man will drop off here." The second attachment, which is for the November 4 load, indicates the route is the same with two extra crossings, one at Zephyrhills Bypass and the second 

at Highway 54. The attachment is annotated "...everything OK here" for the Zephyrhills Bypass 

crossing and "need to lift arm ... I will furnish crane ... " for the Highway 54 crossing. 

 On the October 29 permit, the CSXT Tampa office listed the name and telephone number 

of the signals supervisor in the Vitis subdivision as the point of contact to arrange to raise the 

cantilever signal support at the Highway 54 grade crossing. 

 On March 9, 1993, the CSXT Tampa office issued the fourth permit to Rountree to transport one overdimension load on March 17, 1993. The route indicated ends at the Highway 54 

grade crossing, although the actual destination was Gainesville, Florida. 

 Each of the four single-page permits also show a 24-hour advance notification number 

to call to arrange for a flagman, the name and toll-free telephone number of the CSXT chief 

dispatcher, and the names and telephone numbers of the CSXT signals engineer and communications supervisor for the Tampa area (see figure 7). 

The Intercession City Move

 Route selection and OPR approval--The Rountree regional manager said that he began 

preparing for the Intercession City move in March 1993 by scouting area roadways for 1 1/2 

days to determine an appropriate route. He decided that as far as practical the load bound for 

Intercession City would follow the same route as other similar shipments that Rountree had 

moved from Tampa, splitting off at the junction of Pasco County Road 54 and U.S. 98 east of 

Zephyrhills, Florida. 

 On November 9, 1993, a Rountree vice president met with KUA contractors at the Cane 

Island job site to discuss the details of the move. Neither the regional manager in charge of the 

Intercession City move nor a CSXT representative was present. A KUA contractor said that he 

asked the Rountree vice president if the transport vehicle would be able to traverse the elevated 

profile of the KUA Power Road grade crossing and the vice president assured him it would. He 

and another KUA contractor reported that the vice president told those attending that a CSXT 

flagman would be at all railroad grade crossings on the route. 

 Rountree's regional manager reported he last visited the KUA Power Road crossing on 

November 23, 1993. The roadway at the new crossing was complete. He said he anticipated 

having no problem getting over the new grade crossing. 
:ed

Figure 7.--The Right-of-Way: Passage Permit issued to Rountree on October 2, 1992,

is a single-page version that shows the CSXT telephone numbers at lower left.

21
22 

 According to FDOT Permit Office records, on November 19, 1993, the FDOT denied 

the first OPR that Rountree filed in October 1993 for the Intercession City movement because 

of a potential problem with a highway structure on the proposed route. After Rountree modified 

the route, the FDOT Permit Section approved the OPR on November 23, 1993. 

 The Rountree regional manager reported that after the Florida DOT Permit Section 

approved the OPR, he was traveling over the State-approved route and discovered that a bridge 

had been removed and replaced with a temporary steel bridge.15 Believing that the temporary 

bridge might slow or prevent passage of the turbine, he defined a different route, which he listed 

when he applied for and received the Polk County permit on November 29, 1993. He did not 

notify the Florida DOT Permit Section of his intent to deviate from the State-approved route. 

CSXT Permit.--According to the Rountree regional manager, he phoned the CSXT Tampa 

office in March 1993 and discovered that the project engineer with whom he had dealt previously had retired. When he asked the new CSXT project engineer for a right-of-passage permit 

to take a turbine from Tampa to Intercession City, the project engineer told him he was not 

familiar with the permit form. The regional manager said he read the title of the form, DEHouse Moving Application Sample (revised 11/03/89), from a prior permit. The CSXT project 

engineer responded that he did not know where the form was, but that he would try to find it. 

The Rountree regional manager said he twice called to remind the project engineer that he would 

be coming in to pick up the permit before the Intercession City trip. 

 The Rountree regional manager says he told the CSXT project engineer he was transporting a turbine from Tampa to Intercession City. He did not identify any roadways he intended 

to travel or tracks he would cross and the project engineer did not ask for any route information. 

 The CSXT project engineer says that he remembers getting a telephone call from Rountree, probably in October, telling him the plans for the Intercession City move, and that he 

arranged to complete the paper work. 

 On November 22, 1993, a Rountree administrative assistant went to the CSXT Fertilizer 

Business Unit office to pick up the CSXT permit. She showed the new project engineer an 

earlier permit listing a Tampa area route, which he used as a guide for filling out the 

Intercession City permit. 

 The CSXT project engineer later confirmed her account, stating, "At the time I was new 

in the capacity as a project engineer and never really handled any of these movements, permits, 

before." He said that he had looked in the former project engineer's files to find "something to 

give me some idea how to do it." In making out the new permit, he said, "I took them [Rountree] through what I thought was either to their final destination or at least through the Tampa 

 

 15 The temporary bridge was installed on November 19, 1993, 4 days before the FDOT Permit Section approved 

the Rountree OPR. A Permit Section official said that had his personnel known about the temporary bridge, which 

usually has a wooden pile substructure, they would have rerouted the Rountree vehicle because the load-carrying 

capacity of the substructure was uncertain. 
 23 

Division and since there wasn't anymore there [on the previous permit], I didn't follow through 

to see if it was going anywhere else." 

 The Rountree regional manager stated he was not concerned that the CSXT permit did 

not list all the planned grade crossings on the Intercession City trip. He said that the CSXT 

project engineer with whom he had dealt in the past had been interested only in Tampa area 

crossings, and had displayed no interest in crossings farther away. The Rountree manager also 

was not concerned about the omission of one Tampa area crossing because it was just a switching track and not a mainline. He expected the flagman to leave the convoy after this switching 

track because it was the location at which flagmen had left previous convoys. The CSXT permit 

did not list the accident crossing. The Rountree manager said that this omission did not surprise 

him because the crossing "was on KUA property, not public property," therefore the KUA 

crossing was not subject to permit requirements. He considered Old Tampa Highway the end 

of the permitted route and the KUA Power Road simply a job site entrance. Further, he considered it the responsibility of KUA to ensure safe delivery to its job site, which he felt included 

providing train-related information. 

 The route description on the Intercession City permit (see figures 8a and 8b) is identical 

to the route on the October 2, 1992, permit. Like the previous four single-page permits, it 

contains the advance notification telephone number to call to arrange for a flagman. Unlike the 

four previous permits, the project engineer used a two-page form for the Intercession City 

permit. On the single-page permits issued for previous moves, the toll-free telephone number 

of the CSXT chief dispatcher, and the names and telephone numbers of the CSXT signals 

 engineer and communications supervisor for the Tampa area appear at the lower left corner of 

the document. On the two-page form, this notification information is on the second page. On 

March 9, 1995, the project engineer informed the Safety Board that he could not recall if he 

gave the second page of the permit to the Rountree administrative assistant. On March 14, 1995, 

the project engineer signed an affidavit stating that he provided both pages, including the second 

page containing the telephone numbers, to the administrative assistant. The Rountree administrative assistant stated that she was given only the first page of the permit. 

 Postaccident Revisions.--On January 10, 1995, an official from CSXT's engineering 

department advised the Safety Board that as a result of the Intercession City accident, on July 

13, 1994, CSXT introduced Form 4493-(6/94), Permit For The Transportation and Movement 

of Unusual Vehicle Or Object Across Track(s) At Grade, for use throughout the CSXT system. 

The new form requests not only the name and address of the applicant and the time and date of 

the planned crossing, but also a description and the dimensions of the object being transported, 

and a description of the crossing, including city, county, state, DOT/AAR crossing inventory 

number, rail subdivision, rail MP, and the name of the roadway. CSXT requires that applicants 

prepare a separate form for each crossing they will traverse. The form does not ask that the 

applicant supply the final destination of the load. It requests that the applicant provide an emergency contact number and has a block for the CSXT division engineer's telephone number. The 

form does not include any other CSXT telephone numbers. 

 During a December 1994 deposition taken in conjunction with litigation stemming from 
Tampa, Florida, &.J. 22, , 1994

RIG,,T-OF-WAY : Passage

Division Manager

CSX Transportation

5656 Adamo Drive

Tampa, Florida 33619-3240

CSX TRANSPORTATION, INC.

Application is hereby made by !%a QTR E \a&aaCJz~C$ %+%Iq,zi3

the undersigned, hereinafter called "LicZsee:, for permission to move a

house across track and right-of-way property of CSX Transportation, Inc.,

hereinafter called "Licensor", at the following locations(s):

' \- 2-9 - 93 zz%-l

i.&.xr-rrb Pa&n- -l-e u- ST-., UoWH To &xwa CR., EAsTT<

so- ST. I MsaTu tp COLU~px~ cc. Eeg -iG b& 30

Date and Time Location

It is fully understood and agreed that said movement(s) shall be

made at the entire cost and expense of Licensee, including the coast of

flag protection, as specified in the Operating Rules of Licensor, and the

expense of any wireline or crossing signal changes necessary to

accomplish said movement(s). Licensee agrees to schedule said

movement(s) at an hour which will not interfere with the train operations

of Licensor and provide, without exception, 24 hour notice to Licensor as

to tine and date of movement, telephone (813) 664-63h.S-losrr= eJ.*m

In consideration o f the granting of this application, Licensee

hereby assumes and agrees to indemnify and hold harmless Licensor, its

successors and assigns, from and against all loss, costs, expense,

including attorney's fees, claims, suits and judgments whatsoever, in

connection with injury to or death of any person or persons, or loss or

damage to any property arising at or in any way connected wrth said

movement(s). ckas.s *.4-s-%5

Am

Fzu;o. Ilm.-4j

deposit of two hundred dollars ($200.00) is hereby

posted to cover anticipated expenses incurred by Licensor.

(Company Name) ~00~7zE -Tea\-& eG'Ui,G

(Address) m7n 3.0. %- &JE.

(City, State. zip) F=i.%

(Signature)

(Date) hbu. 22. 1-3 -

80 percent of original size

Figure 8a.--The first page of the Right-of-Way: Passage Permit for the Intercession City trip.

24
FORMS: DE-House Moving Application

Sample (revised 11-03-89)

cys: Mgr. Misc. Billing & Collections - Check for $ attached

Mr. R.J. Green, Chief Dispatcher - (800) 232-0149

Mr. M.R. Spoores, Engineer Signals -(813) 626-4027

Mr. R.H. Billingsley, Supv. Communications - (813) 626-9492

Roadmaster

 25 

Figure 8b.--Top of the second page to the Right-of-Way: Passage Permit for 

the Intercession City trip. Actual second page is full size.

the Intercession City accident, the CSXT project engineer involved in the Intercession City move 

produced a different Permit For The Transportation and Movement of Unusual Vehicle(s) Or 

Object(s) Across Track(s) At Grade than the CSXT Jacksonville Headquarters provided the 

Safety Board. The permit has different information than the July 13, 1994, permit, and includes 

spaces for listing all crossings, the "exact movement route," and the final destination. In a 

March 1995 interview with the CSXT project engineer, he stated that he has not received any 

official permit or instructions from CSXT. He said that he had "kind of pieced some stuff 

together in developing the form after the accident." This form has no CSXT telephone numbers. 

 After the accident, KUA contracted another motor carrier to deliver a replacement turbine. When the motor carrier notified CSXT of its intended route, a CSXT signals supervisor 

accompanied the motor carrier over the entire route before the intended move and listed each 

of the grade crossings by street or highway, railroad MP, DOT/AAR number, and the nearest 

city. He then notified all CSXT divisions about the crossings along the intended route. The 

replacement turbine was delivered in May 1994 without incident. 

Medical and Pathological Information 

 Most of the injured were transported by ambulance or bus to area hospitals, where they were 

treated for minor abrasions, lacerations, and contusions. Five of the six seriously injured 

were evacuated by two air ambulance helicopters. 

 Three passengers sustained serious injuries from being tossed against walls or tables. A 

woman, age 81, suffered fractured ribs and a concussion; a woman, age 77, suffered facial fractures; and a man, age 64, suffered facial lacerations and a head injury. The assistant engineer 

suffered hip and ankle fractures. An assistant conductor received a fractured sternum and neck 

injuries from striking a table and wall in the lounge. The truck driver, who suffered lacerations
26 

to his right ear and forehead and a cervical compression, was kept in the hospital for observation 

more than 48 hours. 

 Other train crew members who were admitted for further treatment included the engineer, 

who received cervical and lumbar trauma along with knee contusions; an OBS attendant, who 

received a fractured nose after striking a seat in the last car; and an OBS attendant, who received 

fractured ribs from striking a table in the lounge car. 

Survival Aspects 

Postaccident Survey.--Within 30 days 

of the accident, the Safety Board contacted 53 

passengers who were treated at local hospitals 

to obtain their observations about events 

shortly before and after the accident. Of those 

contacted, 17 responded. Their observations 

are summarized in figure 9. 

Lounge Car Injuries.--At the time of 

the accident, 12:40 p.m., 18 to 20 people 

were in the lounge (figure 10). In addition to 

the two injured OBS attendants noted above, 

an OBS attendant complained of minor 

injuries after being thrown against a lounge 

table and a lounge attendant received minor 

burns after being splashed with hot coffee. 

One passenger sustained chest trauma from 

striking tables, and another passenger received a head contusion after striking his 

head on a lounge partition wall. A passenger in 

a pedestal seat at table 11 received spinal 

trauma after she reportedly was thrown 

against and over the table. She said a broken chair also struck her right leg. Another passenger 

at table 11 was thrown more than 8 feet, striking table 10 with his left temple. 

Emergency Procedures 

Background.--Historically, railroads performed their own wreck-clearing following a 

derailment. During the past 2 decades, rail carriers increasingly have used private contractors, 

working under railroad supervision, to clear wreckage debris while the rail crews perform minor 

rerailing and damaged equipment loading. Some rail contractors became involved in the wreckage clean-up business because they were former pipeline contractors, and as such, owned large 

crawler tractors with side booms, which are used in pipe laying. According to spokespersons for

Most passengers indicated that the only warning they 

felt or heard prior to impact was the application of 

emergency braking. 

Most passengers were seated. Those facing forward 

were thrown forward and sustained mostly head and 

chest injuries from striking a seat back, seat back tray 

or dining table. Passengers reported several latched 

seat back trays dropped open. 

Those thrown to the floor struck their lower extremities on seat backs and seat supports. Several said 

their legs became pinned underneath the coach seats 

when they were thrown to the floor and they were 

unable to move until train crewmembers freed them 

by releasing the seat locks and rotating the seats. 

Passengers were able to use the exits from most 

coaches. However, after the train came to rest, several 

coaches were tilted, which precluded using the 

step devices that OBS personnel usually place on 

station platforms to facilitate exit from the train. 

Responders stacked railroad ties at some coaches to 

form steps at the exits. Other coaches were so tilted 

that emergency response personnel had to lower 

several passengers from the windows.

 Figure 9. Passenger survey responses.
Figure 10.--Lounge car interior. Graphic shows location of damaged pedestal seats and tables.

27
28 

the rail industry, contracting a major portion of the wreckage-clearing operations is more cost 

effective for the rail carriers. 

 Postaccident Events--After arriving at the accident scene at 3 p.m., the CFPL field 

engineer advised the IC about the two high-pressure liquid mainlines. The IC indicated he knew 

nothing about the pipelines.16 The CFPL field engineer then called his supervisor in Tampa and 

told him that debris and railcars were near and over both pipelines. The CFPL manager and 

engineer supervisor traveled to the derailment site, arriving about 5:40 p.m. The CFPL manager 

advised a CSXT division superintendent whom he believed to be in charge of wreckage removal 

and recovery not to operate heavy machinery over or near the pipelines because of the possibility 

of fire or explosion. 

 Wreck-clearing operations began about 9 p.m. The Safety Board received conflicting 

reports from CFPL and CSXT regarding the practices that CSXT followed during clean-up 

operations. For example, the CFPL manager stated that when using a crane to move a railcar, 

CSXT crews set it down on the ground above the 10-inch-diameter pipeline. The CSXT 

contractor said that he had 14 years experience in operating heavy equipment and in installing 

pipelines and that his crews did not move the railcar in such a way as to endanger the pipeline. 

When CFPL excavated the pipelines, it found no visible indications of damage to the exterior 

of the pipe. 

 CSXT Emergency Procedures.--The CSXT emergency procedures manual states that the 

first priority for its Operations Center dispatchers following an accident is "to promptly notify 

appropriate local emergency response agencies when an emergency situation exists. These 

include city or county, fire, police, civil defense and other similar agencies." After notifying 

local emergency agencies, the Operations Center is to notify appropriate CSXT division/system 

officers and departments, the Florida Department of Transportation, and the National Response 

Center. To facilitate emergency notification of local emergency response agencies, the CSXT 

Operations Center maintains a list of emergency phone numbers for each county with a "main 

track and sidings" map showing mile posts and the nearest station. 

 CSXT emergency procedures do not define the derailment of a train in an area occupied 

by a pipeline as an emergency condition. In addition, CSXT has no established company-wide 

emergency notification procedures for notifying users of its right-of-way following a derailment 

or other incident. The CSXT Managing Director stated, "At an accident scene, a supervisor may 

notify utilities directly or request that such notification be made by the CSX Transportation 

Operations Center." He added that no additional notification was necessary at the Intercession 

City accident, because "pipeline and utility locator service personnel were present during the 

clean-up operations." 

 

 16 One week before the accident, an Osceola County fireman attended a training session on pipeline emergency 

response actions that was sponsored by CFPL. The CFPL gave the fireman a map of area CFPL pipelines, which he 

placed in the battalion commander's vehicle. He had not briefed others at the fire station about proper response actions 

or about the two CFPL pipelines before the accident occurred. The IC subsequently retrieved the map and examined it 

at the scene about 2 hours after his arrival. 
 29 

 The CFPL was notified about 3 p.m. as a result of the actions of an individual CSXT employee. At 2:38 p.m. on November 30, 1993, an assistant roadmaster from the CSXT Orlando 

office called the Florida one-call system and informed the center operator that a train had derailed 0.3 of a mile south of milepost 816 and that a crew was on-site with heavy machinery to 

rerail train cars.17 The one-call operator checked the map grids for the emergency site and by 

3:03 p.m. notified the four underground facility operators in those grids: CFPL, General 

Telephone, MCI Telemarketing, and Williams Communications. 

 CFPL Emergency Procedures.--In its employee emergency procedures manual, CFPL 

identifies potential hazards posed to pipelines in a railroad right-of-way and classifies the 

derailment of a train as an emergency condition. Upon being notified of a derailment near its 

pipelines, CFPL procedures call for promptly assessing the effect on the pipeline, promptly 

dispatching pipeline personnel to the emergency site, and taking actions to minimize an 

emergency condition, including closing block valves, shutting down the operation of the pipeline, 

reducing the pressure in the line, and controlling any released product. The procedures note that 

it is important that the CFPL be notified promptly of emergency conditions, such as train 

derailments over its lines, so that the company can direct operator personnel to take necessary 

emergency actions. The CFPL emergency manual contains several telephone numbers for 

employees to call in the event of a pipeline emergency. It does not contain the CSXT toll-free 

telephone number. 

 In addition to its employee emergency procedures manual, CFPL also has a "spill 

emergency call list" that contains the telephone numbers of emergency agencies and organizations such as the CSXT to be contacted in the event of an emergency involving CFPL 

pipelines. The CFPL developed the call list in 1991 and updates it at least annually. The CSXT 

telephone numbers on the spill list include the roadmasters at Tampa and Taft and the toll-free 

number on both the one-page and two-page CSXT right-of-way: passage permits. 

 The CFPL Manager acknowledged that CFPL and CSXT have not worked together in 

a coordinated effort to define what actions are necessary to protect each another's facilities 

during emergency response activities. 

StatePlans and Procedures.--The Florida Department of Community Affairs, Emergency 

Management Division approved the June 1992 Osceola County, Florida Disaster Plan 

(PEP) as meeting all Federal and State emergency planning requirements. Also, the Osceola County 

Emergency Management Division has developed standards operating procedures (SOPs) for 

incident commanders at railroad incidents involving either passenger or freight trains. 

 In determining potential hazards following passenger train derailments, the SOP states, 

 

 17 The roadmaster told the Safety Board that he established this policy based on his past experience and because 

he knew that pipelines were in the area. He said his railroad maps did not show pipelines in the vicinity. He was 

not aware of any CSXT procedure to inform the one-call system of derailments, and had not been directed to notify 

either the one-call system or CFPL directly. 
30 

"[There is] little or no hazardous materials problem other than the train's own fuel." Also, the 

SOP advises to use the train crew as a resource, in that the "train crew can assist with 

knowledge of train, hazards, victim location." The focus of the SOP is emergency-response 

manpower and material requirements along with identification and evacuation guidelines for 

hazardous materials train incidents. For freight trains, the SOP states "Identify any hazardous 

materials involved. Train crew, train waybill, tank car design, placards on car(s), obvious visual 

or odor identification." 

 The Administrative Chief of the Osceola Department of Fire and Emergency Services 

stated that CSXT had provided his department with two telephone numbers by which his 

personnel could contact the railroad in the event of an emergency. He believed that one number, 

which had been provided to the department several years before the Intercession City accident, 

was for the nearby CSXT trainyard at Taft, Florida. He said that CSXT provided him with a tollfree number after the Intercession City accident. The toll-free number given to the Osceola 

chief is the same number on both the one-page and two-page Right-of-Way: Passage permits 

issued to Rountree. 

Past Accidents--On May 12, 1989, a Southern Pacific Transportation Company freight 

train derailed near San Bernadino, California, destroying the entire train and destroying or 

extensively damaging 11 homes located in the adjacent neighborhood. Two train crewmembers 

and 2 local residents were killed. 

 Because a 14-inch high-pressure liquid pipeline was buried beneath the wreckage site, 

local officials evacuated the residents of nearby homes for 24 hours as a precautionary measure 

until the owner, Calnev Pipe Line Company18 (Calnev), determined that the derailment did not 

damage the pipe. Wreckage clearing and cargo removal operations continued for several days 

after families returned to the area. 

 About 8:05 a.m. on May 25, 1989, 13 days after the train derailment, the pipeline 

ruptured at the derailment site, releasing gasoline under pressure, which spewed over homes in 

the immediate area and then ignited. The resulting fires killed 2 residents, injured 19 others, 3 

seriously, and destroyed 11 homes and 21 motor vehicles. Three other homes received moderate 

fire and smoke damage.19 

 The Safety Board's investigation determined that the pipeline's 4 to 6 feet of earth cover 

protected it during the derailment, and that the pipeline was mechanically dented and gouged by 

earth-moving equipment. This damage most likely occurred during removal of the train wreckage 

or the train's dry bulk cargo which was spilled at the site, and that the catastrophic failure 

occurred at one of the points where this damage was located. 

 

 18 Calnev and CFPL are both owned by GATX. 

 19 For further information, see Railroad Accident Report Derailment of Southern Pacific Transportation Freight 

Train on May 12, 1989, and Subsequent Rupture of Calnev Petroleum Pipeline on May 25, 1989, San Bernardino, 

California (NTSB/RAR-90/02).
 31 

 The Safety Board concluded that neither the railroad nor the pipeline operators' 

surveillance of excavating equipment operations was sufficient to prevent damage to the pipeline. 

Consequently, it recommended that the Research and Special Programs Administration (RSPA): 

 P-90-25

Require, in conjunction with the Federal Railroad Administration, operators of 

pipelines located on or adjacent to railroad rights-of-way to coordinate with the 

railroad operators the development of plans for handling transportation emergencies that may impact both rail and pipeline systems and then to discuss the plan 

with affected State and local emergency response agencies. 

Concurrently, the Safety Board recommended that the FRA: 

R-90-25

Require, in conjunction with the Research and Special Programs Administration, 

railroad operators to coordinate with operators of pipelines located on or adjacent 

to their railroad rights-of-way the development of plans for handling transportation emergencies that may impact both the rail and pipeline systems and then to 

discuss the plan with affected State and local emergency response agencies. 

 In March, 1993, DOT/FRA revised its Hazardous Materials Emergency Response Plan 

Guidance Document for Railroads20 by issuing a special notice, developed by FRA and RSPA, 

concerning pipelines that might be affected by a railroad accident. The Notice cautioned that 

many railroad rights-of-way contain underground high-pressure hazardous materials pipelines 

that may be damaged by a derailment, heavy equipment operations, digging activities, or other 

activities that disturb the right-of-way. The Notice emphasized the need for railroads to: 

Actively coordinate their emergency response activities with pipeline operators 

to assess possible damage due to the incident and to prevent damage during 

response and cleanup operations... Railroad emergency response plans should 

include information on underground pipelines which could be damaged by a rail 

incident. This information should include location, materials carried, and 

emergency numbers for the pipeline operator. 

 On March 2, 1994,21 RSPA issued an Advisory, which appeared in the Federal Register, 

informing natural gas and hazardous liquid pipeline operators and State pipeline safety program 

managers about the FRA Special Notice, and encouraging pipeline operators to work with 

railroad operators in mutually undertaking the development of plans for handling emergencies 

involving both rail and pipeline systems. 

 

 20 See DOT FRA ORD-93/09. 

 21 See 59 Federal Register 10035.
32 

 As a result of the actions taken by the FRA and RSPA, the Safety Board classified Safety 

Recommendations R-90-25 and P-90-25 as "Closed-Acceptable Alternate Action." 

 In the course of this investigation, the Safety Board contacted officials of several class 

I carriers, all of whom stated their companies never received the FRA special notice and became 

aware of it only after reading the RSPA pipeline advisory in the Federal Register. As a followup measure, the Board contacted an FRA official, who stated that the FRA mailed the 1993 

special notice to "chief operating officers" using addresses on a list of carriers charged FRA user 

fees. He indicated several mailings were returned because the addresses were those of the 

carriers' attorneys, who handled this aspect of the carriers' business. The FRA official said that 

the FRA has no record of receipt or action taken. 

Tests and Research 

Speed Recorders. 

 Locomotive.--The speed indicator on the locomotive reportedly was destroyed by 

impact forces and torch damage incurred when CSXT contract crews cut the locomotive apart 

to facilitate clearing the wreckage from the railroad right-of-way. Investigators sent one paper 

strip chart from the locomotive's Barco/Bach-Simpson speed recorder to the Safety Board 

Vehicle Performance Division laboratory for readout and evaluation. Laboratory personnel 

inspected the paper strip chart visually and found diesel fuel had stained several portions of the 

recording area, including the area immediately after the point where the final speed was 

recorded. Because the speed indicator must be functional to conduct postaccident calibration of 

the speed recording system, the Safety Board could not verify the validity of the recorded speed. 

 According to the engineer, he was operating about 79 mph before the accident and had 

not noted any deficiencies with the locomotive speed indicator. He said that he checked the 

speed indicator about 8 to 10 miles before the collision site (MP A-824.8) and noted an 

indicated speed of 81 mph. The FRA regulations at 49 CFR 229.117(1) require that a locomotive 

built since December 31, 1980, be equipped with a speed indicator that is accurate to within +/- 

3 mph for speeds of 10-30 mph and +/- 5 mph for speeds in excess of 30 mph. 

 Equipment Defect Detector.--A wayside equipment defect detector records and 

annunciates a safety message to the operating crew that includes noted defects followed by the 

noted length, speed, and total axles of the train. On the day of the accident, the wayside defect 

detector at MP A-819.8, about 13,800 feet from the collision crossing, annunciated and recorded 

a speed of 83 mph.22 The engineer stated that he noted the segment of the message announcing 

"no defects," but not the annunciated speed. 

 

 22 The defect detector manufacturer specifies a +/- 2 mph degree of accuracy for the speed recorder. The CSXT 

and Amtrak operating officials state that the speed indicated by an equipment defect detector is not used to evaluate 

train operations or for train speed checks. No Federal regulations require a defect detector to record a train's speed. 
 33 

Sight Distance.--The Safety Board conducted two tests to determine the distance at which 

Amtrak operating personnel could discern the presence of a large object on the KUA Power 

Road grade crossing. In the first test, investigators placed a CSXT truck in the middle of the 

grade crossing and approached the crossing at 10 mph in a locomotive. At a distance of 1,385 

feet from the crossing, the engineer could see an object on the track, but could not distinguish 

what it was. Thirty-five- to 40-foot-high trees about 25 to 30 feet south of the track parallel the 

curve and are about 800 to 1,500 feet from the KUA Power Road crossing. At a distance of 

1,169 feet from the crossing, the engineer could plainly see the truck. 

 In the second test, investigators lined up five vehicles so that they extended on either side 

of the track. At 1,518 feet from the crossing, the engineer could see the farthest vehicle north 

of the crossing, but could not distinguish what it was. At 1,269 feet from the crossing, he could 

see the strobe light on the vehicle parked on the north side of the crossing. 

Stopping Distance.--At the Safety Board's request, Amtrak calculated the estimated 

distances in which the train as configured could reasonably be expected to stop using the weights 

of the locomotive and cars, brake types, calculated emergency braking forces, and a given speed 

of 79 mph. Calculations indicated that the brake rate would be about 4.20 feet/second2, with a 

stopping distance of 1,954 feet. Amtrak advised that the calculation is subject to a 15 percent 

tolerance. 

Track.--Investigators checked the track for level, gauge and line, and found all the 

elements were within the required standards for a FRA class 4 track. 

Crossing Signals.--Title 49 Code of Federal Regulations, Part 234 Section 234.5 

Paragraph (c), requires that an active highway-rail grade crossing warning system indicate the 

approach of a train at least 20 seconds prior to the train's arrival at the crossing. On December 

1, 1993, investigators participated in tests of the undamaged crossing signal equipment and found 

that the relays, crossing gate, and lights functioned as designed. 

Radio Test (Dispatcher).--A radio test was performed on December 1, 1993, at 

approximately 12:25 p.m. from a CSXT vehicle located 10 feet west of the main track in the 

middle of KUA road crossing. The dispatcher immediately responded and the reception was 

good both receiving and sending. The dispatcher was toned in through the Davenport, Florida, 

Tower, and he responded immediately. The dispatcher is located in the carrier's control center 

in Jacksonville, Florida. 

 Time-Distance Calculations.-- A train traveling at 79 mph, which the engineer reported 

was the speed of the train as it approached the crossing, would give about 18.6 seconds audible 

warning of its approach before reaching the crossing if the whistle was sounded at the whistle 

post 2,160 feet from the crossing. A train traveling at 79 mph would reach the crossing in 28.6 

seconds from the location of the crossing signal electronic start 3,317 feet from the crossing. 
34 

 Grade Crossing Survey.--The American Railroad Engineering Association (AREA) and 

the American Association of State Highway and Transportation Officials (AASHTO) standard23

for roadway vertical profiles at railroad/highway grade crossings state in part: 

Acceptable geometrics necessary to prevent drivers of low-clearance vehicles 

from becoming caught on the tracks would provide the crossing surface at the 

same plane as the top of the rails for a distance of 2 ft outside of the rails. The 

surface of the highway should also not be more than 3 inches higher nor 6 inches 

lower than the top of the nearest rail at a point 30 ft from the rail unless track 

superelevation dictates otherwise....24

 The Safety Board was present when CSXT surveyed the KUA Power Road grade 

crossing and determined that the top of the north rail was superelevated 0.27 feet above the top 

of the south rail, with a 5.4 percent grade. 

 Using the +3 inch to -6 inch parameters set out in the AREA/AASHTO guidelines and 

assuming a constant +5.4 percent grade, the surface of the roadway 30 feet north of the north 

rail should have been between 1.12 ft and 1.87 ft higher than the rail. Calculations based on the 

survey data indicate the roadway surface 30 feet north was 1.032 ft higher than the top of the 

north rail, or 0.088 feet below the lower tolerance stated in the standards. 

 Using the same parameters and assuming a constant -5.4 percent grade, the roadway 

surface 30 feet south of the south rail should have been between 1.37 ft and 2.12 ft lower than 

the rail. Calculations based on the survey data supplied indicate the roadway surface was 1.5 feet 

lower than the top of the south rail, within the tolerances stated in the guidelines. 

Other Information 

 Railroad-Highway Crossing Inventory and Numbering System.--In 1972, the DOT 

submitted a Report to Congress with recommendations for a central collection system of grade 

crossing information. Through the cooperative efforts of the Federal Highway Administration 

(FHWA), FRA, AAR, individual states, and individual railroads, a national rail-highway 

crossing inventory data file was established by 1974. The program is largely voluntary. Based 

on submissions of the DOT-AAR crossing inventory forms and update information provided, the 

FRA maintains a database containing information describing the physical and operational 

characteristics of public and private at-grade rail-highway crossings. Each crossing is assigned 

a unique identification number having six numeric characters and an alphabetic character. Either 

 

 23 A Policy on Geometric Design of Highways and Streets, 1990, American Association of State Highway and 

Transportation Officials, pp. 842-843. Adopted as a Federal Highway Administration standard in April 1993. 

 24 The standards do not further define "unless track superelevation dictates otherwise." Given the context of the 

phrase, the Safety Board presumes it means that when one rail is superelevated above the other, the measurement reference line may be moved from level to a point at the same plane as the top of the rails.
 35 

the State or the railroad can voluntarily provide updated information to the FRA about crossing 

changes, such as installation of new traffic control devices. 

 A tag bearing the DOT/AAR crossing inventory number is nailed or, in the case of a 

temporary tag, strapped to a crossing fixture. Typically, the tag is put on the crossbuck or 

flashing light pole. The tags are considered temporary and designed to last a maximum of 5 

years. Posting of permanent metal tags or stenciling the number on the post is also voluntary. 

As of June 1994, about 99 percent of all highway-rail grade crossings, or 280,503, had been 

assigned DOT/AAR numbers and were in the national inventory. 

Other State Crossing Safety Measures.--Florida's law requiring that operators of low 

clearance vehicles provide railroads carriers with advance notice of intended grade crossings is 

based upon Section 11-703 of the 1992 revision of the Uniform Vehicle Code and Model Traffic 

Ordinance.25 (See Appendix E.) Fifteen States have similar requirements. (See Appendix F.) 

The Safety Board reviewed several programs to identify the various measures that other States 

use to ensure crossing safety. 

 New York is the only State that requires the carrier to obtain a railroad permit before the 

highway permit is issued. Two States, Texas and Delaware, have established toll-free notification 

programs for the public to use to report problems at grade crossings. 

State Escort Policies.--Florida Highway Patrol (FHP) officers may perform certain offduty activities for pay while in uniform and while driving State-assigned vehicles, provided their 

troop commander approves the employment in advance. Commonly-approved off-duty employment 

may include providing escort for oversized vehicles and providing security at public gatherings. 

When using State-assigned vehicles, officers must provide proof of liability insurance coverage and 

reimburse the State for mileage driven. 

 As mentioned earlier, escort officers were only required to radio the FHP dispatcher at 

the onset of the trip, when they began escorting the overdimension load before the Intercession 

City accident. After the Intercession City accident, the FHP adopted a new FHP escort policy 

that requires FHP officers applying to escort overdimension and certain hazardous materials 

vehicles to include the following information in the application: 

1. A safety plan that includes a description of the material being transported, 

vehicle dimensions, a route map, a trip timetable, proof that appropriate county 

and municipal authorities along the route have been advised of the movement, and 

a listing of telephone numbers for emergency service agencies. 

2. Authentication that the transporter operator has obtained all required permits, 

and the approval and emergency telephone numbers of railroads, utility companies, and private entities whose activities might be affected by the movement. 

 

 25 National Committee on Uniform Traffic Laws and Ordinances, 405 Church Street, Evanston, Illinois 60201. 
36 

 3. A listing of any safety apparatus installed on the load-bearing vehicle. 

 4. Copies of any FDOT, county, and/or municipal government permits. 

5. A liability release signed by an officer of the company contracting for the 

services of escorting officers. 

 If the planned route of the escort extends beyond the geographical limits of any troop, 

copies of the plan shall also be supplied to other troop commanders along the path of the 

escorted vehicle. Before initiating the escort or permitting the load-bearing vehicle to be placed 

in motion, officers shall inspect to verify compliance with dimensional specifications outlined 

in the safety plan and safety requirements identified on any permit. 

 Officers shall also verify the validity of the operator's driver license, and ensure the 

operator is in compliance with Florida laws and regulations governing commercial vehicle safety 

and hazardous material laws and regulations. 

 Copies of the safety plan shall be maintained in each Highway Patrol vehicle assigned 

to the escort, with at least two vehicles assigned to each escort. At least one of the escorting 

vehicles must be equipped with a cellular telephone supplied by the entity requesting escort 

services. If an escort is disrupted by breakdowns or other unforeseen circumstances, any changes 

to the original safety plan must be approved by the troop commander, and railroads, utilities, 

and other private entities must be notified of such changes. 
 37 

ANALYSIS 

 In the following analysis, the Safety Board lists the factors and conditions that it was able 

to exclude as being causal or contributory in this accident, recapitulates the accident from a 

causal perspective, and addresses each of the following safety issues identified in this accident 

investigation: 

 1. Rountree oversight of oversize moves; 

 2. Oversize move coordination; 

 3. State permitting requirements and procedures; 

 4. Emergency notification procedures; 

 5. Wreck clearing coordination; 

 6. Overdimension vehicle escorts; and 

 7. Lounge car seat support design. 

Exclusions 

 Evidence indicates that the Amtrak crew was qualified to perform their duties in accordance with operating rules and hours of service requirements. The condition of the track, 

operation of the wayside signals, crossing devices, mechanical condition of the train, and the 

roadway profile did not cause or contribute to the accident. 

 

 At an engineer-reported speed of 79 mph on a clear signal, the calculated stopping 

distance was 1,954 (+/- 15 percent) and the available sight distance was about 1,300 feet. The 

Safety Board concludes that when the traincrew first sighted the Rountree vehicle, they did not have 

sufficient distance to stop the train in time to avoid the collision. 

 

 The Rountree vehicle driver and tiller operator did not experience any mechanical problems with their vehicle from Tampa to the KUA facility near Intercession City. Inspection and 

examination of Rountree's vehicle did not reveal any missing or broken components that were 

not the result of the accident. Safety Board interviews with the Rountree crew revealed that it 

was stopped on the grade crossing to make adjustments to clear the track, not because of any 

mechanical malfunctions. The Safety Board concludes that the Rountree vehicle had no preexisting mechanical problems or conditions that caused or contributed to the accident. 

 The Safety Board found that the vertical profile of the KUA Power Road at the grade 

crossing was consistent with the AASHTO and AREA recommended practices. 
38 

 The negative results of drug and alcohol testing on samples obtained from the truck 

driver indicate substances played no role in his actions at the time of the accident. Likewise, the 

negative drug testing results for the other three Rountree employees indicate those drugs did not 

influence their respective roles in the accident. No alcohol testing was conducted on the three 

Rountree employees and no testing of any kind was done on the train crewmembers; however, 

observations of their actions after the accident would indicate that they were not influenced by 

drugs or alcohol. The Safety Board concludes no evidence indicates that any Rountree or Amtrak 

employees involved in the accident were under the influence of alcohol or other drugs. 

The Accident 

 The Safety Board believes that from the pretrip phase to postaccident response and 

cleanup, the various transportation entities directly and indirectly involved in this accident failed 

to cooperate effectively to promote general public safety. 

Pretrip Phase.--During the planning phase of the trip, the Rountree regional manager did 

not advise CSXT of all crossings that he would be traversing on the trip to Intercession City. 

Although Florida statute requires that operators of low-clearance vehicles notify railroad operators of each intended crossing, the Rountree regional manager later stated that he was not aware 

of the statute. The FDOT currently has no procedure for communicating this requirement to 

vehicle operators applying for overdimension, low-clearance moves. 

 To protect train movements, CSXT requires that over-dimension vehicle operators apply 

for passage protection by the railroad if the movement includes traversing at-grade crossings. 

However, the company's Right-of-Way: Passage application form used before this accident did 

not request that the applicant list the crossings or the final destination of the vehicle. Further, 

the CSXT employees preparing the Intercession City and previous applications for the Rountree 

regional manager took no proactive measures to determine the entire vehicle route so protection 

could be arranged for all crossings. The CSXT signals supervisor for the Tampa area maintains 

he stressed that the Rountree regional manager arrange for protection at any intended crossing. 

However, when he accompanied the regional manager for Rountree's reported first application, 

 he did not ask the Rountree manager where the vehicle was going or advise him that the form 

should list all rail crossings on the route. In the case of this trip, Rountree did not traverse any 

more highway-rail crossings. 

 When the Rountree regional manager contacted the CSXT Tampa office to apply for 

passage protection for the Intercession City move, the project engineer with whom he had dealt 

previously was no longer there. The new project engineer was not familiar with the application 

form. When tasked with preparing the Right-of-Way: Passage form, he could not find any copies 

of the form or information about preparing it in his office files and did not get advice 

or direction about completing the form from peers or supervisors when he called them. The project 

engineer therefore prepared the Intercession City move application form by copying information 

from a previous passage application form that Rountree provided as a sample. 
 39 

 The Rountree regional director also arranged for an FHP escort as required by the 

FDOT. In the course of the trip, he deviated from the FDOT-approved route, which voided his 

FDOT moving permit. However, because the FHP did not require that escorts follow prescribed 

measures to ensure the safety of the vehicle's movement, the off-duty patrolmen accompanying 

the Rountree vehicle did not know that the convoy was not following the permitted route or that 

Rountree had not arranged for CSXT to protect crossing movements. 

 Problems at the Site.--While the Rountree regional manager had visited the KUA Power 

Road crossing on two occasions, the equipment supervisor, who was responsible for the movement of the vehicle, had not. At no time did the equipment supervisor or any other member of 

the vehicle crew attempt to determine in advance if they might experience complications at the 

KUA access road. Further, they were not prepared to contact CSXT should an emergency arise. 

Guy wires blocked the crew's first attempt to turn onto the KUA facility access road. On their 

second attempt, they swung onto KUA Power Road and continued across the track until they 

bottomed out. While the crew shimmed the goose neck with the cargo deck straddling the track, 

the Rountree regional manager tried to call a CSXT trainmaster in Orlando only to get no 

answer. He then called a CSXT toll-free number and got a menu, which prompted him to hang 

up in frustration. He called the toll-free number a second time and was in the process of 

listening to the menu items when he heard the train whistle blow. Shortly thereafter, Amtrak 

train 88 broadsided the vehicle and turbine. 

Postaccident Activities.--When the train derailed, the locomotive and several other cars 

came to rest above and/or near two high-pressure hazardous liquid pipelines. Neither Osceola 

County nor CSXT emergency response procedures include determining the presence of or 

potential endangerment to pipelines or other buried facilities following a derailment. When 

notified of the accident, the CSXT dispatcher contacted the appropriate CSXT officials indicated 

on the CSXT Division Emergency Notification List and the National Response Center in accordance with CSXT dispatch operating procedures. He was not required to contact nor did he 

have a method of identifying operators of facilities buried in the derailment area. 

 Osceola County emergency responders were on scene within 11 minutes of the collision. 

Having no knowledge of the presence of the pipelines and no safety training stressing precautions to 

take should they observe a pipeline marker, they did not take any measures to protect them-selves 

or the accident victims from a potential pipeline breach. Further, no one recognized the 

need to notify the IC of the presence of pipeline markers. Almost all train passengers were evacuated by 1:15 p.m. and the front-end crew were extricated from the locomotive by 1:37 p.m. 

Photographs taken shortly before 2 p.m. show people, including firefighters, standing next to 

a pipeline marker, however, no one alerted the IC about the presence of the pipelines until 

CFPL employees arrived about 3 p.m. Further, the earliest notification that CFPL received was 

at 1:50 p.m. from an off-duty CFPL employee who happened to see a news broadcast about the 

accident. The notification that CFPL received from the one-call system about 2 1/2 hours after 

the collision occurred only because an individual CSXT employee has a personal policy of 

notifying the Florida one-call system when the rail company dispatches excavation equipment 

to a site. By this time, CSXT had begun contacting clean-up contractors who would use bulldozers, cranes, and other heavy equipment that could potentially damage the pipelines. 
40 

Rountree Oversight of Oversize Moves 

Grade Crossing Flagging Arrangements.--Rountree arranged to have CSXT flag crossings 

only in the immediate Tampa area. Consequently, CSXT personnel protected only 8 of 13 

crossings on the Intercession City trip. These arrangements were similar to those made for four 

previous Rountree trips from Tampa to various destinations beginning in October 1992. The 

Safety Board concludes that Rountree had an obligation to ensure that all the crossings it intended to traverse were protected before proceeding across them, and failed to do so. 

 Without a flagman, Rountree lost the direct coordination with CSXT necessary to provide 

safe passage over all five unflagged crossings. Rountree's regional manager tried to contact 

CSXT minutes before the collision, however, the telephone numbers that he called did not 

connect him with a CSXT representative who could stop or slow the train. 

 According to KUA officials, a Rountree representative assured KUA during a planning 

meeting that CSXT flagmen would be at all grade crossings. However, the Rountree regional 

manager reported that he considered the KUA Power Road crossing to be a job site entrance and 

therefore considered KUA responsible for ensuring the delivery. No evidence indicates that a 

Rountree representative ever expressed this viewpoint to KUA personnel. Rountree's expectation 

that KUA would be responsible for ensuring safe delivery after the vehicle entered the KUA 

Power Road was the first of several assumptions preceding the collision. 

 The Rountree regional manager said that he believed that KUA officials were in contact 

with CSXT, and that the next train was due at the crossing at 1 p.m. based on statements made 

by KUA personnel when the Rountree vehicle approached the crossing and again when it was 

over the track. The KUA personnel who allegedly made these statements deny making them. 

 Regardless of what KUA officials may or may not have told the Rountree regional manager, 

the responsibility for deciding whether to pull the vehicle over the track was Rountree's 

alone. The belief that a train would not arrive until 1 p.m. may have led Rountree officials to 

assume erroneously that they had sufficient time to clear the track. Without first determining the 

cargo deck height necessary to clear the track, the transporter was at risk of bottoming out, 

which is, in fact, what happened. 

 Because Rountree did not arrange for a flagman at the KUA crossing, their vehicle and 

load were not protected. The Safety Board concludes that Rountree failed to ensure that it was 

safe to proceed over the KUA Power Road grade crossing before doing so. 

Route Selection.--Rountree obtained FDOT approval for a route to Intercession City that 

the regional manager later changed when he discovered a temporary bridge on the approved 

route. Rountree's decision to change the route appears to be justified; an FDOT official stated 

that the Rountree vehicle would not have been routed over the temporary bridge. However, 

because Rountree failed to apply for a new route, the FDOT did not have the opportunity 

to calculate whether the highway structures on the new route could support the oversize load. The 

Safety Board concludes that Rountree may have increased the risk of damage or even the 
 41 

collapse of a highway structure by traveling on an unapproved route. 

Work Schedule.--The project supervisor, truckdriver and tiller operator were on duty on 

Monday, November 29 for about 12.5 hours. They slept Monday evening for about 4.5 to 5.5 

hours and went back to work that same night. By the time of the accident, 12:40 p.m. on November 30, they had been up about 14.5 hours. This equates to only 4.5 to 5.5 hours of sleep 

in a 31.5 hour period. The regional manager worked about 12 hours on November 29, slept 2 

hours, and then worked 15.5 hours before the accident. This equates to 2 hours of sleep in a 

27.5 hour period. 

 The schedules of all four Rountree employees allowed for a limited and likely inadequate 

amount of sleep on the day before the accident. Such hours are fatigue producing and exceed 

the Hours of Service rules that apply to the truckdriver and the tillerman. Research has shown 

that humans need approximately 8 hours of sleep per night, though individual differences range 

from about 5 to 10 hours.26

 Sleep losses can degrade individual performance capabilities. In a recent accident report27, 

the Safety Board cited a NASA Ames Research Center report, in which the authors addressed 

the effect of sleep loss, stating "Sleepiness can be associated with decrements in decision 

making, vigilance, reaction time, memory, psychomotor coordination, and information processing (e.g., fixation on certain material to the neglect of other information)." "For example, 

the individual may react slowly to information, may incorrectly process the importance of the 

information, may find decision making difficult, may make poor decisions, may have to check 

and recheck information or activities because of memory difficulties. This performance 

degradation can be a direct result of sleep loss and the associated sleepiness and can play an 

insidious role in the occurrence of an... accident." 

 The Safety Board has highlighted the potential deleterious effects of sleep loss in past 

accidents and continues to have serious concerns about the impact of long work hours. However, despite the long work hours of the Rountree crew, the role of sleep loss in this accident 

is difficult to quantify. It appears that the decisions to cross the tracks without a flagman, and 

without determining the trailer height necessary to accomplish it, closely correspond to 

procedures used by the crew on previous trips and earlier portions of this trip. Nevertheless, 

the Safety Board is concerned that their failure to make appropriate decisions may have been 

influenced by a lack of sleep and the number of hours they were on duty. 

 

 26 Dinges, D.F., "The nature and timing of sleep." Transactions & Studies of the College of Physicians of 

Philadelphia, 1984. Ser5:6(3), pp 177-206. 

 27 For additional information, read Airline Accident Report, American International Airways Flight 808, 

Douglas DC-8-61, N814CK, Uncontrolled Collision with Terrain, Guantanamo Bay, Cuba, August 18, 1993.

(NTSB/AAR-94/04.)
42 

Oversize Move Coordination 

 The first reported contact between Rountree and CSXT occurred when a Rountree vehicle 

became stuck under a signal bridge in October 1992. The CSXT signals supervisor who 

responded to the scene reported that Rountree didn't tell him where the load was going, and he 

didn't ask because he assumed that it was going a power plant facility in the Zephyrhills area. 

The permit that CSXT issued post facto lists only the crossing where the Rountree vehicle 

became stuck. 

 Shortly after the first contact, the same signals supervisor responded to an early morning 

call from the Rountree regional manager advising him that Rountree was going to proceed 

without a flagman when the assigned flagman did not show at the appointed time and place. The 

signals supervisor said that on this and the earlier occasion, he emphasized to the regional manager never to travel over an unprotected crossing. However, in this instance, he flagged for 

Rountree only to the end of his assigned territory and didn't ask whether the vehicle was going 

over any other crossings. 

 On the CSXT application for the load transported on November 4, 1992, Rountree wrote 

that the planned route included two additional crossings outside the Tampa area. Concerning the 

first of these two crossings, Rountree indicated "everything OK here." 

 The contacts between Rountree and CSXT for trips between October 1992 and November 

1993 apparently followed the same general pattern: Rountree did not provide complete 

information regarding all the crossings on its route, and the CSXT personnel in Tampa with 

whom Rountree dealt did not ask what was the final destination of the load or whether the route 

included crossings outside the Tampa area. 

 In a conversation with the CSXT signals supervisor, the Rountree regional manager 

reportedly implied that he felt the small amount of time it took his vehicle to cross over a track 

did not warrant obtaining a flagman. This would indicate that despite reported warnings to the 

contrary, the Rountree regional manager did not have a real appreciation for the hazards 

involved at grade crossings. 

 The Rountree regional manager's action also suggests that he viewed obtaining permits, 

including the CSXT Right-of-Way: Passage application, as merely a necessary requirement with 

no safety implications. For example, he did not comply with FDOT requirements concerning 

permits when he deviated from the State-approved route, potentially placing highway structures 

in jeopardy. 

 Communications again broke down between the motor carrier and the railroad when 

Rountree attempted to obtain a permit for the Intercession City move. The Rountree regional 

manager maintains that he did advise CSXT of the destination, which the CSXT project engineer 

denies. However, the CSXT project engineer responsible for permitting was new to the job and 

not familiar with the forms or permitting process. When presented with a previous permit to use 

as an example, he copied the information shown, which was only through the Tampa area. 
 43 

 Although it was the responsibility of Rountree to provide CSXT information about the 

entire route of its vehicle, including all rail crossings, this accident investigation identified 

another problem in the permitting process. The Safety Board believes that the CSXT permitting 

procedures do not take precautions to ensure that information provided by the motor carrier is 

accurate and complete. The Board recognizes that the CSXT is not required by Federal or State 

regulations to coordinate moves with motor vehicles. The Board acknowledges the efforts of 

CSXT to improve the safety at highway-rail crossings by requiring that operators of oversize 

low-clearance vehicles obtain a permit to arrange for a flagman. However, the Safety Board 

believes that CSXT needs to improve the permitting process and its forms. The current form 

does not provide space for the motor carrier to list the crossings along the route. Over 99 

percent of all crossings have DOT/AAR identification numbers. Requiring motor carriers to 

indicate the DOT/AAR number or other identifying features of all rail crossings they intend to 

traverse would improve the communication and coordination between the CSXT and the motor 

carrier. The CSXT should require applicants to supply the final destination and clearly identify 

all crossings on the planned route. Further, the Safety Board believes that CSXT has a responsibility 

to make certain that the CSXT employees issuing permits are familiar with the process 

to ensure that travel over the CSXT system is as safe as possible. The Safety Board concludes 

that the CSXT permitting procedures do not ensure that the information provided by the motor 

carrier is accurate and complete. 

 As part of this investigation, the Safety Board contacted five other Class 1 rail carriers 

to determine whether and what type of procedures they had for coordinating the transit of overdimension, low-clearance highway vehicles across railroad tracks and, if so, how their procedures compared with those of CSXT. The rail carriers contacted included Burlington Northern 

Railroad, Consolidated Rail Corporation, Florida East Coast Railroad, Norfolk Southern Railroad, and Union Pacific Railroad. 

 The officers of three carriers said that their companies arrange for protection of such 

highway movements on an ad-hoc basis through local railroad officials. They said they have no 

formalized systemwide procedures for coordinating overdimension, low-clearance vehicle 

crossing movements. They also stated that they have never experienced any problems with such 

movements and have no records of accidents or incidents involving such movements. 

 The other two rail carriers have formalized procedures for protecting overdimension lowclearance vehicle crossing movements. One carrier not only checks the route indicated on applications against a company map showing all grade crossings, but also requires that the applicant 

(or his agent) accompany a railroad employee on a pre-move inspection trip during which they 

drive the route to determine whether any specialized protection is required or whether any 

crossing grade might pose a problem. 

 The officers of all five rail carriers emphasized that for the railroads to protect oversized 

vehicle movements at grade crossings, the motor carrier must first contact and advise the rail 

carrier of the move. They further stressed that the safest method of protecting such movements 

is to have a rail carrier employee, such as a flagman, on site and communicating with the rail 

dispatcher to coordinate control of the site. 
44 

 From interviews, the Safety Board discovered that the CSXT's procedures for providing 

protection to motor carriers at grade crossings are typical of other Class 1 rail carriers. Further, 

although other major carriers stated they have never experienced an incident like the Intercession 

City accident on their property, the Safety Board believes that rail carriers should review their 

procedures for coordinating overdimension, low-clearance vehicle crossing movements for the 

benefit of public safety. The Safety Board believes that the Association of American Railroads 

and the American Short Line Railroad Association should inform their members of the facts and 

circumstances of this accident and recommend that they review their procedures for coordinating 

the transit of overdimension, low-clearance highway vehicles across their rights-of-way to ensure 

the safety of such movements. 

State Permitting Requirements and Procedures

 When issuing permits, the FDOT does not advise applicants that Florida law requires 

operators of certain low-clearance vehicles to provide railroads with advance notification of the 

applicant's intent to travel over grade crossings. The Safety Board concludes that during the 

Intercession City permit process, the FDOT did not ensure that Rountree had notified railroads 

of the grade crossings that it intended to traverse. The Safety Board believes that the American 

Association of State Highway and Transportation Officials should urge the FDOT and the other 

States' permitting authorities having this requirement to routinely advise permittees that notifying 

the railroads is a condition of the State permit's validity. Further, the Safety Board believes that 

those States that do not require low clearance overdimension/overweight operators to provide 

railroads with advance notification of travel over crossings should revise their permitting 

requirements to do so. 

 The Specialized Carriers and Rigging Association28 publishes the "Permit Manual of State 

Permits and Canadian Regulations," which contains a State-by-State listing of State permitting 

agencies and an analysis of overdimension or overweight vehicle permitting requirements in each 

jurisdiction. The Manual currently does not indicate the States that require operators of lowclearance vehicles to provide railroads with advance notification of their intent to travel over 

grade crossings. The Safety Board believes that including such State requirements in the manual 

will serve to educate operators of this requirement, and help to minimize incidents involving low 

clearance vehicles becoming stuck on unprotected grade crossings. 

 The Safety Board also believes that The National Committee on Uniform Traffic Laws 

and Ordinances should revise Section 14-112, "Permits for Excess Size and Weight," of the 

Uniform Vehicle Code to require State agencies to notify carriers of the provisions contained 

in Section 11-703, "Moving Heavy Equipment at Railroad Grade Crossings," of the Uniform 

Vehicle Code. 

 

 28 Specialized Carriers and Rigging Association, 2750 Prosperity Avenue, Suite 620, Fairfax, Virginia 22031, 

(703) 698-0297. 
 45 

Emergency Notification Procedures 

 CFPL began a shutdown of its pipelines at 1:54 p.m., about an hour and 12 minutes after the 

accident, because an off-duty CFPL employee saw a report of the accident on television, assumed 

that the CFPL pipelines may have been in the area, and reported the accident to on-duty CFPL 

personnel. CSXT did not initiate notification to other users of its right-of-way at the 

accident site until 2:38 p.m., when an assistant roadmaster in CSXT's Orlando office notified 

Candy/UNCLE of the accident. He notified the one-call system on his own initiative, not in 

response to any established company-wide CSXT emergency notification procedures. 

 Had the CSXT Operations Center had emergency notification procedures regarding 

pipeline hazards, its personnel could have notified not only CFPL, but also the IC while he was 

en route to the site, thus ensuring that responders received prompt information about the location 

of pipelines, materials involved, and need to notify the affected utilities. 

 The Safety Board addressed the issue of CSXT's emergency notification procedures in 

two other recent investigations. Following the derailment of an Amtrak passenger train operating on 

CSXT track at Lugoff, South Carolina, on July 31, 1991,29 emergency responders were delayed when CSX dispatchers used an outdated telephone list for notification. In its investigation 

report, the Safety Board recommended that CSXT: 

 

Maintain an up-to-date emergency response telephone list. (Class II, Priority 

Action)(R-93-20) 

 On March 9, 1995, CSXT's Vice President of Safety And Operations Support notified 

the Safety Board that CSXT had completed new local emergency number contact notebooks for 

each division in August 1994 and computerized the division notebooks in September 1994. 

Because CSXT completed the recommended action, the Safety Board is classifying Safety 

Recommendation R-93-20 "Closed--Acceptable Action." The Safety Board notes, however, that 

the contact notebooks do not contain hazardous liquid pipeline emergency numbers or identify 

locations where hazardous liquid pipelines are present. 

 

 The Safety Board again addressed the adequacy of CSXT's emergency notification procedures during its investigation of the derailment of a Ringling Brothers and Barnum & Bailey 

Circus Blue Train near Lakeland, Florida on January 13, 1994.30 This accident occurred on the 

same segment of track 30 miles west of the Intercession City accident and derailed railroad 

equipment threatened the integrity of hazardous liquid pipelines owned by CFPL. Again, CSXT 

did not notify CFPL of the accident and the potential threat to its pipelines. CFPL learned of 

the accident about 1 hour after the derailment from two different sources, a county utility 

coordinator and a CFPL employee's wife, who heard the news of the derailment on the radio. 

 

 29 Derailment and Subsequent Collision of Amtrak Train with Rail Cars on Dupont Siding of CSX Transportation 

Inc., at Lugoff, South Carolina, on July 31, 1991. (NTSB/RAR-93/02) 

 30 Derailment of a Ringling Bros. and Barnum & Bailey Circus train on January 13, 1994.(NTSB/RAR-95/01)
46 

The Safety Board found that CSXT's emergency telephone list did not identify operators of 

pipelines on or adjacent to its railroad right-of-way that could be damaged by a rail incident. 

The Safety Board therefore recommended that the CSXT: 

Include on its emergency response telephone list those operators that have pipelines on or adjacent to your right-of-way that could be damaged by a rail incident. 

(Class II, Priority Action) (R-95-8) 

 On April 28, 1995, CSXT wrote the Safety Board in response to Safety Recommendation 

R-95-8 stating that it (CSXT) was updating its emergency response telephone notification list to 

include the locations of all pipelines on or adjacent to its rights-of-way and operators to contact 

should a rail incident occur. The CSXT indicated that it should have the pipeline emergency 

numbers added to its notification list by July 1995. The Safety Board is pleased that CSXT has 

taken this action and classifies Safety Recommendation R-95-8 "Open--Acceptable Action" 

pending completion of the program. 

Wreckage Clearing Coordination

On-scene Problems.--After arriving on-scene, CFPL personnel marked the locations of 

its pipelines through the derailment site before wreckage clearing operation began. CFPL representatives cautioned CSXT personnel in charge of clean-up operations about the need to protect 

the pipelines, the hazards posed by the presence of the pipelines, and the need to protect them 

from damage during recovery operations. 

 CSXT and CFPL presented conflicting views regarding the potential hazard to the pipeline during wreckage clearing operations. Regardless of the actual hazard potential in this 

accident, the Board is concerned about efforts to maintain the safety of emergency response, 

railroad, and pipeline personnel and property during wreckage clearing operations. A breach in 

a hazardous liquid pipeline during wreckage recovery operations would result in the release of 

a flammable product, which, if ignited could injure nearby workers and destroy or damage 

nearby property. Even if not ignited, release of this material would delay the safe resumption 

of railroad and pipeline operations through an affected area for days or even weeks while the 

environment is restored. 

 Similar complaints and coordination problems also arose between railroad and pipeline 

on-scene personnel during the wreckage clearing operations at Lakeland. Following that accident, neither CSXT nor CFPL took actions to determine the reasons for the problems that arose 

during wreckage clearing. The Safety Board concludes that the lack of cooperative action plan 

between CSXT and CFPL contributed to a break-down in communication during wreck-clearing 

operations. The Safety Board believes that CSXT and CFPL should jointly develop a plan for 

effective on-scene coordination that would ensure the protection of pipelines and other facilities 

buried within the railroad right-of-way so as to abate the risk to on-scene personnel and the 

public. Further, CSXT should cooperate with pipeline operators in its other operating areas to 

develop a similar cooperative plan. 
 47 

 The need for all railroads and pipelines to actively coordinate their emergency response 

activities was recommended to the rail industry in a March 1993 FRA special notice and to the 

pipeline industry in a March 1994 RSPA pipeline advisory, the latter of which was printed in 

the Federal Register. Many Class I rail carriers were not aware of the FRA special notice until 

they read about the RSPA advisory in the Federal Register. From interviews, the Safety Board 

determined that several Class I carriers have included information about the recommended 

actions in their emergency response plans. The Safety Board notes that none of the carriers 

indicated that they have included training of railroad personnel or contractors who supervise or 

oversee wreck-clearing operations in their plans. 

Risk Identification.--In formulating immediate emergency actions, the only potential 

hazard that on-scene emergency responders readily identified and closely monitored was the 

diesel fuel leaking from the locomotive. No emergency responder or CSXT employee in the 

derailment area noted the pipeline markers and reported the presence of the pipelines to the incident commander. The CFPL had provided the Osceola County Fire Department with information 

about the location of the pipelines, however, a fireman had put the documents in the fire chief's 

vehicle without telling him. Consequently, the incident commander was not aware of the pipelines until a CFPL representative arrived on-scene about 3:05 p.m., 2 hours, 23 minutes after 

the accident. 

 Although the Florida Department of Community Affairs, Emergency Management 

Division, approved the June 1992 Osceola County Disaster Plan as meeting all Federal and State 

emergency planning requirements, the standard operating procedures developed for incident 

commanders responding to freight and passenger train incidents or derailments do not include 

determining the presence of or potential endangerment to pipelines or other buried facilities 

within the railroad right-of-way. 

 The Safety Board concludes that Osceola County emergency responders failed to determine and assess the risks posed by potentially hazardous pipelines at the accident site. The 

Safety Board believes that Osceola County should revise existing risk identification standard 

operating procedures for railroad incidents to require that responders immediately determine 

whether pipelines or other potentially hazardous facilities are present at the site, and assess the 

risks posed by any facilities when formulating initial emergency response plans. When a determination is made that such facilities pose a potential risk, such standard operating procedures 

should emphasize the need for an incident commander to notify the facility operators and to 

continue monitoring and maintaining protective control measures at the site both during the 

initial emergency response and during subsequent wreckage removal and recovery operations. 

 The Safety Board believes that the State of Florida Division of Emergency Management 

in coordination with hazardous liquid and gas pipeline operators and railroads should establish 

procedures for prompt notification of all involved parties including public safety officials 

following a transportation accident and establish comprehensive plans for monitoring and 

maintaining protective control measures during wreck-clearing operations. 
48 

Overdimension Vehicle Escorts 

 Before the Intercession City accident occurred, policies and procedures for obtaining 

approval for off-duty FHP officers to perform escort services for overdimension vehicles varied 

little from those required for obtaining approval for providing off-duty security at a public 

gathering. The FHP was only expected to control highway traffic along the route. After the 

accident, the FHP extensively revised its escort approval requirements; the Safety Board believes 

these revisions should minimize the possibility of future similar occurrences in Florida. 

 During its investigation of this accident the Safety Board contacted several States and 

determined that requirements for providing escort of overdimension vehicles vary widely. Some 

jurisdictions, like Florida, permit (or require) off-duty police personnel to provide escort services 

while others use on-duty officers. Other jurisdictions don't use police personnel, but instead 

permit (or require) private professional escort services, usually with minimum qualification and 

training requirements established by the lead police agency in the jurisdiction. 

 Although the type of organization providing overdimension vehicle escort services may 

vary among the several jurisdictions, the Safety Board believes that those firms or agencies 

providing such services should ensure that the vehicle being escorted is in compliance with all 

applicable requirements for each jurisdiction. In the 16 States that require that low-clearance 

vehicle operators notify railroads in advance of the intent to travel over grade crossings, escorts 

should ensure that such advance notification has been given. 

 The Safety Board believes that the International Association of Chiefs of Police and the 

National Sheriff's Association should advise their membership of the facts and circumstances of 

this accident and request that members whose activities include providing escort for overdimension vehicles, or which exercise oversight of private organizations providing overdimension 

vehicle escort, review their policies and procedures to ensure that those responsible for performing the escort ensure that the overdimension vehicle operator is in compliance with all applicable permit and advance notification requirements, and has the information and the communications capability to contact railroad, utility, and other private entities along the vehicle's planned 

route in the event of a change in plans or an emergency. 

Lounge Car Seat Design 

 In the Amtrak Heritage lounge car, most passengers sustained minor injuries when they 

were thrown into car tables/seats. At least two lounge car passengers were injured when they 

were struck by displaced pedestal seats. During the derailment, the seat columns on four pedestal 

seats separated from the floor attachment flanges allowing the seats to be projected forward. 

 Had the pedestal seats collapsed or buckled along the pedestal support column, the 

potential for injury would have been reduced. The Safety Board concludes that separation at the 

weld connecting the base and column of the pedestal seats in the lounge car contributed to 

passenger injuries. 
 49 

 In a letter dated April 13, 1995, Amtrak advised the Safety Board that all Heritage 

lounge cars are expected to be out of service in the first quarter of 1996. The Safety Board 

believes that as an interim measure Amtrak should inspect all Heritage lounge cars still in 

service to identify and correct weld deficiencies in the pedestal seat floor attachment. Further, 

should lounge cars be refurbished before being retired, Amtrak should modify the pedestal seats 

to mitigate passenger injuries. 
50 

CONCLUSIONS 

Findings

 1. The AMTRAK crew was qualified to perform their duties in accordance with 

operating and hours of service rules. 

 2. The condition of the track, operation of the signals, and the mechanical condition 

of the train did not cause or contribute to the accident. 

 3. When the traincrew first sighted the Rountree vehicle, they did not have sufficient 

distance to stop the train in time to avoid the collision. 

 4. The Rountree vehicle had no preexisting mechanical problems or unusual conditions that caused or contributed to the accident. 

 5. No evidence indicates that any Rountree or Amtrak employees involved in the 

accident were under the influence of alcohol or other drugs. 

 6. Rountree had a statutory duty to provide advance notice to CSXT of all highway- 

 rail crossings it intended to traverse before proceeding across them, and failed to do so. 

 7. Rountree failed to ensure that it was safe to proceed over the KUA Power Road 

grade crossing before doing so. 

 8. Rountree may have increased the risk of damage or even the collapse of a highway structure by traveling on an unapproved route. 

 9. The CSXT permitting procedures do not ensure that the information provided 

by the motor carrier is accurate and complete. 

10. CSXT's procedures for providing protection to motor carriers at grade crossings are 

similar to those of other Class 1 rail carriers. 

11. During the Intercession City permit process, the FDOT did not ensure that Rountree had 

notified the railroads of the grade crossings that it intended to traverse. 

12. The lack of a coordinated action plan between CSXT and CFPL resulted in untimely 

notification of the pipeline operator, and a breakdown in communication during wreckclearing operations. 

13. Osceola County emergency responders failed to determine and assess the risks posed by 

potentially hazardous pipelines at the accident site. 
 51 

14. Separation at the weld connecting the base and column of the pedestal seats in the 

lounge car contributed to passenger injuries. 

Probable Cause 

 The National Transportation Safety Board determines that the probable cause of the 

accident was the failure of Rountree Transport and Rigging, Inc. to notify CSXT in advance of 

its intent to cross the railroad track and to ensure through CSXT that it was safe to do so. Contributing to the accident were deficiencies in the permitting processes of the CSXT and the 

Florida Department of Transportation that resulted in a lack of appropriate guidance for 

permitting officials, oversize, low-clearance vehicle operators, and escort personnel. 
52 

RECOMMENDATIONS 

As a result of its investigation of this accident, the National Transportation Safety Board makes 

the following recommendations: 

To the American Association of State Highway and Transportation Officials-- 

Inform your members of the facts and circumstances of the Intercession City, 

Florida, accident, and urge that they require operators of low clearance, overdimension/overweight vehicles to provide railroads with advance notification of 

travel over grade crossings. Further, recommend that your members revise their 

permit documents to state that compliance with this notification requirement is a 

condition of permitting. (Class II, Priority Action) (H-95-7) 

To the American Gas Association-- 

Advise your members of the pipeline safety issues identified in the Intercession 

City, Florida, accident report, and urge them to work with railroad operators in 

developing plans for handling emergencies involving both rail and pipeline. (Class 

II, Priority Action) (P-95-31) 

To the Interstate Natural Gas Association of America-- 

Advise your members of the pipeline safety issues identified in the Intercession 

City, Florida, accident report, and urge them to work with railroad operators in 

developing plans for handling emergencies involving both rail and pipeline. (Class 

II, Priority Action) (P-95-32) 

To the American Public Gas Association-- 

Advise your members of the pipeline safety issues identified in the Intercession 

City, Florida, accident report, and urge them to work with railroad operators in 

developing plans for handling emergencies involving both rail and pipeline. (Class 

II, Priority Action) (P-95-33) 

To the American Petroleum Institute-- 

Advise your members of the pipeline safety issues identified in the Intercession 

City, Florida, accident report, and urge them to work with railroad operators in 

developing plans for handling emergencies involving both rail and pipeline. (Class 

II, Priority Action) (P-95-34) 
 53 

To Central Florida Pipeline Corporation-- 

Cooperate with the CSXT and any other railroads in your operational areas to 

develop a program to notify the railroad when pipeline accidents endanger 

railroad operations. (Class II, Priority Action) (P-95-35) 

To the Association of American Railroads-- 

Inform your members of the facts and circumstances of the Intercession City, 

Florida, accident and recommend that they review their procedures for 

coordinating the transit of overdimension, low-clearance highway vehicles across 

their rights-of-way. (Class II, Priority Action) (R-95-24) 

Advise your members of the safety issues identified in the Intercession City, Florida, accident report, and urge that they work with pipeline operators in 

developing plans for handling emergencies involving both rail and pipeline. (Class 

II, Priority Action) (R-95-25) 

To the American Short Line Railroad Association-- 

Inform your members of the facts and circumstances of the Intercession City, 

Florida, accident and recommend that they review their procedures for coordinating the transit of overdimension, low-clearance highway vehicles across their 

rights-of-way. (Class II, Priority Action) (R-95-26) 

Advise your members of the pipeline safety issues identified in the Intercession 

City, Florida, accident report, and urge them to work with pipeline operators in 

developing plans for handling emergencies involving both rail and pipeline. (Class 

II, Priority Action) (R-95-27) 

To the National Railroad Passenger Corporation-- 

Inspect all Heritage lounge cars still in service to identify and correct separation 

problems between the base and pedestal column of the pedestal seat. Should 

lounge cars be refurbished before being retired, modify the pedestal seats to 

mitigate passenger injuries.(Class II, Priority Action) (R-95-28) 

To the Osceola County (Florida) Emergency Management Division-- 

Revise your standard operating procedures for a railroad incident to include 

immediately determining whether pipelines are present and whether they may 

pose a risk during the initial emergency response effort and subsequent wreckage 

removal operations. (Class II, Priority Action) (R-95-29) 
54 

To the State of Florida Division of Emergency Management-- 

In coordination with hazardous liquid and gas pipeline operators and railroads, 

establish procedures for prompt notification of all involved parties, including 

public safety officials, following a transportation accident and establish comprehensive plans for monitoring and maintaining protective control measures during 

wreck-clearing operations. (Class II, Priority Action) (P-95-36) 

To CSX Transportation Corporation-- 

Revise your permitting process and forms to ensure that overdimension vehicle 

operators provide load and complete route information so that CSX Transportation 

Corporation (CSXT) can ensure protection; ensure that CSXT employees issuing 

permits are familiar with the process and include a staffed 24-hour CSXT telephone number on the permit forms. (Class II, Priority Action) (R-95-30) 

Cooperate with Central Florida Pipeline Corporation and any other pipelines in 

your operational areas to develop a program to notify the pipelines when railroad 

accidents endanger pipeline operations. (Class II, Priority Action) (R-95-31) 

Develop, in coordination with hazardous liquid and gas pipeline operators, procedures for coordinating emergency response and wreckage clearing operations 

with public safety officials to ensure that the actions of its employees and its 

contractors do not endanger personnel safety or the facilities of others on or 

adjacent to the railroad right-of-way. (Class II, Priority Action) (R-95-32) 

To the Specialized Carriers and Rigging Association-- 

Advise your members of the facts and circumstances of the Intercession City, 

Florida, accident, and urge that they implement procedures to ensure that personnel coordinate with railroads when traversing grade crossings, comply with all 

statutes, obtain all necessary permits, have a emergency contingency plan, and 

outfit the move crew with appropriate emergency equipment, telephone numbers, 

and contacts. (Class II, Priority Action) (H-95-8) 

Revise the Permit Manual of State Permits and Canadian Regulations to list those 

jurisdictions that require low-clearance vehicle operators to provide railroads with 

advance notification of intended travel over grade crossings and include a caution 

that coordinating with railroads is necessary to ensure safe travel over grade 

crossings. (Class II, Priority Action) (H-95-9) 
 55 

To the International Association of Chiefs of Police-- 

Advise your members of the facts and circumstances of the Intercession City, 

Florida, accident, and request that those whose activities include providing 

or overseeing overdimension vehicle escort review their policies and procedures to 

ensure the vehicle operator is in compliance with all applicable permit and advance notification requirements, and has the communications capability and telephone numbers to contact railroad, utility, and other private entities along the 

route in the event of a change in plans or an emergency. (Class II, Priority 

Action) (H-95-10) 

To the National Sheriffs' Association-- 

Advise your members of the facts and circumstances of the Intercession City, 

Florida, accident, and request that those whose activities include providing or 

overseeing overdimension vehicle escort review their policies and procedures to 

ensure the vehicle operator is in compliance with all applicable permit and advance notification requirements, and has the communications capability and 

telephone numbers to contact railroad, utility, and other private entities along the 

route in the event of a change in plans or an emergency. (Class II, Priority 

Action) (H-95-11) 

To the National Committee on Uniform Traffic Laws and Ordinances-- 

Revise Section 14-112, "Permits for Excess Size and Weight," of the Uniform 

Vehicle Code to require that State agencies notify carriers of the provisions 

contained in Section 11-703, "Moving Heavy Equipment at Railroad Grade 

Crossings," before issuing permits. (Class II, Priority Action) (H-95-12) 

BY THE NATIONAL TRANSPORTATION SAFETY BOARD

 JAMES E. HALL 

 Chairman 

 ROBERT T. FRANCIS II 

Vice Chairman 

 JOHN A. HAMMERSCHMIDT 

Member

May 16, 1995 

 57 

APPENDIX A 

INVESTIGATION

Investigation 

 The National Transportation Safety Board was notified of this accident at 1 p.m. on 

November 30, 1993, by the news media. 

 Accident investigators dispatched from the Safety Board's Atlanta, Georgia, regional 

office arrived on scene at 7 p.m., and investigators dispatched from the Safety Board's headquarters office in Washington, D.C. arrived on scene at 10 p.m., November 30, 1993. 

 Participating in the investigation were representatives of Rountree Transport and Rigging, 

Inc., CSX Transportation, Inc., the National Railroad Passenger Corporation (AMTRAK), the 

Central Florida Pipeline Corporation, the Brotherhood of Locomotive Engineers, the Osceola 

County (Florida) Fire and Rescue Department, the Florida Highway Patrol, the Florida Department of Transportation, the Federal Railroad Administration, and the Federal Highway Administration. 

Hearing/Deposition 

 The Safety Board did not hold a public hearing or deposition proceedings in connection 

with this accident. On December 1, 1993, the Safety Board obtained sworn testimony from the 

engineer, the conductor, and the assistant conductor. 

 59 

APPENDIX B 

INJURY INFORMATION

 Injuries in this accident have been coded to the revised 1990 Abbreviated Injury Scale 

of the American Association for Automotive Medicine, which is a standard system of assessing 

injury severity. 

Abbreviated Injury Scale Table 

Injuries Truck Driver Train Crew Train Passengers Total 

 AIS-1 Minor 1 2 50 53 

 AIS-2 Moderate 0 2 3 5 

 AIS-3 Serious 0 1 0 1 

 AIS-4 Severe 0 0 0 0 

 AIS-5 Critical 0 0 0 0 

 AIS-6 Unsurvivable 0 0 0 0 

 AIS-0 None 0 5 36 44 

 AIS-9 Unknown 0 0 0 0 

 Total 1 10 89 103 

APPENDIX C 

RAILROAD/HIGHWAY GRADE CROSSINGS 

ON THE ROUTE OF THE ROUNTREE VEHICLE 

. . c&X Tran;;o&tion .- ,’ .;, .. j; 

‘1 D~y&n~Subt,iivision .. . . ‘: 

DiCdP;;MI. :: ‘;I ...I 

._ :.: i,: 

Fertilizer Business Unit Chcm Lead. Hooker’s Point Spur 

DOT/BAR No. 626438-W 

I* _. . . .:. : ~843.23 Fertiliir Business Unil Guy Verger Blvd., Ho&r’s Point Spur 

DOTiAAR No. 626438-W 

, .” ‘.2( -2.“. . ,T Feiiiliier Business Unit 

,3;: .;i$ S843.23 .: - 22nd Street, Hooker’s Point Main Track 

-...--.,.. -- ““:.“A; . .: _... ^... .._* :..A _‘. .-. _ _ -22 --7.2 .:. _.._ _ .: DOT/AAR No. 626398-B 

‘.T.’ - . . . ,’ .“.“,., I.. .‘i”’ I 

.?Z. __ S843.22 “. Fertili&r Business Unit Route 60. H&er’s’Poiit Main Track 

DOTIAAR No. 626957-Y 

i : Fcni,izcr Busi”m Uni, Route 60 

DOT/AAR No. 624820-X 

: 

6* ~878.8 Fertilizer Business UnitlLtkehtnd East Tampa Blvd. and 7th Avenue 

” _. ” DOTlAAR No. 624365-C . .._ - 

.:...: . . . . .. .:... . .._ -’ Y .-.. 7*. A876.0 ‘- Fertilizer Business Unit/Lakeland Route 574 

-. DOTlAAR No. 624363-T 

. . . 

8.: ._.. -...I S809.46; 1. Fertilizer Business UttitlYeom;m Pasco County Road 535 

DOTIAAR No. 623822-N 

* _ .- I _ 

AR838.6 Per&& Business UnitNitis ‘“9@“-- .State Route 54 

DOTIAAR No. 62285 I-P 

c,y-‘- -.... . .. 

IO A827.29 JacksonvilIe&akeland Bates Road. Polk County 

DOTlAAR No. 622968-X 

11 A8234 Jaeksonvill&.akeland Standard Sand and Silica Spur 

DOTIAAR No. 622959-Y 

12 A816.30 Jacksonville/Lakeland ..’ KUA Power Road 

DOTIAAR NO. 643879-N 

- Sk to warehouse crossing ‘Old Tampa 

13 A81280 JaeksonviIhz/lakeland i 

-, Highway ahout 2110 mile west of 

Poinciana Blvd. (crossed twice.) ._ DOTIAAR No. 622951-U 

l Crossings ivhm CSXT provid.ed flagging -proteCtion 

1. . 

’ 61 

C 

APPENDIX C

RAILROAD/HIGHWAY GRADE CROSSINGS

ON THE ROUTE OF THE ROUNTREE VEHICLE

: 

APPENDIX D

CSXT PERMITS ISSUED TO ROUNTREE
Appendix 0 

. 

.. -, . . _. 

. 

., . . - _.- 

. .._ _ -. e .: 

-_ :. 

c 

. - 

..Y 

.A. ., 

. 

. : 

-I 

__ .. 

: I : 

2840 NON\ lane Awnw X80 SW 46lh kenue 4 I2 A TaIL-vhwland uoad 

- ,J4ckmwdte. Fbh 32206 tt lmdeww~. nDlre4 333 14 wurdo. fbfl8a 32624 

1.600-342ao36 1.600-432.2203 407 1655.7306 

004/?81-1033 3OW587.1333 

. il 

: 

-. 

she4 lof2 i 

i SPEClAthED l%iUi.tNG & RlOGlNQ . ! 

, ,SonlnQ the S’duiheaftern United hates 

; ._ ,-. ,. . Attachment 1 to the October 29 Permit 

64 
Appendix D 

; 

! 

SPECtklZED HAtJLlsjG & ~~IGGlNG . 

Ssstufng the~%utheartern Udted States 

t 

L --. . . . . e-m.. 7. . . . . . e-. -. I __ IAttackeut 2 to the Cktotw 29 Pesmit 

: 65 

‘. 
a0 prrcmt of odginal she 

66 

. 

. 

- _ i :., -i ..-. A..-d-e.. ____..._. _- -...- &..I :-. __ __ 
. 

. 

Appendix D 

._ _ A . 

‘- 

,. _. -5 \ _ “.r_. .,._ .-x. . .?. k- 

.-,.; .--f .,- .y,. ..“‘:‘.-,’ - -_ : ,. 

_i . . . ..S...” _. .-------W 

< 

I;- EiX&iT-OF&AY: Pa&sag&, -&r&h 9, 1993 

Rountrcc Transport & Rigging, Inc. '-1, ;_ . j I . ' . . 2‘ . . I L . :. - '..I.'. .:' ., . *$ :‘;‘.-- s.',.:'... -. -.,:;;.",, ..;- .i,:-:. I:. “:. >-, _:., . .;'> '_" . : 

2-T R&t~‘~br '(lhui&& ~d~&e~t'~across CSXT tracks at the fOlloiJing ".'~":locdtions'bcginning':at 12:Of .AM, March 17, 1993: I 

:-’ :.. . . . .;--;;,,7. .. T’$(: 7 “l’,-;&. ;‘.:: c’: . .. 

:: .+Begin at-Guy~Verg&r':and Maritime Blvd., Hookers Pdint, 

continue north on 20th Street to Durham, 

_- East on Durham to..22nd Stree.t, . . 'North to State Road 60,.(Adamo Dr.), --“- East ii0 tiS41” (50th Street), : . . . , 

-:-----North 'to -Columbus Drive, 

East across Sabal Park lead track. 

i'ephyffiiilb; FL, && Road'54 (Signal needs adjusted at this 

. . ' l,ocationApou-ctree to furnish crane) ;.: :. ., _, :' ~ ! - .- 

. .." -'. . . . . 

*. 

. . ._ . .’ 

_ . . : . . . 1’. : 

. .!, >:. I: ._ . . 

: : . . . ,y> . ..- 

: 

.I 

. . 

67 

 69 

APPENDIX E 

SECTION 11-703 OF THE UNIFORM VEHICLE CODE AND

SECTION 316.170 OF THE FLORIDA UNIFORM TRAFFIC CONTROL

"Moving Heavy Equipment at Railroad Grade Crossings", provides that: 

(1) No person shall operate any crawler-type tractor, steam shovel, derrick, or roller, 

or any equipment or structure having a normal operating speed of 10 or less miles per 

hour or a vertical body or load clearance of less than 1/2 inch per foot of the distance 

between any two adjacent axles or in any event of less than 9 inches, measured above 

the level surface of a roadway, upon or across any track at a railroad grade crossing 

without first complying with this section. 

(2) Notice of such intended crossing shall be given to a station agent or other proper 

authority of the railroad, and a reasonable time shall be given to the railroad to provide 

proper protection at the crossing. 

(3) Before making any such crossing the person operating or moving any such vehicle 

or equipment shall first stop the same not less than 15 feet nor more than 50 feet from 

the nearest rail of the railroad and while stopped shall listen and look in both directions 

along the track for any approaching train and for signals indicating the approach of a 

train, and shall not proceed until the crossing can be made safely. 

(4) No such crossing shall be made when warning is being given by automatic signal or 

crossing gates or a flagman or otherwise of the immediate approach of a railroad train 

or a car. If a flagman is provided by the railroad, movement over the crossing shall be 

under his direction. 

. 

APPENDIX F 

state. 

Notification Applicable Ovdmension khicle 

Rcqtxirl?d? Regulation Pennits in 1993 

.- No 66.970 

Arkansas No 

- California ‘. ” No 

ccaxldo YCS 

Connecticut Ntl 

-I’ Yes 

22.660 

l32.ooo 

42-I-609 38.3-u 

68.000 

I 4167 38.789 

Florida I 

Georr?ria I .No 1 

Idaho I NO I I a.700 

Illinois ’ Yes I I I-1203 I 193,500 

It&ma yes 40 198,ooo 

YCS 321.x-I 9o.ooo 

Kmsas 36I-27,36-I-IA 55,ooo 1 L 

Kentucky 1.’ No 1 ! 91 .ooo 

Louistnit ’ I Yrs I 171 I 219.835 

Maine bNo 1 I 25,ooo 

Maryland YeS 21-70-l 99.847 

hlaachuseus I -No I 

Michiaan I No I 

Mitinesow 

Mississippi 

Missouri 

No 106,ooo 

No 200,ooo 

No 105.ooo 

APPENDIX F

STATES REQUIRING NOTIFICATION TO RAILROAD(S) OF 

TRAVEL OVER RAILROAD/HIGHWAY GRADE CROSSING(S)