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NTSB issues safety recommendations based on fatal 2011 Amtrak crash in Nevada

(Source: National Transportation Safety Board press release, January 30, 2013)

WASHINGTON, D.C. — NTSB Releases Safety Recommendations Regarding the June 24, 2011 Highway-Railroad Grade Crossing Collision in Miriam, Nevada.
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January 30, 2013

The National Transportation Safety Board makes the following recommendations to the following organizations:

To the Federal Motor Carrier Safety Administration:

Create a mechanism to gather and record commercial driving-related employment history information about all drivers who have a commercial driver’s license, and make this information available to all prospective motor carrier employers. (H-12-054)

Using the mechanism developed in Safety Recommendation H-12-54, require motor carriers to conduct and document investigations into the employment records of prospective drivers for the 10 years that precede the application date. (H-12-055)

Require motor carriers to retrieve records from the Commercial Driver’s License Information System and the National Driver Register for all driver applicants so that they can obtain a complete driving and license history of prospective drivers. (H-12-056)

Inform commercial vehicle inspectors of (1) the importance of taking pushrod stroke measurements within the specified pressure range, (2) the relationship between pushrod stroke and specific air pressure, and (3) the consequence of taking measurements outside of this range. (H-12-057)

http://www.ntsb.gov/doclib/recletters/2012/H-12-054-057.pdf

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To the National Highway Traffic Safety Administration:

Develop minimum performance standards for onboard brake stroke monitoring systems for all air-braked commercial vehicles. (H-12-058)

Once the performance standards in Safety Recommendation H-12-58 have been developed, require that all newly manufactured air-braked commercial vehicles be equipped with onboard brake stroke monitoring systems. (H-12-059)

http://www.ntsb.gov/doclib/recletters/2012/H-12-058-059.pdf

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To the Federal Highway Administration:

Work with the Federal Railroad Administration to develop a model grade crossing action plan that can be used as a resource document by all states. At a minimum, such a document should incorporate information from US Department of Transportation publications, industry studies, and the American Association of State Highway and Transportation Officials, as well as the best practices and lessons learned at the conclusion of the 5-year grade crossing action plans developed in response to 49 Code of Federal Regulations 234.11, “State Highway–Rail Grade Crossing Action Plans.” (H-12-060)

Work with the Federal Railroad Administration to update your website on the annual reporting requirements for railway–highway crossings, to include comprehensive information on the individual grade crossing action plans developed by the states pursuant to 49 Code of Federal Regulations 234.11, “State Highway–Rail Grade Crossing Action Plans.” (H-12-061)

http://www.ntsb.gov/doclib/recletters/2012/H-12-060-061.pdf

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To the Federal Railroad Administration:

Develop side impact crashworthiness standards (including performance validation) for passenger railcars that provide a measurable improvement compared to the current regulation for minimizing encroachment to and loss of railcar occupant survival space. (R-12-039)

Once the side impact crashworthiness standards are developed in Safety Recommendation R-12-39, revise 49 Code of Federal Regulations 238.217, “Side Structure,” to require that new passenger railcars be built to these standards. (R-12-040)

Require that passenger railcar doors be designed to prevent fire and smoke from traveling between railcars. (R-12-041)

Work with the Federal Highway Administration to develop a model grade crossing action plan that can be used as a resource document by all states. At a minimum, such a document should incorporate information from US Department of Transportation publications, industry studies, and the American Association of State Highway and Transportation Officials, as well as the best practices and lessons learned at the conclusion of the 5-year grade crossing action plans developed in response to 49 Code of Federal Regulations 234.11, “State Highway–Rail Grade Crossing Action Plans.” (R-12-042)

Work with the Federal Highway Administration to update its website on annual reporting requirements for railway–highway crossings, to include comprehensive information on the individual grade crossing action plans developed by the states pursuant to 49 Code of Federal Regulations 234.11, “State Highway–Rail Grade Crossing Action Plans.” (R-12-043)

http://www.ntsb.gov/doclib/recletters/2012/R-12-039-043.pdf

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To the Nevada Highway Patrol:

Inform commercial vehicle inspectors of (1) the importance of taking pushrod stroke measurements within the specified pressure range, (2) the relationship between pushrod stroke and specific air pressure, and (3) the consequence of taking measurements outside of this range. (H-12-062)

http://www.ntsb.gov/doclib/recletters/2012/H-12-062.pdf

__________________________

To the Commercial Vehicle Safety Alliance:

Inform commercial vehicle inspectors of (1) the importance of taking pushrod stroke measurements within the specified pressure range, (2) the relationship between pushrod stroke and specific air pressure, and (3) the consequence of taking measurements outside of this range. (H-12-063)
Inform your members to avoid backing off air brake slack adjusters after a vehicle has been involved in an accident. (H-12-064)

http://www.ntsb.gov/doclib/recletters/2012/H-12-063-064.pdf

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To the American Trucking Associations and the Owner-Operator Independent Drivers Association:

Inform your members of the circumstances of this accident and encourage them to conduct proper maintenance on brake systems with automatic slack adjusters and to install onboard brake stroke monitoring systems on their commercial motor vehicles. (H-12-065)

http://www.ntsb.gov/doclib/recletters/2012/H-12-065.pdf

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To the Towing and Recovery Association of America, Inc.:

Inform your members to avoid backing off air brake slack adjusters after a vehicle has been involved in an accident. (H-12-066)

http://www.ntsb.gov/doclib/recletters/2012/H-12-066.pdf

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To the American Bus Association and the United Motorcoach Association:

Inform your members of the circumstances of this accident and encourage them to install onboard brake stroke monitoring systems on their commercial motor vehicles. (H-12-067)

http://www.ntsb.gov/doclib/recletters/2012/H-12-067.pdf

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To John Davis Trucking Company, Inc.:

Revise your vehicle maintenance to follow recommended practices, particularly with regard to automatic slack adjusters and antilock braking systems. (H-12-068)

http://www.ntsb.gov/doclib/recletters/2012/H-12-068.pdf

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The complete recommendation letters are available at the URLs indicated above.

The letters are in the Portable Document Format (PDF) and can be read using the Acrobat Reader 5.0 or later from Adobe (http://www.adobe.com/prodindex/acrobat/readstep.html).

An archive of recommendation letters is available at http://www.ntsb.gov/safety/safety_recs.html.
Electronic versions of letters may or may not include enclosures; however, related publications, accident briefs, and aviation accident synopses may be found on www.ntsb.gov.

Thursday, January 31, 2013

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