Document ID: FRA-2009-0031-0159
Agency: fra
Document Type: Notice
Title: Safety Advisories: Locomotive Alerters Resetting Without Direct Engineer Action
Posted Date: 2015-12-01T05:00Z

[Federal Register Volume 80, Number 230 (Tuesday, December 1, 2015)]
[Notices]
[Pages 75162-75163]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-30469]

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DEPARTMENT OF TRANSPORTATION

Federal Railroad Administration

[Safety Advisory 2015-06]

Locomotive Alerters Resetting Without Direct Engineer Action

AGENCY: Federal Railroad Administration (FRA), Department of 
Transportation (DOT)

ACTION: Notice of Safety Advisory.

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SUMMARY: FRA is issuing Safety Advisory 2015-06 to notify freight 
railroads of the circumstances of a head-on collision at Hoxie, AR, and 
the risks automated inputs that reset alerter warning timing cycles 
pose. A small number of Union Pacific Railroad (UP) locomotives were 
equipped with alerters that the horn sequencer reset without direct 
engineer action, reducing the alerters' effectiveness. UP has 
appropriately modified its locomotives to resolve the issue and FRA is 
not aware of any other locomotives equipped with alerters that 
automatically reset without direct engineer action. However, all 
freight railroads should review the operation of their locomotives 
equipped with alerters, and modify them as necessary, to ensure no 
system resets the alerter warning timing cycle without direct engineer 
action.

FOR FURTHER INFORMATION CONTACT: Mr. Gary Fairbanks, Staff Director, 
Motive Power and Equipment Division, Office of Railroad Safety, FRA, 
1200 New Jersey Avenue SE., Washington, DC 20590, (202) 493-6322; or 
Mr. Michael Masci, Trial Attorney, Office of Chief Counsel, FRA, 1200 
New Jersey Avenue SE., Washington, DC 20590, (202) 493-6037.

SUPPLEMENTARY INFORMATION:

Background, Including Accident Summary and Regulatory Context

Locomotive Alerter Functioning

    A locomotive alerter is a safety feature installed on a locomotive 
to ensure the locomotive engineer remains alert while operating the 
locomotive. The alerter monitors the engineer's interactions with the 
locomotive and initially produces an alarm in the cab when no control 
actions are taken to reset the alerter warning timing cycle within a 
certain length of time. Because over-the-road locomotive operations 
often do not require frequent engineer actions (control inputs), 
alerter systems are also equipped with a manual reset button that 
allows the engineer to reset the warning timing cycle directly. If no 
control action or manual reset occurs after the alarm sounds, the 
alerter system will initiate a penalty brake application and reduce 
locomotive power to idle to stop the locomotive.
    Horn activation is a locomotive control action that will reset the 
alerter warning timing cycle, but when automated (using a horn 
sequencer) it can also interfere with the alerter's normal 
functionality. On many locomotives, there are two distinct ways to 
activate the horn: (1) During ordinary operation, the engineer holds a 
manual horn controller in the ``on'' position to activate it, and then 
releases the controller to silence it; and (2) when approaching a 
crossing, the engineer activates a separate switch (often a foot pedal) 
to initiate an automatic horn sequencer (sounding the long-long-short-
long sequence FRA's regulations require for public highway-rail grade 
crossings, see Title 49 Code of Federal Regulations (CFR) 222.21(a)). 
The simple presence of a horn sequencer is not a safety issue. The horn 
sequencer is a convenient tool, because of the frequent need to sound 
the long-long-short-long horn sequence for public highway-rail grade 
crossings. However, when the horn sequencer enables the alerter warning 
timing cycle to reset without direct engineer action, it acts to delay 
the alerter's safety functionality and reduce its effectiveness, which 
could have serious safety consequences.

Accident Summary and Testing

    The head-on collision at Hoxie highlights the importance of this 
issue.\1\ On August 17, 2014, at approximately 2:28 a.m. (CDT), a 
southbound UP freight train passed an approach and then a stop 
indication and collided with a northbound UP freight train while 
transitioning from double-main track to single-main track at Control 
Point Y 229 on the UP Hoxie Subdivision in Hoxie. The collision 
resulted in two crewmember fatalities. The event recorder on the lead 
southbound locomotive was destroyed, but the event recorder and a 
camera on a trailing locomotive enabled the National Transportation 
Safety Board (NTSB) to recreate certain key events leading up to the 
moment of impact. Four minutes and 53 seconds before impact, the 
engineer activated the horn sequencer, which continued to cycle for 4 
minutes and 6 seconds, at which time he deactivated it after passing a 
grade crossing at Hickory (Milepost (MP) 227.84)). During the time the 
horn sequencer was operating, the engineer made one throttle change, 
but took no action after passing an approach signal at MP 227.4.
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    \1\ This section provides a brief summary of the circumstances 
surrounding the collision, based on the NTSB and FRA preliminary 
findings to date. The probable cause and contributing factors, if 
any, have not yet been established. Therefore, nothing in this 
safety advisory is intended to attribute a cause to this incident, 
or place responsibility for this accident on the acts or omissions 
of any person or entity.
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    Given the recorded speed of the train, there were two intervals 
during horn sequencer operation when the alerter could have sounded, 
alerted the crew, and initiated a penalty brake application if no 
response was given. The evidence available does not rule out the 
possibility that the engineer was manually resetting the alerter on the 
lead locomotive. However, if the locomotive was set up the same as the 
trailing locomotive, which is likely, the alerter would not have 
reached its intended timing cycle limit before the actual impact, 
regardless whether the automatic activation of the horn sequencer reset 
the timing cycle. The interval from deactivation of the horn sequencer 
to impact was 44 seconds, or 9 seconds shorter than the alerter warning 
timing cycle interval of 53 seconds at the impact speed of 45 mph, so 
no alarm or penalty brake application could have occurred in this 
interval.
    FRA cannot determine whether an alerter activation would have 
prevented the Hoxie collision. Yet, if the alerter had alarmed during 
the minutes leading up to the collision, it could have provided an 
opportunity to prevent or mitigate this accident. FRA tests of another 
locomotive in the same series verified that the horn sequencer 
installed in these locomotives reset the alerter warning timing cycle 
after each sounding of the horn, even though all but the first horn 
blast were initiated automatically. This series of 40 locomotives, 
which were built over 20 years ago, were factory-equipped with a stand-
alone horn sequencer, wired to reset the alerter with every sounding of 
the horn, including the sounding of the horn by the horn sequencer.
    UP has appropriately modified this series of locomotives to address 
this issue. FRA did not specifically regulate the manner of the 
alerter's interaction with the horn sequencer when the locomotives were 
manufactured. As discussed below, freight locomotives of

[[Page 75163]]

this age will not fall under FRA's alerter regulations until January 1, 
2017.

FRA Regulations

    FRA safety regulations addressing alerters on freight locomotives 
are found at 49 CFR 229.140. See 77 FR 21312 (April 9, 2012). Section 
229.140 requires all controlling locomotives that are placed in service 
for the first time on or after June 10, 2013, and operated at speeds in 
excess of 25 mph to be equipped with an alerter. This section also 
requires all controlling locomotives operated at speeds in excess of 25 
mph on or after January 1, 2017, to be equipped with an alerter, 
regardless of when they were first placed in service.
    This section prohibits automatic systems from resetting the 
locomotive alerter. Specifically, 49 CFR 229.140(b)(3) requires 
movement of the engineer's horn activation handle to reset the alerter 
warning timing cycle. Using a horn sequencer to reset the alerter with 
each sounding of the horn (one for each of the long-long-short-long 
sequence) does not satisfy 49 CFR 229.140(b)(3), because all but the 
first horn blast are initiated automatically. This section requires 
engineers to take direct action, either by operation of certain 
controls or actuation of the manual reset, to restart the alerter 
warning timing cycle. Further, under 49 CFR 229.140(e), the alerter 
must be functioning and operating as intended when the locomotive is 
used. FRA addresses failures to comply with these regulatory 
requirements through inspections and enforcement activities.
    Recommended Action: In light of the discussion above, and because 
many older locomotives, including locomotives from smaller 
manufacturers and remanufacturers are still in service, FRA recommends 
that all freight railroads check the operation of their locomotives 
equipped with alerters to ensure that no system resets the alerter 
warning timing cycle without direct engineer action. This review should 
include, but not be limited to, the operation of horn sequencer 
circuitry, if equipped. Railroads should modify any such systems they 
find to ensure that no system interferes with the alerter warning 
timing cycle. In particular, FRA recommends that railroads that may 
have installed alerters prior to June 10, 2013, review the design of 
those systems and modify them as necessary, before January 1, 2017, to 
ensure safety and compliance with 49 CFR 229.140(b)(3).

    Issued in Washington, DC, on November 25, 2015.
Patrick T. Warren,
Deputy Associate Administrator for Safety.
[FR Doc. 2015-30469 Filed 11-30-15; 8:45 am]
BILLING CODE 4910-06-P