Prepared by: The Federal Railroad Administration, Office of Railroad Safety

SAFETY BULLETIN

2023-05

SUBJECT: Shoving Movement Close Clearance Fatality

The Federal Railroad Administration (FRA) is investigating a fatality that occurred on August 6, 

2023. Based on FRA’s preliminary investigation, the conductor was riding the end of the leading 

intermodal car controlling the yard shoving move and a conductor trainee (CT) was riding the 

leading end of the second car. The move consisted of two locomotives and nine loaded 

intermodal well cars. Both employees were riding on the same side of the cars. The accident 

occurred at night. The leading end of the movement traversed a slight curve and approached a set 

of three parked locomotives on the adjacent track to their right. The conductor continued the 

shove movement even though the track centers were becoming increasingly narrow. The 

conductor’s stature allowed him to position himself to pass the locomotives. However, the CT 

was not able to pass the locomotives and received fatal crushing injuries between the car he was 

riding and the parked locomotives. It is important to note that the conductor had less than a year 

of experience and never made this switch prior to the accident. The CT was released from 

classroom training approximately two weeks prior to this incident. 

The purpose of this Safety Bulletin, which is informal in nature, is to ensure the railroad industry 

is aware of this recent accident that resulted in a fatality of an employee and encourage railroads 

to identify locations where clearance specific safety issues could occur, cover these serious 

safety issues during safety-briefings, and (re)train employees as needed. As FRA completes its 

investigation, it may take additional actions with respect to this accident.

FRA requests that railroads review this Safety Bulletin with employees to increase awareness of 

the dangers of close clearances when riding moving equipment and ensure employees who ride 

moving equipment do so safely, to include:

1. Railroads should review their training programs to ensure the programs are adequate to 

prepare employees to identify close clearance and equipment fouling situations while 

riding equipment. Training programs should ensure that employees overseeing trainees

possess sufficient experience and understanding of their duties to adequately impart a 

safety-first mindset and proper instruction to trainees they oversee.

2. Railroads should identify yard and main line close clearance tracks where employees 

should not ride equipment and post those findings in the railroads operating rules, special 

instructions, and timetables. Additionally, railroads should consider marking all 

permanent close/no clearances with highly visible signs.

3. Employees should only ride equipment when necessary for job duties, and only after the 

process for doing so is discussed in a job briefing. Further, employees should only ride 

equipment after determining it is safe to do so.
Prepared by: The Federal Railroad Administration, Office of Railroad Safety

4. Railroads should review with their employees Switching Operations Fatality Analysis 

(SOFA) Safety Alert - August 2023. That alert is available on FRA’s website at 

https://railroads.dot.gov/elibrary/sofa-alert-august-11-2023. The SOFA Working Group is 

a voluntary, non-regulatory, workplace safety partnership formed to identify 

commonalities among fatalities that occur during switching operations. 

Issued: August 16, 2023

##