PB85-916313 

NATIONAL 
TRANSPORTATION 
SAFETY 
BOARD___ 

HEAD-ON COLLISION OF CHICAGO, 
SHORE AND SOUTH BEND RAILROAD 
TRAINS NOS. 123 AND 2 1 8 
GARY, INDIANA 
JANUARY 2 1 , 1 9 8 5 

WASHINGTON, D.C. 20594 

REPORT 

NTSB/RAR-85/13. 

UNITED STATES GOVERNMENT 



TECHNICAL REPORT DOCUMENTATION PAGE 
Report No. 

N T S B / R A R - 8 5 / 1 3 
2 .Government Accession No. 

P B 8 5 - 9 1 6 3 1 3 
*t. Title and Subtitle Railroad A c c i d e n t R e p o r t - -

H e a d - O n Collision o f C h i c a g o , South Shore and South Bend 
Railroad Train N o s . 123 and 218, Gary, Indiana, January 21 
1985 _ 

7. Author(s) 

3 .Recipient's Catalog No. 

5 . Report Date 
O c t o b e r 21, 1985 

6.Performing Organization" 
Code 

8. Performi ng Organ i zat ion" 
Report No. 

Performing Organization Name and Address 
N a t i o n a l Transportation S a f e t y Board 
Bureau o f A c c i d e n t Investigation 
Washington, D . C . 20594 

1 0 .Work Unit No. 
4103B 

11.Contract or Grant No. 

12.Sponsoring Agency Name and Address 

NATIONAL TRANSPORTATION SAFETY BOARD 
Washington, D. C. 20594 

3 -Type of Report and 
Period Covered 
R a i l r o a d A c c i d e n t R e p o r t 

January 21, 1985 

1 V. Sponsoring Agency Code 

15.Supplementary Notes 

jaaL 
7 6 . Abstract A b o u t 6:51 p.m., e.s.L, bn January 21, 1985 
and South Bend Railroad (South Shore) ti ain N o . 123 and westbound South Shore train N o . 218 
c o l l i d e d head-on on the eastward main tijack_alJdU$^$90 feet! west o f the west end o f the Gary 
Station platform at Gary, Indiana. T h e k e a ^ w a l ^ i ! ^ T n l ? a c K was being used for s i n g l e - t r a c k 
operation for about 3.5 miles b e t w e e n the end o f the double track east of Gary Station and 
Clark Crossover west o f Gary Station because d a m a g e caused by cold w e a t h e r breaks t o the 
catenary propulsion p o w e r system o v e r the westward main track made the track unusable by 
e l e c t r i c a l l y propelled trains. T h e lead cars of the s e l f - p r o p e l l e d units of each train w e r e 
crushed and d e r a i l e d . S e v e n t y - n i n e passengers, 6 c r e w m e m b e r s , and 2 o f f - d u t y e m p l o y e e s 
w e r e injured in the c o l l i s i o n . T h e South Shore e s t i m a t e d the d a m a g e t o be about $2,433,000. 

eastbound C h i c a g o , South Shore 

The N a t i o n a l Transportation S a f e t y Board d e t e r m i n e s that the probable cause 
of this a c c i d e n t was the failure o f the dispatcher to c o o r d i n a t e the m o v e m e n t of the t w o 
trains properly; the lack o f a clear provision in G e n e r a l N o t i c e N o . 62 for a meeting of t w o 
opposing trains scheduled to depart Gary Station at the same t i m e ; and the mistaken 
d e t e r m i n a t i o n by the c r e w o f eastbound train N o . 123 w h i l e at Clark Road Station that there 
was sufficient t i m e f o r the train t o reach Gary Station and c l e a r the single track b e f o r e t h e 
scheduled departure o f westbound train N o . 218. 

17 - Key Words Head-on c o l l i s i o n ; MU Trains; 
catenary; pantograph; single track operation; 
g e n e r a l order, train order; OS circuit stop and 
p r o c e e d signal a s p e c t ; deadman c o n t r o l ; operating 
rules; flat t i m e 

1 8 .Distribution Statement 
This document is a v a i l a b l e to 
the public through the N a t i o n a l 
T e c h n i c a l I n f o r m a t i o n S e r v i c e , 
Springfield, Virginia 22161 

19 Security Classification 
(of th i s report) 

UNCLASSIFIED 

2 0 .Security Classification 
(of this page) 
UNCLASSIFIED 

21 No. of Pages 

4 1 

2 2 . Price 

N T S B F o r m 1 7 6 5 2 ( R e v . 9 / 7 4 ) 



E R R A T A 

************************************ 
* THESE C O R R E C T I O N S SHOULD BE * 
* MADE TO THE P R E V I O U S L Y P U B L I S H E D * 
* R E P O R T I D E N T I F I E D A S FOLLOWS * 
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 

RAILROAD ACCIDENT REPORT 
NTSB/RAR-85/13 (PB85-916313) 

The cover page on this report should be corrected to read 
as followed 

HEAD-ON COLLISION OF CHICAGO, 
SOUTH SHORE AND SOUTH BEND RAILROAD 
TRAINS NOS. 123 AND 218 
GARY, INDIANA 
JANUARY 21, 1985 

November 27, 1985 



C O N T E N T S 

S Y N O P S I S 1 

I N V E S T I G A T I O N 1 
Events Preceding The A c c i d e n t 1 
The A c c i d e n t 5 
Injuries t o Persons 8 
D a m a g e 8 
C r e w m e m b e r Information 12 
Training 12 
Train Information 14 
Track Information 15 
Method o f Operation 15 
M e t e o r o l o g i c a l Information 18 
M e d i c a l and P a t h o l o g i c a l Information 18 
Survival A s p e c t s 18 
Tests and Research 19 
Other Information 19 

A N A L Y S I S 20 
Train Operations 20 
The Dispatcher 22 
Train N o . 218 C r e w m e m b e r s 25 
Train N o . 123 C r e w m e m b e r s 25 
Training 27 
Survival F act ors 2 8 

C O N C L U S I O N S 29 
Findings 29 
Probable Cause 30 

R E C O M M E N D A T I O N S 30 

A P P E N D I X E S 33 
Appendix A — I n v e s t i g a t i o n 33 
Appendix B — C r e w m e m b e r Information 34 
Appendix C — O p e r a t i n g Rules 36 
Appendix D — C a t e n a r y Information 39 
Appendix E—Excerpt from T i m e t a b l e 40 

i i 



N A T I O N A L T R A N S P O R T A T I O N S A F E T Y B O A R D 
W A S H I N G T O N , D . C 

R A I L R O A D A C C I D E N T R E P O R T 

Adopleds O c t o b e r 219 1985 

H E A D - O N C O L L I S I O N O F 
C H I C A G O S O U T H S H O R E A N D S O U T H B E N D R A I L R O A D 

T R A I N NOS„ 123 A M D 218 
G A R Y , I N D I A N A 

J A N U A R Y 21, 1985 

S Y N O P S I S 

About 6:51 p . m . , e.s.t., on January 21, 1985, eastbound C h i c a g o , South Shore and 
South Bend Railroad (South Shore) train N o . 123 and westbound South Shore train N o . 218 
collided head-on on the eastward main track about 1,490 f e e t west of the west end of the 
Gary Station platform at Gary, Indiana. T h e eastward main track was being used tor 
s i n g l e - t r a c k operation for about 3.5 miles b e t w e e n the end of the double track east of 
Gary Station and Clark Crossover west o f Gary Station because damage caused by cold 
weather breaks to the catenary propulsion p o w e r system o v e r the westward main track 
made the track unusable by e l e c t r i c a l l y propelled trains. T h e lead cars o f the 
s e l f - p r o p e l l e d units of each train w e r e crushed and d e r a i l e d . S e v e n t y - n i n e passengers, 
6 c r e w m e m b e r s , and 2 o f f - d u t y e m p l o y e e s w e r e injured in the collision. T h e South Shore 
estimated the damage to be about $2,433,000. 

The National Transportation Safety Board determines that the probable cause of this 
accident was the failure o f the dispatcher to coordinate the m o v e m e n t of the t w o trains 
properly; the lack o f a clear provision in G e n e r a l N o t i c e N o . 62 for a meeting o f t w o 
opposing trains scheduled to depart Gary Station at the same t i m e ; and the mistaken 
determination by the c r e w of eastbound train N o . 123 while at Clark Road Station that 
t h e r e was sufficient t i m e tor the train t o reach Gary Station and clear the single track 
b e f o r e the scheduled departure of westbound train N o . 218, 

I N V E S T I G A T I O N 

Events P r e c e d i n g T h e A c c i d e n t 

T r a c k Conditions.—The C h i c a g o , South Shore and South Bend Railroad (South Shore) 
provides propulsion p o w e r for its multiple-unit, e l e c t r i c a l l y p o w e r e d c o m m u t e r trains 
through a 1,500-volt d.c. catenary system 1/ spanning both main line tracks b e t w e e n 
Gary, Indiana, and C h i c a g o , Illinois. On January 19, 1985, a low ambient t e m p e r a t u r e of 
minus 22° F in the Gary area caused s e v e r a l tensile stress breaks in the catenary system 
o v e r both tracks b e t w e e n Gary Station and Clark Crossover, which is about 2.7 miles west 
o f Gary Station. The breaks b e t w e e n those locations made the c a t e n a r y system unusable 
for normal s e r v i c e by e l e c t r i c a l l y propelled trains. 

1/ A n overhead wiring system from which propulsion p o w e r is drawn by means of a 
pantograph. 



- 2 -

On January 20, 1985, train orders w e r e used t o m o v e eastbound and westbound trains 
through the area on the eastward main track using d i e s e l - e l e c t r i c l o c o m o t i v e units in 
shuttle s e r v i c e . By about 4 a.m. on January 21, 1985, the catenary o v e r most o f the 
eastward main track had been repaired, and trains w e r e moved on the eastward main 
track by e l e c t r i c p o w e r using train orders. A b o u t 10:15 a.m., the South Shore 
Superintendent o f Transportation, who is l o c a t e d at Michigan C i t y , Indiana, issued G e n e r a l 
N o t i c e N o . 62, which specified that the eastward main track would be used for 
s i n g l e - t r a c k operation o f eastbound and westbound trains under s i n g l e - t r a c k o p e r a t i n g 
rules b e t w e e n Clark C r o s s o v e r at milepost ( M P ) 61.6 and the east end o f the double track 
at MP 58.1, which is about 0.8 mile east o f Gary Station. 

The n o t i c e e l i m i n a t e d the requirement for the train dispatcher t o issue a train order 
to move each train b e t w e e n the track limits specified in the n o t i c e . A l l the area c o v e r e d 
by the n o t i c e was within Gary yard l i m i t s . (See figure 1.) T h e n o t i c e was posted about 
10:15 a.m. on January 21, 1985, at the reporting point for trainerews and e n g i n e c r e w s in 
Michigan C i t y . A b o u t the same t i m e , copies o f the n o t i c e w e r e forwarded by a train 
messenger to be posted at the Randolph S t r e e t Station in C h i c a g o . 

A l s o , on January 21, 1985, the Superintendent o f Transportation issued G e n e r a l 
N o t i c e N o . 61 specifying a drop pan 2 / area b e t w e e n MP 59.4 and MP 60 on the eastward 
main track where the catenary could not be used because o f d a m a g e . A u t o m a t i c wayside 
block signal 591, which governs eastbound train movements on the eastward main track, is 
l o c a t e d at MP 59.42, which was within the drop pan l i m i t s . Signal 591 was not r e m o v e d 
from s e r v i c e , and it would have displayed a s t o p - a n d - p r o c e e d aspect (see appendix C , 
rule 291) as its most r e s t r i c t i v e aspect i f : 

( a ) a train w e r e occupying the eastward main track at Gary Station, 

( b ) a train w e r e b e t w e e n signal 591 and Gary Station, 

( c ) a switch on the eastward main track b e t w e e n signal 591 and Gary Station 
w e r e open, 

( d ) the inside switch just east of Gary Station leading from the A D D track 
to either the eastward or westward main tracks w e r e aligned to p e r m i t a 
train m o v e m e n t from the A D D track to the eastward main track (the 
switch normally is aligned from the A D D track to the westward main 
t r a c k ) , 

( e ) the eastward main track switch leading to the A D D track (through the 
inside s w i t c h ) either was unlocked or was open, 

( f ) a broken rail was in the signal block, or 

( g ) t h e r e was a malfunctioning signal. 

Train N o . 2 1 3 . — A t 12:40 p.m. on January 21, 1985, a c r e w consisting o f a 
conductor, an engineer, and a c o l l e c t o r / b r a k e m a n reported at Michigan C i t y for their 
assignment. T h e c r e w m e m b e r s c o m p a r e d the t i m e shown on their watches with the t i m e 
shown on the standard c l o c k at Shops and on each other's watches when they r e p o r t e d for 

2 / Usually a damaged section o f the catenary system that requires the engineer to l o w e r 
the pantographs while passing beneath that s e c t i o n . 



NOT TO SCALE 

Figure l . « P i a n v i e w o f accident s i t e . 



- 4 -

work. T h e y said that the t i m e s shown on their watches w e r e " a c c e p t a b l e " in both 
instances. T h e c r e w deadheaded 3/ t o Randolph S t r e e t Station where they a r r i v e d about 
2:10 p . m . The c r e w was assigned to o p e r a t e train N o . 213 to G a r y . A t 2:57 p.m., the 
dispatcher issued c l e a r a n c e card N o . 210 t o the conductor of train N o . 213 s p e c i f y i n g no 
train orders. A t 3:15 p.m., a f t e r a s a t i s f a c t o r y brake test, train N o . 213, consisting o f 
t h r e e multiple-unit e l e c t r i c cars, departed Randolph S t r e e t Station for Gary. T h e c r e w 
was a w a r e o f General N o t i c e Nos. 61 and 62. 

T h e trip toward Gary was unremarkable until the train passed Clark C r o s s o v e r and 
the engineer could see automatic wayside signal 593 l o c a t e d west o f Gary Station a t 
MP 60.17. 4/ Signal 593 was displaying an approach aspect ( s e e appendix C , rule 285), 
which indicated to the engineer that he must reduce the speed o f his train to 30 mph and 
be prepared to stop at the next signal, signal 591, because it could be displaying a 
s t o p - a n d - p r o e e e d aspect. The engineer said that he reduced the train's speed t o 30 mph 
to c o m p l y with the speed requirement o f the approach aspect and at the same t i m e he 
radioed the dispatcher about the approach signal aspect. He said that the dispatcher 
asked him for the block (signal) number, that he told the dispatcher the number, and that 
the dispatcher said "okay." 

When the engineer of train N o . 213 was able to see signal 591, he said that it was 
displaying a s t o p - a n d - p r o c e e d ( r e d ) aspect. T h e engineer said that about the t i m e he saw 
signal 591, he was b e t w e e n MP 59.4 and MP 60 and dropped the train's pantographs in 
c o m p l i a n c e with the drop pan order specified in General N o t i c e N o . 6 1 . The train's 
forward momentum was sufficient to carry it beyond the drop pan area, where the 
pantograph could be raised again to draw p o w e r . If the engineer had stopped the train in 
the drop pan area, the train would have had to be t o w e d from that point because the 
pantographs could not be used to draw propulsion power from the damaged catenary. T h e 
engineer said that he c a l l e d the dispatcher and said, " I ' v e g o t a 591 red, it's right in the 
pan drop, stop and p r o c e e d , what should I d o ? " He said that the dispatcher replied, " W e l l , 
you sure. . . can't stop. You are in the middle o f a pan drop. You w i l l be dead, so what 
are you t e l l i n g me? You can't stop, you are going to have t o whistle and p r o c e e d . " T h e 
engineer of train N o . 213 said that a f t e r this communication with the dispatcher he 
slowed the coasting train's speed to about 20 t o 25 mph, blew t w o blasts on the whistle as 
the train approached signal 591, and continued past the signal. A f t e r clearing the drop 
pan area, he raised the train's pantographs and p r o c e e d e d into Gary Station where the 
train a r r i v e d at 4:05 p.m. T h e engineer said that later during the tour o f duty, while in 
C h i c a g o , he told the conductor about his conversation with the dispatcher concerning the 
s t o p - a n d - p r o c e e d aspect displayed by signal 591. 

T h e dispatcher later denied that he had a conversation about signal 591 with the 
engineer o f train N o . 213, and he said that he did not authorize the engineer o f train 
N o . 213 to pass signal 591 without stopping. T h e normal operating procedure for a train 
c o m i n g upon a signal displaying a s t o p - a n d - p r o c e e d aspect is for the engineer to stop the 
train, blow t w o blasts on the whistle, and then p r o c e e d past the signal at r e s t r i c t e d 
speed. 5/ T h e dispatcher took no e x c e p t i o n to the arrival of train N o . 213 at the Gary 
Station. A trouble report maintained by the dispatcher and/or the telephone switchboard 
o p e r a t o r had no entry indicating a failed signal for either signal 593 or signal 591 on 
January 21, 1985. 

3/ A c r e w in pay status but not operating a train in an assigned position. 
4/ Signal numbers do not correspond with milepost indicators. 
5/ D e f i n i t i o n — P r o c e e d prepared t o stop short of train or obstruction e x p e c t i n g to find 
broken rail or open switch, or anything that may require the speed of a train t o be 
reduced, not to e x c e e d f i f t e e n (15) miles per hour. 



- 5 -

A f t e r train N o . 213 a r r i v e d at Gary Station, the equipment was moved onto the A D D 
track 6/ to clear the eastward main track, and a fourth car was added. A b o u t 4:10 p.m., 
the conductor telephoned the dispatcher to report the a r r i v a l of train N o . 213 at Gary and 
to obtain a c l e a r a n c e card for the c r e w ' s next assignment, train N o . 216, scheduled t o 
depart Gary at 4:45 p.m. for C h i c a g o . A t 4:10 p.m., the dispatcher issued c l e a r a n c e card 
N o . 215 to westbound train N o . 216 to the conductor specifying "no train orders." A b o u t 
4:35 p . m . , the equipment for train N o . 216 was m o v e d from the A D D track onto the 
eastward main track at the station platform and a f t e r passengers boarded, the train 
departed Gary on schedule at 4:45 p.m. The required brake tests w e r e p e r f o r m e d at Gary 
with a c c e p t a b l e results. 

Eastbound train N o . 115 en route from C h i c a g o was scheduled to depart Gary 
Station i o r Michigan C i t y , at 4:45 p . m . , the same departure t i m e as train N o . 216. T h e 
c r e w m e m b e r s of train N o . 216 did not discuss the l o c a t i o n of train N o . 115 among 
themselves or with the dispatcher. The c r e w m e m b e r s said later that train N o . 115 was 
usually 5 to 7 minutes l a t e and that train N o . 216, because of its westward d i r e c t i o n , was 
the superior train. 7/ H o w e v e r , a f t e r train N o . 216 l e f t Gary Station, and was near 
MP 61, the engineer radioed the engineer o f train N o . 115 t o inquire about the train's 
l o c a t i o n . A t that t i m e train N o . 115 was west o f Clark Crossover and did not a r r i v e at 
Clark Crossover until after train N o . 216 had crossed to the westward main t r a c k . Train 
N o . 216 arrived in Randolph S t r e e t Station at 5:35 p.m. T h e c r e w ' s next assignment was 
t o o p e r a t e eastbound train N o . 123 t o Michigan C i t y . 

The A c c i d e n t 

Train N o . 1 2 3 . — A t 5:47 p.m., the dispatcher issued c l e a r a n c e card N o . 219 t o the 
conductor o f train N o . 123 specifying "no train orders." T h e c r e w was a w a r e that G e n e r a l 
N o t i c e N o s . 61 and 62 w e r e still in e f f e c t . A t 5:58 p.m., train N o . 123 departed Randolph 
S t r e e t Station, a f t e r a r e p o r t e d l y s a t i s f a c t o r y brake test, with the c r e w o p e r a t i n g the 
same f o u r - c a r set o f equipment they had o p e r a t e d inbound as train N o . 216. En route t o 
Gary, train N o . 123 was delayed s e v e r a l minutes at Kensington Interlocking while moving 
from the Illinois C e n t r a l Gulf Railroad ( I C G ) onto the South Shore track because o f signal 
trouble at the Kensington I n t e r l o c k i n g . A l s o , when train N o . 123 arrived at S t a t e L i n e 
Interlocking, the engineer radioed the dispatcher that he had a stop signal. T h e dispatcher 
c o n t a c t e d the o p e r a t o r at the S t a t e L i n e Interlocking, who changed the signal to p r o c e e d , 
and the train p r o c e e d e d t o w a r d G a r y . 

Just east o f Kensington Interlocking, it is customary for the engineer of a South 
Shore train to radio the South Shore dispatcher when the train has entered onto the South 
Shore track. T h e dispatcher recorded the t i m e the engineer o f train N o . 123 r e p o r t e d 
onto the South Shore track as 6:25 p.m. T h e dispatcher l a t e r stated that this reporting 
t i m e is not significant in figuring a train's running t i m e , 8/ because o f variations in the 
reporting and recording o f these t i m e s . A c c o r d i n g to the dispatcher the t i m e only serves 
to l e t the dispatcher know that the train is on the South Shore l i n e . 

6 7~A~sforage~ track l o c a t e d just east of the Gary Station and b e t w e e n the t w o main tracks 
used to store equipment. ( S e e figure 1.) 
7/ Rule S - 7 1 , South Shore T i m e t a b l e N o . 5, e f f e c t i v e 4:01 a.m., Sunday, O c t o b e r 31, 
1982, reads "westward trains are superior to eastward trains of the same class." 
8/ T h e train's schedule s p e c i f i e s the t i m e a train should require b e t w e e n stations. In 
most instances a train can run b e t w e e n t w o stations in less t i m e than is shown in the 
schedule. If a train is l a t e , the dispatcher can c a l c u l a t e the t i m e a train can be e x p e c t e d 
to a r r i v e at a station by knowing the actual running t i m e versus the scheduled running 
t i m e . 



- 6 -

T h e engineer o f train N o . 123 said that while the train was stopped at Clark R oad 
Station about 0.2 mile west o f Clark Crossover to discharge passengers, he r e f e r r e d t o his 
t i m e t a b l e to v e r i f y the scheduled 6:50 p.m. departure t i m e from Gary Station for 
westbound train N o . 218. Further, he v e r i f i e d the scheduled 6:50 p.m. departure t i m e 
from Gary Station eastbound to Michigan C i t y for train N o . 123 and c h e c k e d the t i m e 
train N o . 123 was due t o pass Clark C r o s s o v e r . He c o n f i r m e d that train N o . 123's 
scheduled t i m e at Clark Crossover was 6:42 p.m. He said that he then checked his watch 
for the t i m e , which he r e m e m b e r e d as being 6:44 p.m. or 6:45 p.m. The engineer said that 
a f t e r the passengers detrained he looked back at the conductor, who was on the ground, 
for a signal and that the conductor was pointing to his watch. T h e engineer said that he 
understood the conductor's action to be a r e f e r e n c e to t i m e and that t o him it meant the 
conductor b e l i e v e d that sufficient t i m e was a v a i l a b l e for train N o . 123 to continue t o 
Gary Station and a r r i v e by 6:50 p . m . He said that he b e l i e v e d this meant he could depart 
Clark Road Station, pass Clark Crossover, continue into Gary Station, and c l e a r the track 
for train N o . 218. A t the same t i m e he t o o concluded that t h e r e was sufficient t i m e to 
o p e r a t e train N o . 123 to Gary Station and a r r i v e there b e f o r e 6:50 p.m. He e s t i m a t e d 
that it would take a maximum o f 3.5 minutes to p r o c e e d into Gary Station from Clark 
C r o s s o v e r . He departed Clark Road Station, continued past Clark C r o s s o v e r , and 
p r o c e e d e d t o w a r d Gary Station. (Even though a conductor g i v e s a p r o c e e d signal t o an 
engineer, the engineer does not have to l e a v e that location unless the engineer b e l i e v e s 
that the train can reach the next c l e a r a n c e point or station in t i m e to clear the track for 
an opposing superior train. (See appendix C , rule 1005.)) 

The conductor t e s t i f i e d that when he checked the t i m e on his watch at Clark R oad 
Station it was 6:45 p.m. He said that this a l l o w e d train N o . 123 f i v e minutes to p r o c e e d 
t o Gary Station and t o c l e a r the eastward main track at Gary Station for train N o . 218. 
He t e s t i f i e d that he b e l i e v e d 5 minutes was sufficient t i m e for this m o v e . T h e r e f o r e , he 
g a v e the engineer a p r o c e e d signal. N e i t h e r man said initially in their i n t e r v i e w s how 
they e x p e c t e d to c l e a r train N o . 123 from the eastward main track for train N o . 218, but 
they said that they e x p e c t e d train N o . 218 to be in the A D D track until train N o . 218's 
scheduled 6:50 p.m. departure t i m e . L a t e r , the conductor and engineer said that they had 
e x p e c t e d to back onto the s t o r a g e track west o f Gary Station to clear the eastward main 
track for train N o . 218, either unloading passengers b e f o r e g e t t i n g in the c l e a r or a f t e r 
train N o . 218 had l e f t . 

T h e engineer said that when train N o . 123 approached signal 591, it was displaying a 
s t o p - a n d - p r o c e e d aspect. H o w e v e r , he said that he b e l i e v e d the circumstances at that 
t i m e w e r e the same that had confronted him earlier in the day on train N o . 213, so he did 
not c a l l the dispatcher. He said that he dropped the train's pantographs and sounded t w o 
blasts on the whistle, and that the train c o a s t e d past signal 591 at an e s t i m a t e d speed of 
b e t w e e n 25 and 30 mph. (In later testimony, the engineer said that the speed was 15 t o 
17 mph.) 

A l m o s t i m m e d i a t e l y after train N o . 123 passed signal 591, the train c a m e to the end 
of the drop pan area, and the engineer o p e r a t e d the c o n t r o l to raise the pantographs. He 
said that he looked back o v e r the train t o see if all the pantographs had raised properly, 
and that when he looked forward again he saw a train's headlight in front of him at a 
distance he e s t i m a t e d to be from 1,000 t o 1,200 f e e t . He said that he may have grabbed 
the radio r e c e i v e r (handset) to c a l l the other train, but he did not use i t . Instead, he 
released the deadman c o n t r o l f o o t pedal and ran back into the passenger c o m p a r t m e n t . 
He said he b e l i e v e s that he shouted a warning to the passengers, but he was not c e r t a i n . 
He said that after reaching the passenger c o m p a r t m e n t , he started to seat himself in a 
coach seat, but that he was suddenly thrown into the seat when the trains c o l l i d e d . 



~7~ 

Train N o . 2 1 8 . - - A t 2:45 p.m., on January 21, 1985, a c r e w consisting o f a conductor, 
an engineer, and a c o l l e c t o r / b r a k e m a n , reported for work on their regular assignment at 
Michigan C i t y . T h e c r e w m e m b e r s compared the t i m e shown on their watches with the 
t i m e shown on the standard clock at Shops and on each other's watches when they 
reported for work. T h e y said that the t i m e s shown on their watches w e r e either c o r r e c t 
or within an a l l o w a b l e 30-second deviation and that the t i m e s on their individual watches 
compared s a t i s f a c t o r i l y . T h e c r e w deadheaded to the Randolph S t r e e t Station where they 
arrived at 4:30 p . m . T h e c r e w was assigned to o p e r a t e eastbound train N o . 121, destined 
to Michigan C i t y , as tar as Gary. 

A t 5:12 p.m., the dispatcher issued c l e a r a n c e card N o . 218 to the conductor of train 
N o . 121 s p e c i f y i n g "no train orders." A t 5:28 p.m., a f t e r a proper brake t e s t , train 
N o . 121, consisting o f six multiple-unit e l e c t r i c cars, departed Randolph S t r e e t Station for 
Gary, where it a r r i v e d about 6:35 p.m., 10 minutes l a t e . T h e crew's next assignment was 
to o p e r a t e westbound train N o . 218, scheduled to l e a v e Gary Station at 6:50 p.m., from 
Gary to C h i c a g o . 

A c c o r d i n g to the t e s t i m o n y o f the dispatcher and conductor of train N o . 218, the 
conductor telephoned the dispatcher about 6:40 p . m . to obtain a c l e a r a n c e card for train 
N o . 218. A t 6:41 p.m., the dispatcher issued c l e a r a n c e card N o . 220 to the conductor of 
train N o . 218 s p e c i f y i n g "no train orders." The c r e w was a w a r e that G e n e r a l N o t i c e 
N o s . 61 and 62 w e r e in e f f e c t . T h e conductor said that when he r e c e i v e d the c l e a r a n c e 
card, he asked the dispatcher if "he [westbound train N o . 218] should lay back and a l l o w 
[eastbound] train N o . 123 t o c o m e into Gary." The conductor wanted to know if he 
should be g i v e n instructions or a train order to wait for train N o . 123, which he knew was 
due to depart Gary Station eastbound for Michigan C i t y at 6:50 p.m., the same t i m e train 
N o . 218 was scheduled to depart westbound for C h i c a g o . The conductor said that the 
dispatcher rep lied , "you've g o t your orders, you [ t r a i n N o . 218] are the superior train; if 
he c o m e s in [ i n t o Gary S t a t i o n ] it's his head." The conductor said that the dispatcher 
then g a v e him v e r b a l permission to bring the equipment for train N o . 218 out o f the A D D 
track and to occupy the eastward main track at Gary Station. 

The dispatcher later t e s t i f i e d that he saw no c o n f l i c t b e t w e e n train N o s . 123 and 
218 because he b e l i e v e d that train N o . 123 was about 10 to 11 minutes l a t e . L a t e r in his 
testimony, he said that he could v e r i f y only that train N o . 123 was 7 minutes l a t e and that 
he anticipated some delay because o f the drop pan s e c t i o n . He said that based on his 
b e l i e f that eastbound train N o . 123 was l a t e , he b e l i e v e d it would not proceed east o f 
Clark Crossover until a f t e r westbound train N o . 218 a r r i v e d at that l o c a t i o n and crossed 
o v e r to the w e s t w a r d main track t o c l e a r the eastward main t r a c k . 

The conductor informed the engineer and c o l l e c t o r / b r a k e m a n o f train N o . 218 of his 
conversation with the dispatcher. T h e conductor g a v e instructions t o a mechanical 
d e p a r t m e n t e m p l o y e e (a car inspector) to bring the equipment for train N o . 218 from the 
A D D track up to the s w i t c h leading to the eastward main track. A b o u t 6:45 p.m., the 
c r e w boarded the equipment for train N o . 218, which consisted of t w o multiple-unit 
e l e c t r i c cars, and moved it onto the eastward main track at the Gary Station p l a t f o r m so 
passengers could board and the train would be ready to depart on schedule at 6:50 p.m. 
N o flag p r o t e c t i o n was established to p r o t e c t the equipment. T h e car inspector and the 
engineer made a s a t i s f a c t o r y brake test on the equipment. 



T h e c r e w m e m b e r s t e s t i f i e d later that a f t e r only t h r e e passengers boarded the rear 
car, train N o . 218 departed Gary Station westbound about 6:50:20 p.m. I m m e d i a t e l y a f t e r 
the train l e f t the station, a running brake test was made by the engineer and 
a c k n o w l e d g e d by the c o l l e c t o r / b r a k e m a n , which signified to the engineer that the brakes 
w e r e o p e r a t i n g p r o p e r l y . 

T h e engineer said that when train N o . 218 was about 1,000 f e e t west o f Gary 
Station, while in a 2°39' curve to the l e f t and at the beginning of a 1.92-percent 
descending g rad e w e s t w a r d , he saw the headlight o f an approaching train on the eastward 
main track. He said that he placed the train brakes into e m e r g e n c y and ran back into the 
passenger c o m p a r t m e n t , which was occupied only by the conductor. He shouted t o the 
conductor to "hit the f l o o r , " and then he dropped to the f l o o r just b e f o r e the trains 
c o l l i d e d . 

T h e collision occurred about 6:50:42 p.m. about 1,490 f e e t west of Gary Station 
while train N o s . 123 and 218 w e r e moving about 30 mph and 15 mph, r e s p e c t i v e l y . T h e 
lead car o f each train was derailed as a result o f the collision. T h e front o f each car was 
crushed s e v e r e l y in the vestibule area. When the t w o trains c o l l i d e d , the c a t e n a r y p o w e r 
was disrupted. T h e propulsion p o w e r monitoring system indicated that p o w e r was 
disrupted at 6:50:42 p.m. 9/ The engineer o f train N o . 218 radioed the dispatcher o f the 
a c c i d e n t , who in turn c a l l e d for e m e r g e n c y assistance. 

Injuries to Persons 

C r e w m e m b e r s 
Injuries N o . 218 N o . 123 

F a t a l 0 0 
N o n f a t a l 3 3 
None 0 0 

T o t a l 3 3 

Damage 

T h e forward vestibule areas o f the t w o lead cars w e r e crushed on i m p a c t . F r a m e 
and body d e f o r m a t i o n was evident t o a depth o f about 8 f e e t into the passenger 
c o m p a r t m e n t of each unit. (See figures 2, 3, and 4 . ) T h e t w o lead cars w e r e e s t i m a t e d to 
be a t o t a l loss, while the trailing cars r e c e i v e d only minor d a m a g e . Damage to the track 
was n e g l i g i b l e , and t h e r e was no d a m a g e t o the catenary or signal systems. 

T h e South Shore estimated the d a m a g e to b e : 

Car N o . Damage 

1 $ 8,000 
26 1,200,000 

9 5,000 
17 1,200,000 
21 5,000 
27 15,000 

$ 2 , 4 3 3 , 0 0 0 

O f f - d u t y 
e m p l o y e e s Passengers T o t a l 

0 0 0 
2 79 87 
0 26 26 
2 105 113 

9/ S p e c i f i c a l l y , the recorded t i m e was shown as 1850.7 (6:50:42) on the monitoring 
equipment. 



CO 
1 

F i g u r e 2.—East v i e w of first and seeond cars o f t r a m N o . 123 
( f o r e g r o u n d ) and train N o . 218 (background). 





F i g u r e 4.—Interior o f lead car o f train N o . 123. 



- 1 2 -

Crewmember Information 

T h e e r e w m e m b e r s of each train and the dispatcher w e r e all qualified for their 
r e s p e c t i v e positions in accordance with South Shore operating rules. B e f o r e reporting for 
duty on January 21, 1985, all c r e w m e m b e r s and the dispatcher had the required rest 
specified by t h e F e d e r a l Hours o f S e r v i c e L a w , 49 C F R 228,19. In addition, all train 
c r e w m e m b e r s and the dispatcher t e s t i f i e d that they w e r e satisfied with their assignments, 
and that they w e r e physically rested and a l e r t b e f o r e and while on duty on January 2 1 . 

T h e dispatcher had been qualified as a dispatcher since N o v e m b e r 1979, and on 
January 21, 1985, he was working his regularly assigned 3 p . m . - t o - l l p.m. shift. He had 
served as a c o l l e c t o r / b r a k e m a n and an engineer, and in A p r i l 1980 he was p r o m o t e d to the 
position of dispatcher. 

Some South Shore train and enginecrew e m p l o y e e s told S a f e t y Board investigators 
that they w e r e reluctant to c o m m u n i c a t e with the train dispatcher because he was curt 
and g a v e them the impression that they w e r e not to bother him. T h e chief dispatcher, 
who had been in that c a p a c i t y only for about 4 weeks, said that he had observed this 
discourteous communications manner in the dispatcher and that about the t i m e o f the 
accident he was planning to speak to him about his a t t i t u d e . 

The c r e w m e m b e r s o f each train w e r e working regular assignments, e x c e p t the 
engineer o f train N o . 123, who had been an e m e r g e n c y 10/ engineer since 
O c t o b e r 30, 1980, and an extra train dispatcher since A p r i l 27, 1984. He had served as a 
c o l l e c t o r / b r a k e m a n and worked as an engineer in freight and passenger s e r v i c e . He also 
worked each Friday from 3 p.m. t o 11 p.m. as a train dispatcher. He t e s t i f i e d that the 
irregular work routine had not caused him any concern and that he b e l i e v e d he p e r f o r m e d 
his job s a f e l y . ( F o r additional c r e w m e m b e r / d i s p a t e h e r information, s e e appendix B . ) 

Training 

Training for South Shore operating e m p l o y e e s is accomplished by o n - t h e - j o b training 
( O J T ) . A l l e m p l o y e e s in train and engine s e r v i c e begin training as c o l l e c t o r s / b r a k e m e n in 
passenger s e r v i c e . T h e trainees begin training by studying the first 35 pages o f the 
operating rules book, which includes operating rule 99 and the current t i m e t a b l e , and by 
b e c o m i n g familiar with the work in passenger and freight s e r v i c e . T h e trainees a r e 
assigned to one or more senior e m p l o y e e s for O J T . These instructor e m p l o y e e s a r e 
s e l e c t e d on the basis o f their p e r f o r m a n c e record, c o n g e n i a l i t y , and ability to instruct and 
c o m m u n i c a t e e f f e c t i v e l y . The senior e m p l o y e e s s e l e c t e d to train newly hired e m p l o y e e s 
are not g i v e n any s p e c i f i c training as instructors to prepare them for their roles as 
instructors, and they are not g i v e n additional pay for training junior e m p l o y e e s . A f t e r the 
t r a i n e e works up t o 15 days with the senior e m p l o y e e s , and if the trainee is considered 
qualified by the senior e m p l o y e e s , each instructor signs a l e t t e r o f introduction previously 
presented t o him by the trainee. T h e l e t t e r o f introduction g i v e n to the trainee by the 
Superintendent o f Transportation identifies the trainee and specifies that he is authorized 
to be on the p r o p e r t y and that he is to be trained as a new e m p l o y e e . 

The t r a i n e e is assigned next to work in freight s e r v i c e as a head brakeman for 10 t o 
20 days. T h e t r a i n e e is then t e s t e d orally by the Superintendent o f Transportation or an 
assistant on the training r e c e i v e d , which includes questions on the portion o f the o p e r a t i n g 
rules the trainee was assigned to learn. T h e r e is no d e f i n i t e policy g o v e r n i n g the 

107 T h e South Shore r e f e r s t o extraboard personnel as e m e r g e n c y c r e w s . T h e y f i l l job 
vacancies resulting from vacations, illnesses, e t c . 



-13-

procedure to be followed if a trainee fails the tests. However, if the trainee does not 
show an aptitude for the work to be performed as a railroad employee, he is dismissed. If 
he passes this first test, he still must serve a 60-day probationary period to prove himself. 
Except for the OJT program, there is no formal training curriculum established, and no 
specific list of tasks or skills to be mastered is provided to either the instructor or the 
trainee. 

Following his initial OJT, the trainee must work 8 to 12 months as a 
collector/brakeman or head brakeman, after which the trainee must pass an oral and 
written examination on the operating rules. A passing grade of 85 percent is required for 
the trainee to continue OJT. There are no specific questions pertaining to the operating 
rules that must be answered correctly for the trainee to obtain a passing grade. Those 
employees who fail the test are returned to OJT, and they continue to study the operating 
rules and test material. The questions missed on the failed test are not reviewed with the 
employee. A retest must be taken within a week. The retest is the same test given the 
first time. A second failure results in dismissal. If the employee passes the test, a 
company officer reviews with the trainee those questions he missed, if any. Following 
successful completion of this phase of training, the trainee must perform 1 day of OJT 
with a qualified rear brakeman to qualify as a rear brakeman in freight service. Following 
the OJT as a rear brakeman, another test is given the trainee consisting of 171 written 
questions and additional oral questions. The same passing qualifications and test review 
procedures apply to this test as to that which follows the initial OJT. A f t e r 1 or 2 years, 
the employee may be required to take a promotion to the position of either conductor or 
engineer. If vacancies exist in both categories, the employee may choose a position; 
otherwise, the employee can be assigned to a vacancy in either category by a supervisor. 

To prepare and qualify for promotion to the position of either conductor or engineer, 
the employee is given a still different test from the one following his initial OJT and 
qualification as a rear brakeman. This test is composed of a 687-question examination on 
operating rules given as a take-home test. In format it consists of the operating rules 
with the omission of key words which the employee must supply. Then the employee is 
examined on the rules by a company officer, rule by rule. The employee must answer 
85 percent of the questions correctly to pass the examination. 

If the employee has elected or has been appointed to become a conductor, the 
employee receives 3 to 5 days OJT from a senior passenger conductor. Following this 
training, the employee receives OJT under the supervision of a senior freight conductor 
for 12 to 30 days. Completion of this training qualifies the employee as a conductor, and 
the employee's name is placed on the list of emergency (extraboard) conductors. 
Advancement thereafter is in accordance with seniority and ability. 

The engineer trainee undergoes a similar training procedure under the supervision of 
a qualified senior engineer. The employee is placed in passenger service for 15 to 20 days 
in OJT. After passing this phase of training, the employee receives O J T training in 
freight service for about 30 days. During the OJT, the Road Foreman of Engines monitors 
the employee's progress by direct observation. The OJT is followed by an oral 
examination covering operating rules, and the location of switches, crossovers, and 
signals. Completion of this training qualifies the employee as an engineer, and the 
employee's name is placed on the list of emergency (extraboard) engineers. Advancement 
thereafter is in accordance with seniority and ability as judged by operations 
management. 



- 1 4 -

Conductors and engineers may be p r o m o t e d to train dispatcher as the need arises. 
Train dispatchers are s e l e c t e d on the basis o f their p e r f o r m a n c e on their assigned j o b , on 
their a t t i t u d e , k n o w l e d g e o f operating rules, and personality as observed by operations 
management personnel. N o f o r m a l evaluation tests are g i v e n . This is an optional 
advancement for management-approved train s e r v i c e e m p l o y e e s when a v a c a n c y occurs. 
The dispatcher trainee puts in an a v e r a g e o f 120 t o 150 hours o f O J T . F o l l o w i n g O J T in 
the dispatcher's o f f i c e , the trainee is examined orally on the operating rules by a company 
o f f i c e r . C o m p l e t i o n o f this training qualifies the e m p l o y e e as a dispatcher, and the 
e m p l o y e e ' s name is placed on the list o f e m e r g e n c y ( e x t r a b o a r d ) dispatchers. Vacancies 
that occur in operations management usually are f i l l e d from the dispatcher's o f f i c e . 

A l l e m p l o y e e s are required to be r e e x a m i n e d on the operating rules e v e r y 2 y e a r s . 
A passing g r a d e o f 85 p e r c e n t is required for an e m p l o y e e to remain in company s e r v i c e . 
T h e biennial rules examination consists o f a 100-question, m u l t i p l e - c h o i c e test which is 
p r e f a c e d with a s l i d e - t a p e presentation of actual occurrences on the railroad which 
highlight applications o f rules. If an e m p l o y e e fails the reexamination, he is required to 
be r e e x a m i n e d . His reexamination can be taken i m m e d i a t e l y , and he has t h r e e 
opportunities to pass. 

Train Information 

T h e multiple-unit e l e c t r i c cars involved in the accident w e r e built b e t w e e n 1981 and 
1983 by Sumitome Corporation o f A m e r i c a and Nippon, Sharyo, S e i z o , Kaisha, L t d . o f 
Japan. T h e cars are p o w e r e d from a 1,500-volt d.c. catenary s y s t e m . Four e l e c t r i c 
traction motors produce a t o t a l o f 640 horsepower per c a r . T h e a v e r a g e e m e r g e n c y 
braking r a t e tor stops from all speeds o f 70 mph or less with a full seated passenger load 
is 2.5 mphps. 1 1 / 

The car bodies are 85 f e e t long, are constructed of stainless s t e e l , and seat 
93 passengers. Operating controls are l o c a t e d at each end o f the car. T h e airbrakes are 
c o n t r o l l e d by a t y p e 26B-1 airbrake c o n t r o l v a l v e . T h e t o t a l braking system includes an 
airbrake blended with dynamic brakes. The cars w e r e built and tested to c o m p l y with 
applicable standards prescribed by the F e d e r a l Railroad Administration ( F R A ) or the 
Association o f A m e r i c a n Railroads ( A A R ) . 

T h e cars are equipped with a public address system, an intercom system for 
intracrew communication, and a radio with three operable frequencies. T h e cars are 
equipped with a deadman c o n t r o l o p e r a t e d by a f o o t pedal at the engineer's o p e r a t i n g 
position. T h e deadman c o n t r o l f o o t pedal is interconnected with the t h r o t t l e so that when 
both a r e released, an e m e r g e n c y brake application w i l l be made. First aid kits a r e 
p r o v i d e d for each car and stored in each end v e s t i b u l e . An e m e r g e n c y t o o l kit for each 
car is stored under the first passenger seat on the noncab side of the car at the " B " end 
(brake e n d ) . 

The seating arrangement o f each car is such that about o n e - h a l f o f the seats f a c e in 
one d i r e c t i o n and o n e - h a l f f a c e in the opposite d i r e c t i o n . Doors into the vestibules are 
l o c a t e d at each end of the passenger c o m p a r t m e n t . Side doors p r o v i d e access to the 
vestibules. A pair o f side sliding doors is l o c a t e d in the middle o f the car on each side. 
A n e m e r g e n c y window e x i t is at each end o f the car on opposite sides, and t w o e m e r g e n c y 
window e x i t s are on e i t h e r side near the c e n t e r o f the c a r . Instructions for opening the 
doors manually in the e v e n t o f p o w e r failure a r e posted. Windows are g l a z e d with s a f e t y 
glass. When catenary p o w e r is lost, e m e r g e n c y lights in the cars are p o w e r e d by 

1 1 / D e c e l e r a t i o n r a t e in miles per hour per second. 



- 1 5 -

r e c h a r g e a b l e s t o r a g e b a t t e r i e s . T h e e m e r g e n c y lights in the t w o lead cars did not 
function a f t e r the collision because the crushing d e f o r m a t i o n o f the cars s e v e r e d the 
cables supplying p o w e r to the lights. 

T h e radios w e r e not t e s t e d f o l l o w i n g the a c c i d e n t because the crash d a m a g e t o the 
t w o head cars crushed the radios. H o w e v e r , the radio on train N o , 123 had o p e r a t e d 
s a t i s f a c t o r i l y e a r l i e r during the eastbound trip, and t h e r e had been no complaints about 
the radio on train N o . 218. 

Track Information 

In a w e s t e r l y d i r e c t i o n from Gary Station, the d o u b l e - t r a c k main line is built on a 
contained f i l l about 25 f e e t a b o v e the s t r e e t l e v e l . P r o t e c t i v e handrails are p r o v i d e d 
along the tops o f the retaining walls. T h e track is constructed o f 115-pound, R E 
continuous-welded rail set on 13-inch t i e plates and 7-inch by 9-inch by 8 - f o o t 6-inch 
wood crossties. T h e main tracks are built on about 3 1 - f o o t c e n t e r s at the point o f the 
a c c i d e n t because o f a c e n t e r track which ends just east o f t h e point o f c o l l i s i o n . T h e 
catenary system in the area o f the a c c i d e n t is supported o v e r the tracks on s t e e l 
structures. 

T h e c a t e n a r y system was installed about 1906, o r i g i n a l l y as a 6,600-volt a.c. s y s t e m . 
It was rebuilt b e t w e e n 1926 and 1929 as a 1,500-volt d.c. compound-catenary s y s t e m . 
T h e catenary is aligned a p p r o x i m a t e l y t o f o l l o w the c e n t e r l i n e o f the track. A 9-inch 
deviation is t o l e r a t e d t o either side o f the track c e n t e r l i n e . T h e t r o l l e y w i r e is 
maintained a p p r o x i m a t e l y 22 f e e t a b o v e the t o p o f the rail ( A T R ) . 

T h e South Shore patrols the catenary system a t 6-month intervals, and d e f i c i e n c i e s 
a r e noted and r e p a i r e d . A n o m a l i e s , such as t r o l l e y w i r e tension in c o l d w e a t h e r and sag in 
hot w e a t h e r , are watched constantly, and action is taken to p r o t e c t the system when 
i r r e g u l a r i t i e s are o b s e r v e d . E x c e s s i v e sag can c r e a t e a need for drop pan orders. T h e 
c o n t a c t w i r e is r e n e w e d as required. 

G e n e r a l N o t i c e N o . 61 was issued because o f a break, caused by c o l d t e m p e r a t u r e s , 
that o c c u r r e d in the t r o l l e y w i r e at MP 59.68 in G a r y . Breaks a r e prone t o occur because 
o f m e t a l f a t i g u e or at heavy wear locations such as at station p l a t f o r m s , where trains a r e 
continually starting, or at overhead bridges and at points w h e r e the c a t e n a r y v a r i e s in 
height A T R . Most breaks occur in the t r o l l e y w i r e i t s e l f , with some occurring in the 
secondary messenger. T h e primary messenger almost n e v e r breaks. ( F o r additional 
catenary information s e e appendix D . ) 

Method of Operation 

South Shore operating rule N o . 3 requires that train and e n g i n e c r e w e m p l o y e e s 
c o m p a r e their company^-approved standard watches with a standard c l o c k when g o i n g on 
duty. Standard c l o c k s a r e l o c a t e d at Shops in Michigan C i t y where the c r e w s r e p o r t for 
duty and a t the dispatcher's o f f i c e . T h e standard clocks a r e set a u t o m a t i c a l l y each day at 
6 a.m. and 6 p.m. by an a u t o m a t i c t i m e - s y n c h r o n i z i n g signal. T h e t i m e indicated by the 
standard c l o c k v a r i e s by only 3 or 4 seconds per t i m e - s e t p e r i o d . I f a trainman's watch is 
more than 30 seconds fast or slow, it must be set t o indicate the c o r r e c t t i m e . In 
addition, members o f a traincrew are required t o c o m p a r e the t i m e indicated by their 
watches with the t i m e shown by each other's watches at the beginning o f a tour o f duty 
and to synchronize them if necessary. 



- 1 6 -

Trains a r e o p e r a t e d o v e r the double track main line of the South Shore b e t w e e n 
Kensington Interlocking on the I C G a t 115th S t r e e t in C h i c a g o and the east end o f the 
double track east o f Gary by the aspects o f a u t o m a t i c wayside c o l o r light signals, and by 
t i m e t a b l e , train orders, and g e n e r a l n o t i c e s . B e t w e e n the east end o f the double track at 
Gary and South Bend, Indiana, train movements a r e g o v e r n e d by the aspects o f a u t o m a t i c 
wayside c o l o r light signals and s i n g l e - t r a c k operating rules, which include t i m e t a b l e , train 
orders, and g e n e r a l n o t i c e s . 

S p e c i a l instruction rule 83a contained in t i m e t a b l e N o . 5, e f f e c t i v e 4:01 a.m., 
Sunday, O c t o b e r 3 1 , 1982, provides for a delay of 3 minutes for a train l e a v i n g South Bend 
if the schedule o f t w o trains would cause them to m e e t a t South Bend. T h e t i m e t a b l e for 
the s i n g l e - t r a c k portion of the South Shore b e t w e e n Gary and South Bend does not 
indicate any eastbound and westbound trains due at the same station at the same t i m e 
unless t h e r e is a siding shown. The t i m e t a b l e indicates where a scheduled m e e t with an 
opposing train w i l l occur. T h e meeting t i m e is shown in bold print, and the train being 
met is indicated. ( S e e appendix E.) 

T h e headblock ( h o m e ) signals 12/ a r e provided with lightout p r o t e c t i o n and arranged 
so that if a bulb burns out in the g r e e n ( c l e a r ) p r o c e e d position, the y e l l o w (approach) 
aspect w i l l be displayed. This decreases the possibility o f a dark signal, which in most 
cases would require a train to stop. 

T h e train dispatcher is l o c a t e d at Michigan C i t y . The dispatcher does not have 
c o n t r o l f a c i l i t i e s to o p e r a t e track signals or switches, but does c o n t r o l train order signals 
at Gary and at Shops in Michigan C i t y by which he can signal an engineer t o stop a train 
and have a c r e w m e m b e r c a l l him for instructions. T h e dispatcher is p r o v i d e d with a 
d e d i c a t e d dispatcher's t e l e p h o n e and company and A T & T d i a l - t e l e p h o n e c i r c u i t s . H e can 
c o m m u n i c a t e with the train engineers by radio. T h e South Shore does not have a tape 
monitor on the dispatcher's communications c i r c u i t s . 

T h e South Shore does not have manned reporting stations along the line t o r e p o r t the 
t i m e a train passes a g i v e n l o c a t i o n . In s o m e instances during the day, a t i c k e t agent may 
report a train's passing at his station, but at night t h e r e are no t i c k e t agents on duty. 
H o w e v e r , the dispatcher can obtain the t i m e a train passes a g i v e n l o c a t i o n by calling the 
train's e n g i n e e r . When a train arrives at Gary, Michigan C i t y , Randolph S t r e e t Station, or 
South Bend, the train's conductor reports t o the dispatcher the train's a r r i v a l t i m e . In 
addition, the dispatcher can obtain the t i m e a train enters or l e a v e s the " O S " 13/ track 
sections ( r e f e r r e d t o as the "OS t i m e " ) at the p o w e r substations from the propulsion p o w e r 
monitoring equipment. ( T h e controls and an information printout unit for the equipment 
a r e in the dispatcher's o f f i c e . ) When a train is scheduled to l e a v e its initial station, the 
conductor is required to c o n t a c t the dispatcher, which usually is done by t e l e p h o n e , t o 
d e t e r m i n e if the dispatcher has any train orders or special instructions for the train. T h e 
dispatcher g i v e s the conductor train orders orally and/or g i v e s a c l e a r a n c e card s p e c i f y i n g 
either the train orders for that train or that there a r e no train orders. 

When the main track is kept in s e r v i c e and short spans o f the catenary system a r e 
not usable for e l e c t r i c train operation, the dispatcher must issue a "drop pan" train order, 
or p r o v i d e such information on a c l e a r a n c e card. An engineer is e x p e c t e d to a l l o w the 
train to attain enough speed so that it w i l l coast through a drop pan area with 

1 2 / T h e signal at the entrance to a signal block indicating a condition a f f e c t i n g the 
m o v e m e n t o f a train. 
13/ T h e r e c o r d e d t i m e a train passes a designated l o c a t i o n . 



the pantographs l o w e r e d . If a drop pan area spans a wayside signal, the signal may be 
taken out of s e r v i c e by a train order or a g e n e r a l n o t i c e . South Shore's Superintendent o f 
Transportation said, h o w e v e r , that a signal is never taken out s e r v i c e if the signal is 
operating p r o p e r l y . If t i m e permits, or if the drop pan order w i l l be needed for an 
extended t i m e , a g e n e r a l n o t i c e is issued specifying the limits o f the drop pan a r e a . 

A c c o r d i n g to operating rule N o . 291 an engineer is required to stop a train for a 
s t o p - a n d - p r o c e e d signal aspect e v e n if it is in a drop pan area. A c c o r d i n g t o the train 
dispatcher, t h e r e is no provision in the rules which a l l o w s a train to pass a 
s t o p - a n d - p r o c e e d signal aspect in a drop pan area, and he t e s t i f i e d that he did not have 
the authority to a u t h o r i z e a train to pass a s t o p - a n d - p r o c e e d signal aspect. South Shore's 
rules examiner said that while a train dispatcher cannot orally countermand an o p e r a t i n g 
rule, he can issue a train order or message o v e r the Superintendent o f Transportation's 
name and modify or bypass an o p e r a t i n g rule. M o r e o v e r , the dispatcher can issue a "call 
order" to a train, which d i r e c t s a member o f the t r a i n c r e w to c a l l the dispatcher b e f o r e 
the train moves past a designated l o c a t i o n . 

Under s i n g l e - t r a c k operating rule N o . S-71 ( T i m e t a b l e Special Instructions) on the 
South Shore, a westbound train is superior to an eastbound train, i . e . , an eastbound train 
must c l e a r the main track if it meets a westbound train o f the same class. Opposing 
trains of the same class 14/ are a l l o w e d t o m e e t on " f l a t t i m e , " which means that an 
eastbound inferior train c o m p l i e s with operating rule N o . S-71 i f it clears the main track 
at a designated point b e f o r e a westbound superior train is scheduled to l e a v e that same 
point. For trains o f the same class, no c l e a r a n c e margin o f t i m e is required. South Shore 
operating o f f i c e r s said that train N o . 123 should have c l e a r e d the track for train N o . 218 
at Clark Crossover (by remaining west o f the c r o s s o v e r ) or at Marshall, or at the west 
end o f Gary Station b e f o r e 6:50 p.m., the scheduled departure t i m e o f train N o . 218. ( S e e 
figure 1.) 

A c c o r d i n g to the South Shore rules examiner, equipment for a scheduled train 
cannot be brought out to occupy the single main track b e f o r e the train's scheduled 
departure t i m e without instructions from the dispatcher. A scheduled train has no right 
to occupy the track until its scheduled t i m e . The c r e w m e m b e r s i n v o l v e d in this a c c i d e n t 
said that it is a p r a c t i c e at Gary Station that passenger equipment is brought onto the 
appropriate main track ahead of the train's scheduled departure t i m e so that passengers 
can board and the train depart on t i m e . T h e dispatchers regularly authorized the 
t r a i n c r e w s at Gary Station t o bring the equipment for the train they are scheduled t o 
o p e r a t e onto the main track ahead o f the scheduled departure t i m e . 

I f equipment is moved onto the main track ahead o f a train's scheduled departure 
t i m e , flag p r o t e c t i o n must be p r o v i d e d t o the front and t o the rear of the train on single 
track and to the rear on double track when operating with the current of t r a f f i c . Special 
instruction N o . 975 in the current t i m e t a b l e and operating rule N o . 99 specify the 
conductor's responsibility in supervising a t r a i n c r e w , including his responsibility t o ensure 
that flag p r o t e c t i o n is provided under circumstances where it is required. T h e train 
c r e w m e m b e r s i n v o l v e d in this a c c i d e n t did not r e m e m b e r e v e r providing flag p r o t e c t i o n 
when equipment was brought onto the main track at Gary Station b e f o r e a train's 
scheduled departure t i m e . 

14/ Trains are assigned a class by t i m e t a b l e . A f i r s t - c l a s s train is superior to a 
second-class train, e t c . 



- 1 8 -

T h e r e is a p r o g r a m m e d 3-minute delay b e f o r e the eastward main track switch 
leading t o the A D D track can be aligned to d i v e r t an eastbound train from the e a s t w a r d 
main track onto the A D D track if a train is b e t w e e n MP 60.29 ( w e s t o f Gary Station) and 
the s w i t c h . T h e timing c y c l e is started when the switch lock is r e m o v e d from the hasp, 
thus unlocking the s w i t c h . When the switch is unlocked, signal 591 i m m e d i a t e l y displays a 
stop-and-proceed a s p e c t , and signal 593 displays an approach aspect. T h e t i m i n g c y c l e is 
intended to p r e v e n t the switch's alignment from being changed to the A D D track 
i m m e d i a t e l y ahead o f an eastbound train that already might have passed signal 591. 

Meteorological Information 

A t 6:50 p.m. on January 21, 1985, i t was dark with some blowing snow. T h e 
t e m p e r a t u r e was 12° F with v i s i b i l i t y about 5 miles, and the wind was from 270° a t 
10 knots gusting t o 20 knots. Data provided by the N a t i o n a l Weather S e r v i c e at Gary 
indicates that the t e m p e r a t u r e dropped from about 28° F during the afternoon o f 
January 18 t o minus 22° F by about 6 a.m., on January 20. T h e t e m p e r a t u r e rose from 
minus 22° F t o 15° F by about 1 p.m. on January 2 1 . T h e l o w e s t t e m p e r a t u r e r e c o r d e d 
from January 18 through January 21 was minus 22° F. 

Medieal and Pathological Information 

South Shore o p e r a t i n g o f f i c e r s requested a t o x i c o l o g i c a l t e s t o f both engineers, but 
not o f the dispatcher or other c r e w m e m b e r s . Blood and urine samples w e r e drawn a t 
10:40 p . m . and 11 p.m. on January 21 from the engineers of train N o s . 218 and 123, 
r e s p e c t i v e l y . T h e test results w e r e n e g a t i v e for alcohol and drugs for the engineer o f 
train N o . 218. T h e test results w e r e n e g a t i v e for alcohol but p o s i t i v e for acetaminophen 
for the engineer of train N o . 123. A c e t a m i n o p h e n is a drug used as a pain suppressant in 
some c o m m o n l y used patent medicines. It does not have adverse human behavioral 
e f f e c t s at therapeutic l e v e l s . 

Of the 87 persons injured in the a c c i d e n t , 9 passengers and 2 c r e w m e m b e r s w e r e 
a d m i t t e d t o area hospitals, while 70 passengers, 2 o f f - d u t y e m p l o y e e s , and 4 
c r e w m e m b e r s w e r e t r e a t e d and released. T h e nature of the injuries r e c e i v e d by those 
injured w e r e r e p o r t e d to be concussions, multiple bruises, lacerations, and fractures o f the 
arms, l e g s , and thighs. 

Survival Aspects 

T h e forward outside body shell of the vestibule on each lead car was crushed so that 
the vestibule was c o m p a c t e d . T h e first rows o f seats for a distance o f about 8 f e e t w e r e 
squeezed t o g e t h e r . T h e sides o f the cars bulged outward near the i m p a c t e d ends. T h e 
l u g g a g e racks in the forward ends o f the cars bent, and some b e c a m e detached. T h e seats 
in the cars, e x c e p t for those in the crush areas, did not separate from their f l o o r 
moorings. N o seat cushions w e r e knocked loose in any seats behind those a f f e c t e d by t h e 
crushing f o r c e s . Passengers could not e x i t through the forward ends o f the lead cars, but 
the doors t o the rear and the side doors could be opened manually by f o l l o w i n g the 
e m e r g e n c y sequence indicated in the printed information on the coach walls. 

T h e engineer o f train N o . 218 informed the dispatcher o f the collision using the 
radio at the rear o f the second car of his train. T h e dispatcher i m m e d i a t e l y n o t i f i e d 
e m e r g e n c y personnel who arrived in about 15 minutes. Rescue e f f o r t s w e r e d i f f i c u l t 
because the trains collided where the track was about 25 f e e t a b o v e s t r e e t l e v e l . 
H o w e v e r , a ramp on the north side of the track structure provided adequate a c c e s s . Units 
from the Gary f i r e and p o l i c e departments and those of s e v e r a l surrounding communi t i es 
responded quickly, g a v e first aid, and e v a c u a t e d the injured t o l o c a l hospitals. 



- 1 9 -

Tests and Research 

A l l signal equipment was found t o be operating properly on January 21, 1985. 

Sight and distance tests w e r e conducted about 9 p . m . on January 24, 1985. T w o cars 
o f the same design as the cars i n v o l v e d in the accident w e r e positioned at the point o f 
i m p a c t , simulating train N o s . 123 and 218. T h e weather was c l e a r , and the t e m p e r a t u r e 
was in the low 20s° F. 

A t the beginning o f the tests, the t w o cars w e r e backed a w a y from each other at 
5 0 - f o o t i n t e r v a l s , and the v i e w o f each engineer t o w a r d the other train was e v a l u a t e d . 
T h e b a c k o f f continued until the t w o cars w e r e 1,000 f e e t apart. P o s i t i v e i d e n t i f i c a t i o n as 
a train was established at distances from 50 t o 500 f e e t apart. T h e i d e n t i f i c a t i o n o f a 
car as a train was less p o s i t i v e at distances o f from 500 t o 700 f e e t apart. 

I n t e r s t a t e 90 parallels the railroad at the accident s i t e , and headlights from highway 
v e h i c l e s i n t e r m i n g l e d with the headlights o f rail t r a f f i c . In addition, mercury vapor lights 
at a nearby s t e e l mill f a c i l i t y w e r e conspicuous in the background near the a c c i d e n t s i t e . 
These w e r e lighted on the night o f the a c c i d e n t . 

On March 7, 1985, the South Shore o p e r a t e d train N o . 113, consisting o f four cars in 
revenue s e r v i c e , for a running t i m e test b e t w e e n Clark Crossover and Gary Station. T h e 
speed authorizations in e f f e c t on January 21 w e r e o b s e r v e d . T h e t e m p e r a t u r e was 38° F, 
and the rails w e r e dry. T h e 2.7 miles w e r e c o v e r e d in 4 minutes 20 seconds, with a l l 
wayside signals displaying c l e a r p r o c e e d aspects. 

A l s o on March 7, about 4:50 p.m., revenue train N o . 115, with four cars, was 
o p e r a t e d b e t w e e n C l a r k Crossover and Gary Station with the engineer observing the drop 
pan requirements b e t w e e n MP 59.4 and MP 60 and the r e s t r i c t i v e signal aspects displayed 
by signals 593 and 591 that confronted the engineer o f train N o . 123 on January 2 1 . Under 
these conditions, with the t e m p e r a t u r e about 37° F, the running t i m e b e t w e e n Clark 
Crossover and Gary Station was 4 minutes 45 seconds, including the required stop at signal 
591, which was assumed t o be displaying a s t o p - a n d - p r o c e e d a s p e c t . 

Other Information 

A substation supervisory system, i d e n t i f i e d by its t r a d e name as Q E I , g i v e s the train 
dispatcher various supervisory c o n t r o l functions and indication features for the system 
that provides p o w e r t o the c a t e n a r y . T h e dispatcher can use the system t o r e m o v e and/or 
r e s t o r e p o w e r at substations by opening/closing c i r c u i t b r e a k e r s w i t c h e s . T h e system has 
a " t y p e r unit" in the dispatcher's o f f i c e which prints out the t i m e that faults occur in the 
s y s t e m . T h e t i m e on t h e "typer unit" printout is indicated t o the nearest 0.1 minute. In 
addition, the y e a r , month, and d a t e are shown. A c o l o r c a t h o d e ray tube displays the 
same i n f o r m a t i o n that is printed on t h e " t y p e r unit" printout. 

T h e 3 p . m . - t o - l l p.m. dispatcher on duty when this a c c i d e n t occurred t e s t i f i e d that 
he monitors the t i m e indicated by the Q E I system by comparing it t o the t i m e indicated 
by the standard c l o c k in the dispatcher's o f f i c e or by comparing it with a standard t i m e 
source obtained by telephone from C h i c a g o . If i t varies as much as 15 seconds, he resets 
it to the c o r r e c t standard t i m e . T h e printout t i m e r e c o r d is not used to r e c o r d train 
passing t i m e s . 



- 2 0 -

T h e QEI system records OS t i m e s on approach and departure circuits for the 
substations on each track. When a train actuates the approach c i r c u i t and when the train 
l e a v e s the circuit, the t i m e is printed on the "typer unit" printout. For the Madison 
Substation, near the accident s i t e , the eastbound west OS t i m e circuit extends 1,788 f e e t 
from MP 59.42 t o MP 59.08 and the eastbound east OS t i m e circuit extends 1,807 f e e t 
from MP 59.08 to MP 58.73 (0.16 mile east o f Gary S t a t i o n ) . 15/ The printout for the OS 
t i m e s does not identify the train by number, but the dispatcher can c o r r e l a t e these t i m e s 
with a train and obtain a passing t i m e . 

T h e "typer unit" printout for January 21, 1985, recorded s e v e r a l t i m e s associable 
with the a c c i d e n t . A t 18:45.8 (6:45:48 p . m . ) the printout indicates that a westbound train 
actuated the eastbound east OS t i m e circuit for the Madison Substation. T h e train was 
i d e n t i f i e d by a South Shore o f f i c e r as the equipment for train N o . 218 entering onto the 
eastward main track from the A D D track at Gary Station. A t 18:50.2 (6:50:12 p . m . ) the 
printout indicates that an eastbound train actuated the eastbound west OS t i m e c i r c u i t 
0.62 m i l e west o f Gary Station. T h e train was i d e n t i f i e d as train N o . 123 approaching 
Gary. 

T h e collision occurred ap p roximately 213 f e e t west of the east end of the eastbound 
west OS t i m e c i r c u i t . Because the QEI system records t i m e in tenths o f a minute, a 
r e c o r d e d t i m e can lag the e v e n t by up to 6 seconds (0.1 t i m e s 60 seconds). In addition, 
t h e r e can b e a 2 - to 3-second scanning t i m e d e l a y . Because of these f a c t o r s , the speed of 
train N o . 123 for the ap p ro x imately 1,575 f e e t only can be placed in the range o f 25 mph 
t o 35 mph based upon the t i m e s recorded by the QEI system. 

A N A L Y S I S 

Train Operations 

G e n e r a l N o t i c e N o . 62 s p e c i f i e d that the eastward main track would be used for 
s i n g l e - t r a c k operations and that s i n g l e - t r a c k operating rules would be in e f f e c t t o g o v e r n 
train m o v e m e n t s until the catenary o v e r the westward main track was repaired. 
B a s i c a l l y , the operation o f trains under the authority of General N o t i c e N o . 62 was no 
d i f f e r e n t than when train orders w e r e used b e f o r e the issuance o f the n o t i c e . A s a m a t t e r 
of operational e x p e d i e n c y , the Superintendent o f Transportation issues a G e n e r a l N o t i c e 
in the f o r m a t o f G e n e r a l N o t i c e N o . 62 when one o f the t w o main tracks in d o u b l e - t r a c k 
t e r r i t o r y is t o be used for s i n g l e - t r a c k operations for an extended t i m e . Since 
s i n g l e - t r a c k operating rules are used regularly b e t w e e n Gary and South Bend, and 
operating e m p l o y e e s are qualified on t h e m , by issuing a G e n e r a l N o t i c e t o establish 
s i n g l e - t r a c k operation for a g i v e n length o f track, the superintendent can a v o i d delay t o 
trains and reduce the workload o f the train dispatcher. 

The most serious problem arising from the establishment o f s i n g l e - t r a c k operation 
b e t w e e n Clark Crossover and the east end o f the double track r e l a t e d to the concurrent 
scheduled departure of eastbound and westbound trains at Gary Station. Under 
double-track operating rules and procedures, this arrangement did not present a problem 
because each train occupied its own d i r e c t i o n a l main track. A l s o , equipment for an 
originating scheduled train could enter onto a main track at Gary Station without 
d i f f i c u l t y because trains would be moving in only one direction on each track. T h e South 
Shore superintendent who prepared General N o t i c e N o . 62 said that when the n o t i c e 

15/ T h e directions east and west r e f e r to directions from the substation. T h e eastbound 
west OS t i m e circuit extends westward from the Madison Substation and usually would be 
a c t i v a t e d by an eastbound train. 



- 2 1 -

was issued, he did not o v e r l o o k the concurrent scheduled departure t i m e s and possible 
c o n f l i c t s for opposing trains at G a r y . H e said that the intent o f General N o t i c e N o . 62 
was t o d e f i n e t h e l i m i t s o f the s i n g l e - t r a c k o p e r a t i o n , and t o establish s i n g l e - t r a c k 
operating rules to g o v e r n train m o v e m e n t s . Further, he said that he e x p e c t e d the 
t r a i n c r e w s and the dispatcher t o r e s o l v e any operating c o n f l i c t s that might arise during 
the m o v e m e n t o f trains, such as the concurrent departure t i m e s of t w o trains at 
Gary Station, by use of the appropriate operating r u l e ( s ) . O p e r a t i n g rule S-71 establishing 
the superiority o f trains was one o f the rules he e x p e c t e d to be used in resolving a possible 
c o n f l i c t such as was present for train N o s . 123 and 218. T h e dispatcher apparently 
discerned no problem with continuing the established p r a c t i c e o f a l l o w i n g equipment t o 
enter a track e a r l y t o load passengers at Gary Station since G e n e r a l N o t i c e N o . 62 had not 
s p e c i f i c a l l y prohibited the equipment o f a westbound train from occupying the eastward 
main track b e f o r e its scheduled departure t i m e . 

T h e c r e w m e m b e r s o f train N o s . 123 and 218 as w e l l as the dispatcher, being 
qualified on the South Shore operating rules, understood that westbound trains w e r e 
superior to eastbound trains o f the same class. T h e y also understood that there was no 
minimum t i m e f a c t o r i n v o l v e d in the main track c l e a r a n c e requirements for trains o f the 
same class. It appears that the c r e w m e m b e r s of each train, the dispatcher, and the 
operating o f f i c e r s depended e x c l u s i v e l y upon the rule g o v e r n i n g the superiority o f trains 
t o deal with any c o n f l i c t s o f opposing trains. 

Throughout the industry railroad operating rules o f f i c e r s d i f f e r in their 
understanding and application o f the rules as to when equipment b e c o m e s a train. S o m e 
maintain that the equipment b e c o m e s a train subject to all r e l e v a n t rules when the 
conductor r e c e i v e s a c l e a r a n c e card from the dispatcher or o p e r a t o r . Others b e l i e v e that 
the equipment does not b e c o m e a train until its scheduled departure t i m e at a station. By 
definition in t h e South Shore operating rules, the equipment for train N o . 218 was a train 
( s e e appendix C ) . H o w e v e r , train N o . 218 had no o p e r a t i o n a l rights until the t i m e t a b l e 
schedule authorized those rights a t 6:50 p.m. 

A c c o r d i n g to the South Shore operating rules, where one t i m e is shown in a 
t i m e t a b l e for a train at a station, it is the departure t i m e unless it is o t h e r w i s e indicated. 
Thus, the t i m e s shown in the t i m e t a b l e for train N o s . 123 and 218 at Gary Station a r e 
departure t i m e s (see appendix E ) . H o w e v e r , the rules further s t a t e (rule N o . 5, s e e 
appendix C ) that w h e r e t h e r e is neither a siding nor f i x e d signals, the t i m e indicated for a 
train applies where t r a f f i c (passengers) is r e c e i v e d or discharged. Since t h e r e was no 
siding or a f i x e d signal at Gary Station, the application o f this rule resulted essentially in 
an impasse, because it a l l o w e d both trains t o be at the station platform at the same t i m e . 
In consideration o f the "flat t i m e " m e e t permissible by the South Shore o p e r a t i n g rules, 
this situation should have been addressed in G e n e r a l N o t i c e N o . 62. 

The S a f e t y Board b e l i e v e s that South Shore rule S-83 was applicable in this 
situation. Rule S-83 states, " A train must n o t . . . pass from one o f t w o or more tracks t o 
single track, until i t has been ascertained whether a l l trains due, which a r e superior, have 
a r r i v e d or l e f t . " T h e conductor o f train N o . 218, in calling the dispatcher b e f o r e moving 
the equipment for his train o n t o the eastward main track, did a t t e m p t t o l o c a t e train 
N o . 123, but the dispatcher did not p r o v i d e him this i n f o r m a t i o n . While South Shore 
rule 93 a l l o w s inferior trains t o use the main track within y a r d l i m i t s if superior trains a r e 
not d e l a y e d , rule 93 precluded train N o . 218's equipment from entering the eastward main 
track at Gary Station until 6:50 p . m . , because until that t i m e train N o . 123 was t h e 
superior train. The dispatcher erred in authorizing train N o . 218's equipment t o occupy 
the eastward main track without knowing the l o c a t i o n of train N o . 123. Since train 
N o . 123 was not scheduled to depart Gary Station until 6:50 p . m . , and so long as it a r r i v e d 



- 2 2 -

t h e r e at or b e f o r e 6:50 p.m., nothing would have been gained by train N o . 123 c l e a r i n g the 
eastward main track west o f Gary Station b e f o r e the passengers w e r e discharged. T h e 
passengers could have been unloaded and train N o . 123 could have l e f t Gary Station a t 
6:50 p . m . ( f l a t t i m e ) and continued t o w a r d Michigan C i t y . 

This analysis is predicated on o n - t i m e train p e r f o r m a n c e , which should have been 
the basis for the instructions contained in G e n e r a l N o t i c e N o . 62, and emphasizes the 
importance o f considering e v e r y possible aspect o f train operations in formulating 
t e m p o r a r y d e v i a t i o n s from standard procedures. Even though it had superior rights until 
6:50 p . m . a c c o r d i n g t o the rules, train N o . 123 was 3 t o 4 minutes l a t e on i t s schedule, and 
it should not have a t t e m p t e d to reach Gary Station in the f a c e of train N o . 218's 
scheduled departure t i m e at 6:50 p.m. T h e S a f e t y Board concludes that G e n e r a l N o t i c e 
N o . 62 was not s u f f i c i e n t l y e x p l i c i t in dealing with the operating c o n f l i c t s that could and 
did arise. 

South Shore operating rule 83a provides for a delay o f 3 minutes for a train l e a v i n g 
South Bend if the schedule o f t w o trains would cause them to m e e t at South Bend, If a 
rule such as rule 83a, which is applicable only to the s i n g l e - t r a c k operation at South Bend, 
had been put into e f f e c t at Gary by G e n e r a l N o t i c e N o . 62, or if a similar provision t o 
e l i m i n a t e the consequences o f c r e w m e m b e r s misjudging the t i m e by s e v e r a l minutes had 
e x i s t e d , train N o . 123 might have reached Gary Station s a f e l y . Rule 3, requiring the 
adjustment o f the watches o f c r e w m e m b e r s , would p e r m i t up to a 1-minute error in t i m e 
i f the t i m e s indicated by the watches w e r e 30 seconds slow in one instance and 30 seconds 
fast in another. Thus, a rule similar t o rule 83a, providing for a 3-minute delay in the 
scheduled departure t i m e from a station i f the schedule o f t w o trains would cause them t o 
m e e t a t that point, would have provided a margin o f s a f e t y and at most caused train 
N o . 218 t o depart Gary at 6:53 p . m . , 3 minutes l a t e . This e x t r a t i m e would h a v e a l l o w e d 
train N o . 123 t o have a r r i v e d at Gary Station s a f e l y . A l s o , i f eastbound trains, and train 
N o . 123 in particular, had been issued a "call order" 16/ for the conductor or engineer o f 
train N o . 123 t o c a l l the dispatcher b e f o r e the train passed Clark C r o s s o v e r , the a c c i d e n t 
could have been p r e v e n t e d . 

Since the South Shore dispatcher's communication circuits w e r e not t a p e - m o n i t o r e d , 
t h e r e is no record o f the communications that occurred at any t i m e during the e v e n i n g o f 
January 21. T h e S a f e t y Board has i n v e s t i g a t e d s e v e r a l accidents 17/ in which 
communications b e t w e e n the dispatcher and engineer or interlocking operators w e r e 
r e c o r d e d by a tape r e c o r d e r . These records, which also p r o v i d e the t i m e o f the 
communications, have been invaluable in improving operating p r a c t i c e s and in a c c i d e n t 
reconstruction. T h e South Shore should consider installing a tape monitor in the 
dispatcher's o f f i c e to record and p r e s e r v e communications b e t w e e n the dispatcher and 
mobile units or telephones. 

The Dispatcher 

T h e dispatcher's actions in s o m e regards and lack o f action in other regards 
indicated that he b e l i e v e d the c r e w o f train N o . 123 knew their train was the inferior 
train and that they w e r e g o v e r n e d by rule S-71 (see appendix C ) that required an inferior 
train t o c l e a r the main track for a superior train. He did not a l l o w any margin for e r r o r . 

167~ A " I o r m ~ T 9 ~ l r a i n order issued by the dispatcher for a train c r e w m e m b e r t o c a l l the 
dispatcher b e f o r e passing a specified l o c a t i o n . 
1 7 / R a i l r o a d A c c i d e n t R e p o r t s — " R e a r - e n d Collision B e t w e e n C o n t r o l Trains O I P I - 6 and 
E N P I - 6 X , near Saltsburg, Pennsylvania, February 26, 1984" ( N T S B / R A R - 8 5 / 0 2 ) ; " H e a d - o n 
C o l l i s i o n o f N a t i o n a l Railroad Passenger Corporation ( A m t r a k ) Passenger Train N o s . 151 
and 168, A s t o r i a , Queens, N e w Y o r k , July 23, 1984" ( N T S B / R A R - 8 5 / 0 9 ) . 



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T h e dispatcher was i n d i f f e r e n t to the location o f train N o . 123 according to the conductor 
o f train N o . 218 when the conductor asked the dispatcher about his responsibility as 
conductor of train N o . 218 if the t w o trains m e t . T h e dispatcher said that he b e l i e v e d 
train N o . 123 was d e l a y e d at Kensington Interlocking and S t a t e L i n e Interlocking and 
would be running about 7 t o 11 minutes l a t e . A l s o , he said that he anticipated an 
additional delay for train N o . 123 at the drop pan area b e t w e e n MP 59.4 and MP 60. 
H o w e v e r , this delay would have occurred a f t e r train N o . 123 passed Clark C r o s s o v e r . T h e 
dispatcher did not make any a l l o w a n c e for the possibility that train N o . 123 might make 
up some o f the lost t i m e b e t w e e n S t a t e L i n e Interlocking and Clark C r o s s o v e r . 

It is apparent that when the conductor of train N o . 218 was talking to the 
dispatcher, the dispatcher did not know the l o c a t i o n o f train N o . 123, which s e e m i n g l y 
should have d i c t a t e d his trying to c o n t a c t the engineer o f train N o . 123 t o d e t e r m i n e the 
train's l o c a t i o n . E x c e p t under unusual circumstances a dispatcher is e x p e c t e d t o and 
should know the l o c a t i o n o f a first-class passenger train to a c l o s e r t o l e r a n c e than 7 to 
11 minutes. A dispatcher should be able to p r e d i c t a train's a r r i v a l at a g i v e n l o c a t i o n 
f a i r l y a c c u r a t e l y because he knows the existing conditions, the p e r f o r m a n c e 
c h a r a c t e r i s t i c s o f an engineer, and the range of running t i m e s o f a train b e t w e e n various 
points. T h e dispatcher in this case should have had a g o o d k n o w l e d g e o f running t i m e s 
based on his e x p e r i e n c e both as an engineer and as a train dispatcher. 

If the t i m e that engineers report their trains onto the South Shore tracks at 
Kensington Interlocking cannot be used reliably t o c a l c u l a t e running t i m e s o f trains, South 
Shore operating o f f i c e r s should establish a s p e c i f i c reporting point. T h e dispatcher 
i n c o r r e c t l y assumed that train N o . 123 would be 7 t o 11 minutes l a t e when he a l l o w e d the 
equipment for train N o . 218 to occupy the eastward main track at the Gary Station 
p l a t f o r m b e f o r e 6:50 p . m . Since it was a c c e p t e d p r a c t i c e t o p e r m i t the equipment for a 
train to occupy the w e s t w a r d main track b e f o r e a train's scheduled departure t i m e under a 
normal d o u b l e - t r a c k o p e r a t i o n , the dispatcher apparently saw no problem in p e r m i t t i n g 
N o . 218's equipment to occupy the eastward main track in a similar manner. H o w e v e r , in 
a proper application o f the rules he should not have g i v e n the conductor o f train N o . 218 
permission to bring the equipment onto the eastward main track without a message or 
train order. T h e train and engine c r e w s operating into and out o f Gary Station knew that 
it was the p r a c t i c e t o bring the equipment onto the w e s t w a r d main track b e f o r e a train's 
scheduled departure t i m e ; t h e r e f o r e , the c r e w m e m b e r s o f train N o . 218 apparently did not 
b e l i e v e it was unusual or unsafe for their equipment to occupy the eastward main track 
ahead o f the scheduled departure t i m e . This b e l i e f was strengthened by the conversation 
the conductor o f train N o . 218 had with the dispatcher concerning train N o . 123. If train 
N o . 123 had e n t e r e d Gary Station at 6:50 p.m. or e a r l i e r , it would not have been a b l e t o 
c l e a r the main track without some shifting moves because train N o . 218's equipment 
would have been blocking the main track. In part, the dispatcher's job in this situation 
was t o d e a l with the ambiguity c r e a t e d by G e n e r a l N o t i c e N o . 62 by making a p o s i t i v e 
command decision. Instead, he a l l o w e d the ambiguity to remain and did not a c t t o r e s o l v e 
t h e c o n f l i c t b e t w e e n train N o s . 123 and 218 as operations management had a n t i c i p a t e d . 

T h e dispatcher had t w o resources a v a i l a b l e t o him for determining the l o c a t i o n o f 
train N o . 123. H e could have c o n t a c t e d the engineer o f train N o . 123 by radio. A l s o , the 
QEI printout would have provided him with an a p p r o x i m a t e l o c a t i o n . He did not use e i t h e r 
source o f i n f o r m a t i o n . 

T h e Q E I system can be used to p r o v i d e the dispatcher useful information about train 
m o v e m e n t s . For e x a m p l e , the dispatcher could and should r e c o r d passing t i m e s o f trains 
at designated points on his train sheet so they w i l l be a v a i l a b l e for i m m e d i a t e r e f e r e n c e ; 
this can be accomplished by use o f the QEI "typer printout." 



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T h e S a f e t y Board has found a dispatcher's lack o f k n o w l e d g e o f train l o c a t i o n s t o be 
a f a c t o r in previous a c c i d e n t s . On M a y 28, 1982, f o l l o w i n g its investigation of a head-on 
collision b e t w e e n t w o trains in B e v e r l y , Massachusetts, 1 8 / the S a f e t y Board issued S a f e t y 
R e c o m m e n d a t i o n R - 8 2 - 2 7 t o the Boston and Maine C o r p o r a t i o n : 

E n f o r c e Boston and Maine Corporation o p e r a t i n g rule 222 that requires 
operators t o promptly r e p o r t and the dispatcher t o promptly r e c o r d train 
passing t i m e s at locations w h e r e passing reports a r e required. 

In that a c c i d e n t , the dispatcher did not r e c o r d p r o m p t l y the OS t i m e s o f trains as 
t h e y passed r e p o r t i n g points. In the absence o f proper and prompt r e c o r d i n g o f OS t i m e s , 
it was d i f f i c u l t f o r him t o k e e p in mind the a p p r o x i m a t e locations o f his trains. 
Consequently, he a l l o w e d t w o opposing trains onto the same track and they c o l l i d e d . T h e 
S a f e t y Board b e l i e v e s that i f the South Shore dispatcher had r e c o r d e d the passing t i m e s o f 
train N o . 123 past the QEI OS points, he would have been able t o respond t o the request o f 
the conductor o f train N o . 218 for the l o c a t i o n o f train N o , 123. 

T h e dispatcher also failed t o respond fully t o the requirements o f his position b e f o r e 
the Gary a c c i d e n t when he did not d e t e r m i n e the cause, i f any, for the s t o p - a n d - p r o c e e d 
signal aspect displayed by signal 591 when the engineer o f train N o . 213 inquired about i t 
e a r l i e r in the day. While the engineer of train N o . 213 should not have g o n e past the 
signal without stopping, the dispatcher must share with the engineer the responsibility f o r 
the rules v i o l a t i o n , whether he authorized the engineer of train N o . 213 t o o p e r a t e past 
the s t o p - a n d - p r o c e e d signal aspect without stopping or not, because he did not r e p o r t t o 
his supervisor that train N o . 213 did not stop at the signal, as operating rule 291 r e q u i r e d . 
(Since the dispatcher was not c a l l e d upon t o p r o v i d e a diesel l o c o m o t i v e t o t o w train 
N o . 213 into Gary, he had t o have been a w a r e o f the f a c t that train N o . 213 did not stop 
at signal 591.) T h e d i f f i c u l t y the engineer o f train N o . 123 had e a r l i e r in obtaining 
p o s i t i v e guidance from the dispatcher, when he was operating train N o . 213 and 
encountered the s t o p - a n d - p r o c e e d signal a s p e c t , l e d t o his not calling the dispatcher 
again when he o p e r a t e d train N o . 123 through the signal just b e f o r e the collision. While 
the dispatcher may have discouraged engineers and conductors from calling him because 
o f his discourteous manner, the engineer o f train N o . 123 said this was not a f a c t o r in his 
decision not t o inquire about the signal. T h e engineer most l i k e l y did not c a l l the 
dispatcher about the s t o p - a n d - p r o c e e d signal when he observed it while operating train 
N o . 123 because he did not e x p e c t any new or additional information from the dispatcher 
concerning the signal. On the other hand, the dispatcher denied the conversation r e l a t e d 
t o the s t o p - a n d - p r o c e e d aspect displayed by signal 591; m o r e o v e r , the trouble r e p o r t 
f a i l e d t o confirm the engineer's report o f the signal abnormality. 

T h e South Shore should have had a provision for the dispatcher t o m o v e a train past 
a stop signal in a drop pan area when the a l t e r n a t i v e was t o stop the train and h a v e i t 
t o w e d t o a point w h e r e the c a t e n a r y was usable or t o the next station. N e v e r t h e l e s s , the 
S a f e t y Board b e l i e v e s that the dispatcher did not comprehend his authority when he s t a t e d 
that he could not a l l o w a train t o pass a s t o p - a n d - p r o c e e d signal aspect without stopping. 
N o r m a l l y , the full authority for the operation o f trains v e s t e d in the Superintendent o f 
Transportation t o m o v e trains as expeditiously and s a f e l y as possible is d e l e g a t e d t o the 
dispatchers. I f an unusual situation d e v e l o p s , the dispatcher can issue train orders or 
messages and v a l i d a t e them by signing the superintendent's initials or name. T h e s e 
instruments then b e c o m e valid operating instructions e v e n i f c o n t r a d i c t o r y t o an 

1 8 / R a i l r o a d A c c i d e n t R e p o r t — " H e a d - o n Collision o f Boston and Maine C o r p o r a t i o n 
Extra 1731 East and Massachussetts Bay Transportation A u t h o r i t y T r a i n N o . 570 on 
F o r m e r Boston and Maine C o r p o r a t i o n T r a c k s , B e v e r l y , Massachusetts, August 11, 1981" 
( N T S B / R A R - 8 2 / 0 1 ) . 



- 2 5 -

o p e r a t i n g rule. Such a means could have been used t o m o v e train N o . 213 past signal 591 
w h i l e it was displaying a s t o p - a n d - p r o c e e d a s p e c t . If, on the o t h e r hand, the dispatcher 
was c o r r e c t when he assumed that on the authority g i v e n to him by the Superintendent o f 
Transportation he could not countermand an o p e r a t i n g rule by using a train o r d e r or a 
message, the South Shore operating o f f i c e r s should publish revised dispatching procedures 
so that the dispatchers and operating c r e w m e m b e r s w i l l understand the a c t i o n t o be taken 
when a train encounters a signal displaying a s t o p - a n d - p r o c e e d aspect in a drop pan a r e a . 

Train N o . 218 Crewmembers 

T h e conductor o f train N o . 218 a t t e m p t e d to d e t e r m i n e from the dispatcher i f he 
needed a train order for a m e e t with train N o . 123, or if train N o . 218 should w a i t at Gary 
Station f o r train N o . 123's a r r i v a l . Since the dispatcher was the conductor's d i r e c t 
supervisor for authorizing train m o v e m e n t s , the conductor p r o c e e d e d as required when the 
dispatcher stated that train N o . 218 was superior t o train N o . 123, and that train N o . 218's 
equipment could occupy the eastward main track. By his actions, the dispatcher 
demonstrated his b e l i e f that the c r e w o f train N o . 123 would c l e a r the eastward main 
track for train N o . 218. T h e conductor should have pursued his concern and insisted on his 
right to be advised o f the l o c a t i o n and m o v e m e n t plans o f train N o . 123. 

L i k e w i s e , the engineer o f train N o . 218 appears t o have e x p e c t e d the c r e w m e m b e r s 
o f train N o . 123 t o w a i t at Clark Crossover a c c o r d i n g t o the o p e r a t i n g rules concerning 
the superiority o f westbound trains. He a c c e p t e d the authority he was g i v e n t o occupy 
the eastward main track at the station p l a t f o r m without considering the possibility o f 
train N o . 123's a r r i v i n g at Gary Station b e f o r e or a t 6:50 p . m . H o w e v e r , the engineer o f 
train N o . 218 could have used his radio and a c t e d on his own behalf and authority t o 
c o n t a c t the engineer o f train N o . 123 to d e t e r m i n e his l o c a t i o n and plans. When train 
N o . 123 had not a r r i v e d at Gary Station by 6:50 p.m., by t i m e t a b l e train N o . 218 was 
authorized to l e a v e the station, which according to the engineer's e s t i m a t e was not until 
about 6:50:20 p . m . 

T h e c o l l e c t o r / b r a k e m a n o f train N o . 218 displayed the same c o m p l a c e n c y shown by 
t h e other c r e w m e m b e r s in r e s p e c t t o train N o . 123. He was t h e junior c r e w m e m b e r and 
he appears t o have a c c e p t e d the judgments o f the conductor, engineer, and dispatcher. 

Train N o . 123 Crewmembers 

T h e engineer o f train N o . 123 should have talked d i r e c t l y with his conductor no l a t e r 
than the t i m e the train reached Clark C r o s s o v e r , where the t w o of them should h a v e made 
a decision concerning m e e t i n g train N o . 218. T h e engineer thought that he understood 
from the motion the conductor made t o w a r d his watch at Clark Road Station that t h e y 
had sufficient t i m e t o p r o c e e d to Gary Station and a r r i v e by 6:50 p . m . In addition, the 
engineer thought it was the conductor's intent for him t o p r o c e e d into Gary Station 
because it was the conductor's responsibility to stop the train at Clark C r o s s o v e r or make 
arrangements to c l e a r the eastward main track at Marshall or the w e s t end o f Gary 
Station if t h e r e was not sufficient running t i m e a v a i l a b l e for p r o c e e d i n g to Gary Station. 
H o w e v e r , South Shore rule 1005 (see appendix C ) charges the engineer with t h e 
responsibility o f not l e a v i n g a station e v e n on the conductor's signal if in his judgment he 
does not have sufficient t i m e to reach the next c l e a r a n c e point s a f e l y . 

T h e engineer's e s t i m a t e o f a 3.5-minute running t i m e b e t w e e n Clark C r o s s o v e r and 
Gary Station proved to be i n c o r r e c t . If the t i m e the conductor and engineer observed 
when train N o . 123 was at Clark Road Station was c o r r e c t , then they had sufficient 
running t i m e (5 minutes) b e t w e e n Clark Road Station and Gary Station. T h e running t i m e 



- 2 6 -

tests indicated that a normal running t i m e b e t w e e n Clark Crossover and Gary Station was 
4 minutes 20 seconds. R e p l i c a t i n g the conditions and circumstances that the engineer o f 
train N o . 123 encountered on January 2 1 , it took the test train 4 minutes 45 seconds f o r 
the same run. A l s o , the engineer o f train N o . 123 apparently did not consider the 
possibility o f a delay because o f the drop pan requirement or o f encountering r e s t r i c t i n g 
signal aspects. H e should have been concerned about delays because o f the drop pan area 
and the p o t e n t i a l for a stop-and-proceed aspect being displayed by signal 591, since these 
conditions had e x i s t e d earlier when he o p e r a t e d train N o . 213 through that a r e a . 

More importantly, it appears that the t i m e the conductor and engineer observed at 
Clark Road Station was either i n c o r r e c t l y observed, i n c o r r e c t l y r e m e m b e r e d , or 
i n c o r r e c t l y stated in their testimony. Both men indicated that they had checked their 
company-approved standard watches with the standard t i m e c l o c k at Michigan C i t y , and 
that the t i m e indicated by their watches compared c l o s e l y with the standard c l o c k and 
each other. Y e t the Q E I printout shows that train N o . 123 a c t u a t e d the west OS t i m e 
circuit for the Madison Substation at 6:50:12 p . m . Based on the 6:45 p . m . t i m e indicated 
by the conductor and engineer that they had observed at Clark Road Station, it took train 
N o . 123 about 5 minutes t o c o v e r a pproximately 2.3 miles from Clark Road Station t o t h e 
west end o f the OS t i m e c i r c u i t at the Madison Substation, which was an a v e r a g e speed o f 
about 27.6 mph b e t w e e n those t w o l o c a t i o n s . Even though the engineer o f train N o . 123 
questions the t i m e d e t e r m i n e d to be the t i m e o f the a c c i d e n t , the facts in their e n t i r e t y 
point t o 6:50:42 p . m . T h e engineer o f train N o . 218 said that he departed the station at 
Gary about 6:50:20. T h e t i m e g i v e n by the conductor o f train N o . 218 as t o when the 
equipment was brought onto the eastward main track is substantiated by the QEI s y s t e m . 
T h e r e f o r e , the S a f e t y Board concludes that the t i m e the conductor and engineer 
r e p o r t e d l y observed at Clark Road Station was i n c o r r e c t . 

T h e engineer o f train N o . 123 made up some o f the t i m e lost on the schedule at 
Kensington and S t a t e L i n e Interlockings b e t w e e n S t a t e Line and Clark C r o s s o v e r . A 
5-minute running t i m e b e t w e e n Clark Road Station and the west end o f the OS t i m e 
circuit for the Madison Substation is not consistent with the engineer's train handling 
b e t w e e n Kensington Interlocking and Clark Road Station. T h e engineer should not have 
had any problem a c c e l e r a t i n g the train to the authorized track speed a f t e r l e a v i n g Clark 
Road Station g i v e n the a c c e l e r a t i n g c a p a b i l i t y o f the equipment. A g a i n , based on the 
f o r e g o i n g data, the S a f e t y Board concludes that the conductor and engineer l e f t Clark 
Road Station at a t i m e l a t e r than 6:45 p.m. as stated in their t e s t i m o n y . 

T h e engineer o f train N o . 123 e x e r c i s e d poor judgment in assuming that t h e 
s t o p - a n d - p r o c e e d signal aspect displayed by signal 591 for train N o . 123 was for the same 
reason as the s t o p - a n d - p r o c e e d aspect he encountered while operating train N o . 213. 
M o r e o v e r , had he inquired o f the dispatcher about the s t o p - a n d - p r o c e e d signal aspect for 
train N o . 123, train N o . 218's engineer might have overheard the radio message and been 
a l e r t e d t o the oncoming train's l o c a t i o n . A n inquiry might have a l e r t e d the dispatcher t o 
the f a c t that train N o . 123 was east of Clark C r o s s o v e r , in which c a s e he might h a v e 
taken note o f the situation and a c t e d t o have p r e v e n t e d the a c c i d e n t . T h e f a c t that the 
engineer o f train N o . 123 was a qualified train dispatcher might have influenced him in his 
decision and misled him into b e l i e v i n g that he knew how the dispatcher would c o p e with 
the r e s t r i c t i n g signal. T h e r e f o r e , he f e l t no need to c a l l the dispatcher about the 
s t o p - a n d - p r o c e e d signal aspect displayed by signal 591 for train N o . 123. T h e decision not 
t o c a l l was not based on a hesitancy t o c a l l . 

Since the l a t e s t t i m e train N o . 123 could have passed Clark C r o s s o v e r and c l e a r e d 
the eastward track for train N o . 218 by 6:50 p.m. was c r i t i c a l , the conductor should h a v e 
g i v e n the decision to g o to Gary or stay at Clark Crossover his full a t t e n t i o n and 
consulted with his e n g i n e e r . Had the conductor o f train N o . 123 d e l e g a t e d t h e 



- 2 7 -

responsibility for detraining the passengers for Clark Road Station to the 
c o l l e c t o r / b r a k e m a n , he could have g i v e n the engineer p o s i t i v e guidance on the m e e t with 
train N o . 218. T h e hand motion made by the conductor at Clark Road Station as described 
by the engineer was not a c l e a r l y e x e c u t e d d i r e c t i v e in v i e w o f the significance o f the 
question to be r e s o l v e d , i . e . , where to c l e a r the track for train N o . 218. T h e conductor 
should have g i v e n the engineer p o s i t i v e guidance on this question. 

T h e c o l l e c t o r / b r a k e m a n made one a t t e m p t o v e r the intercom to c a l l to the 
a t t e n t i o n o f the engineer their m e e t with train N o . 218, but he r e c e i v e d no response. 
Since he shared responsibility with the conductor and engineer for the s a f e operation o f 
the train, he should have pursued the information and should not have concluded that the 
decision made by his senior c r e w m e m b e r s was adequate and c o r r e c t . His a c c e p t a n c e o f 
the decision can probably be best explained by his l i m i t e d e x p e r i e n c e and peer pressure. 

Once train N o . 123 passed Clark C r o s s o v e r , any o f the t h r e e c r e w m e m b e r s could 
have taken action or caused action to have been taken t o p r e v e n t the a c c i d e n t . T h e radio 
could have been used t o c o n t a c t t h e engineer of train N o . 218 t o advise him o f the planned 
m o v e m e n t and l o c a t i o n o f train N o . 123. T h e conductor or engineer could have stopped 
the train and established flag p r o t e c t i o n at 6:50 p.m. when they r e a l i z e d that they w e r e 
operating on train N o . 218's t i m e . T h e train could have c l e a r e d the eastward main track 
at Marshall. T h e r e f o r e , the S a f e t y Board concludes that if any of the seven principals 
i n v o l v e d in this a c c i d e n t had a c t e d to l o c a t e one or the other train or t o advise all 
concerned o f the m o v e train N o . 123 was planning to make, the a c c i d e n t would have been 
a v o i d e d . 

Training 

T h e South Shore's rules reexamination required o f all e m p l o y e e s is intended to 
r e i n f o r c e their k n o w l e d g e o f and their ability to apply the o p e r a t i n g rules. H o w e v e r , as 
was the c a s e here, s o m e o f the operating rules may be used infrequently by a g i v e n c r e w 
assignment. Consequently, frequent reexamination on such rules is essential to k e e p 
e m p l o y e e s constantly f a m i l i a r with their use and application. (Since the a c c i d e n t on 
January 21, 1985, the South Shore has changed from a biennial to an annual rules 
r e e x a m i n a t i o n . ) Since t r a i n c r e w s and dispatchers w i l l encounter varying train operations 
g o v e r n e d by the o p e r a t i n g rules during a 2-year p e r i o d , the S a f e t y Board b e l i e v e s that the 
South Shore's change to an annual rules reexamination should k e e p e m p l o y e e s more 
familiar with infrequently used rules. 

T h e Safety Board has found during s e v e r a l a c c i d e n t investigations that e m p l o y e e s 
o f t e n csan quote the rules and a c h i e v e a p e r f e c t s c o r e on the rules examination, y e t not 
understand how to apply the rules in actual circumstances. 19/ South Shore operating 
o f f i c e r s should r e v i s e their training materials t o include a method for ensuring that 
e m p l o y e e s understand when an operating rule needs t o be applied and how t o apply the 
rule. T h e annual reexamination should test an e m p l o y e e ' s k n o w l e d g e o f the application o f 
the rules both by observation and simulation. 

19/ Railroad A c c i d e n t R e p o r t s — " H e a d - o n Collision o f A m t r a k Trains Extra 769 East and 
N o . 195, Bristol, Pennsylvania, March 29, 1982" ( N T S B / R A R - 8 2 / 0 5 ) ; " H e a d - o n Collision o f 
N a t i o n a l Railroad Passenger Corporation ( A m t r a k ) Passenger Trains N o . 151 and 168, 
A s t o r i a , Queens, N e w Y o r k , July 23, 1984" ( N T S B / R A R - 8 5 / 0 9 ) ; " H e a d - o n Collision o f 
Burlington Northern Railroad F r e i g h t Trains Extra 6714 West and Extra 7820 East, 
Wiggins, C o l o r a d o , A p r i l 13, 1984, and R e a r - e n d Collision o f Burlington Northern R a i l r o a d 
F r e i g h t Trains Extra 7843 East and Extra A T S F 8112 East, near N e w C a s t l e , Wyoming, 
A p r i l 22, 1984" ( N T S B / R A R - 8 5 / 0 4 ) . 



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O J T can be an e x c e l l e n t means o f teaching a t r a i n e e the requirements o f a job and 
helping the t r a i n e e d e v e l o p the skills needed t o p e r f o r m the tasks of the j o b . But the 
success o f the system depends on the capability o f the instructors conducting the trainee's 
O J T and the uniformity of evaluation. T h e S a f e t y Board notes that South Shore 
operational o f f i c e r s s e l e c t the instructors for a trainee's O J T based on the instructor's 
skill and r e c o r d , but that the instructors are not monitored and trained to ensure that 
their methods are c o r r e c t and consistent. Since the instruction o f a t r a i n e e is the 
d e l e g a t e d responsibility o f d i f f e r e n t senior e m p l o y e e s and the tests administered to a 
trainee may be g i v e n by d i f f e r e n t supervisors, the S a f e t y Board b e l i e v e s that the South 
Shore operations management should d e v e l o p and put into e f f e c t a c o m p r e h e n s i v e 
standard training curriculum and examination, c o v e r i n g s p e c i f i c job tasks and skills, t o 
ensure that a l l e m p l o y e e s are k n o w l e d g e a b l e of the c r i t i c a l e l e m e n t s of the position 
b e f o r e a t r a i n e e or senior e m p l o y e e is advanced to a more responsible position. 

Survival Factors 

T h e car equipment p e r f o r m e d w e l l from a crashwocthiness standpoint. T h e cars did 
not o v e r r i d e , but in f a c t the t w o lead cars coupled. T h e major i m p a c t f o r c e s w e r e 
expended in crushing the vestibules and the front part o f the c a r s . 

T h e engineers escaped serious injury because they v a c a t e d their o p e r a t i n g 
c o m p a r t m e n t s just b e f o r e the collision. N e i t h e r engineer could have survived the crash if 
he had remained at the controls o f his train because the cabs w e r e crushed upon i m p a c t . 
T h e crushing resistance absorbed most o f the i m p a c t f o r c e s . 

Since train N o . 123 was approaching Gary Station, passengers w e r e standing in 
preparation for detraining. This made them more vulnerable to injury by i m p a c t f o r c e s , 
and the f a c t that they w e r e standing undoubtedly is responsible for the number o f bruises, 
lacerations, and fractures r e p o r t e d . 

T h e value o f the dead man c o n t r o l was demonstrated in this a c c i d e n t because e v e n 
though the engineer o f train N o . 123 did not apply the train brakes in e m e r g e n c y , the 
brakes went into e m e r g e n c y a u t o m a t i c a l l y seconds a f t e r he released the deadman f o o t 
pedal c o n t r o l . This i m m e d i a t e braking action was desirable under the circumstances and 
showed the value o f a deadman c o n t r o l or a similar d e v i c e . 

T h e S a f e t y Board has i n v e s t i g a t e d a number o f accidents in which a d e v i c e similar 
to the deadman c o n t r o l might have p r e v e n t e d the a c c i d e n t or decreased its s e v e r i t y . 
Although most o f these accidents w e r e caused by the incapacity o f the engineer because 
o f his being asleep, the need for such s a f e t y backup d e v i c e s was d e m o n s t r a t e d . T h e 
S a f e t y Board issued S a f e t y R e c o m m e n d a t i o n R - 7 3 - 8 on March 14, 1973, to the F R A 
f o l l o w i n g the investigation o f an a c c i d e n t in Pennsylvania in 1972: 20/ 

In c o o p e r a t i o n with the Association o f A m e r i c a n Railroads, d e v e l o p a 
f a i l - s a f e d e v i c e t o stop a train in the e v e n t that the engineer b e c o m e s 
i n c a p a c i t a t e d by sickness or death, or falls a s l e e p . Regulations should b e 
promulgated to require installation and maintenance of such d e v i c e . 

20/ R a i l r o a d A c c i d e n t R e p o r t — " H e a d - O n Collision o f T w o Penn C e n t r a l F r e i g h t Trains, 
Herndon, Pennsylvania, March 12, 1972" ( N T S B / R A R - 7 3 / 0 3 ) . 



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T h e r e c o m m e n d a t i o n was superseded by S a f e t y R e c o m m e n d a t i o n R - 8 4 - 3 1 issued to 
the F R A as a result of the Safety Board's investigation of an accident in Indiana in 
1983: 2 1 / 

D e v e l o p and promulgate a requirement that l o c o m o t i v e s o p e r a t e d in 
main track s e r v i c e be equipped with an alerting d e v i c e which w i l l stop a 
train if the engineer fails t o respond to an alarm indicating that he or 
she has fallen asleep or has b e c o m e i n c a p a c i t a t e d . 

The F R A responded t o R e c o m m e n d a t i o n R - 8 4 - 3 1 that it was planning a " L o c o m o t i v e Cab 
S a f e t y Inquiry" project and that the question of a deadman s a f e t y c o n t r o l or similar 
d e v i c e would be considered at that t i m e . Based on that response, R e c o m m e n d a t i o n 
R - 8 4 - 3 1 was classified as " O p e n — A c c e p t a b l e A c t i o n . " 

C O N C L U S I O N S 

Findings 

1. The train c r e w m e m b e r s and the dispatcher had passed the company operating 
rules examination, and they w e r e qualified for their r e s p e c t i v e positions. 

2. S i n g l e - t r a c k operating procedures w e r e not new to the e m p l o y e e s involved in 
this accident since the operation of trains b e t w e e n Gary and South Bend 
regularly was conducted using s i n g l e - t r a c k operating rules. 

3. General N o t i c e N o . 62 did not p r o v i d e for train operations on a single track 
when an eastbound and a westbound train w e r e scheduled to depart a station at 
the same t i m e . 

4. The c r e w m e m b e r s of each train understood that train N o . 218 was superior to 
train N o . 123 by t i m e t a b l e d i r e c t i o n . 

5. The conductor of train N o . 218 made an e f f o r t to d e t e r m i n e his responsibility 
insofar as meeting with train N o . 123 was concerned. 

6. The dispatcher did not a c t responsibly when he made no a t t e m p t to d e t e r m i n e 
the l o c a t i o n of train N o . 123 when the conductor of train N o . 218 c o n t a c t e d 
him. 

7. Train N o . 123 passed Clark Crossover with insufficient t i m e to reach Gary 
Station t o c l e a r the track for train N o . 218. 

8. The d e t e r m i n a t i o n made by the engineer and conductor that t h e r e was 
sufficient a v a i l a b l e t r a v e l t i m e to reach Gary Station when train N o . 123 
departed Clark R oa d Station was based on i n c o r r e c t t i m e observations. 

9. A c c o r d i n g t o rule 99 the c r e w of train N o . 123 should have stopped and 
established flag p r o t e c t i o n against train N o . 218 at 6:50 p.m. 

10. The equipment for train N o . 218 should not have been a l l o w e d to occupy the 
main track at Gary Station b e f o r e 6:50 p.m. 

2 1 / Railroad A c c i d e n t R e p o r t — " R e a r - E n d Collision o f Seaboard System Railroad F r e i g h t 
Trains Extra 8051 North and Extra 1751 North, Sullivan, Indiana, S e p t e m b e r 14, 1983" 
( N T S B / R A R - 8 4 / 0 2 ) . 



- 3 0 -

1 1 . T h e passing t i m e s obtainable from the Q E I system could have been used 
advantageously by the dispatcher to keep abreast o f the locations o f trains 
under his c o n t r o l . 

12. The engineer of train N o . 123 should not have passed signal 591 displaying a 
s t o p - a n d - p r o c e e d aspect without stopping. 

13. Radio was not used by either traincrew or the dispatcher to d e t e r m i n e the 
l o c a t i o n or plans o f train N o s . 123 and 218. 

14. T h e car equipment p e r f o r m e d w e l l in this crash situation. 

15. The South Shore relies on O J T for training operating personnel but does not 
have a comprehensive curriculum t o train and e v a l u a t e e m p l o y e e s . 

Probable Cause 

T h e N a t i o n a l Transportation S a f e t y Board determines that the probable cause of this 
accident was the failure of the dispatcher to coordinate the m o v e m e n t o f the t w o trains 
properly; the lack o f a clear provision in General N o t i c e N o . 62 for a m e e t i n g o f t w o 
opposing trains scheduled to depart Gary Station at the same t i m e ; and the mistaken 
d e t e r m i n a t i o n by the c r e w o f eastbound train N o . 123 while at Clark Road Station that 
there was sufficient t i m e for the train t o reach Gary Station and c l e a r the single track 
b e f o r e the scheduled departure o f westbound train N o . 218. 

R E C O M M E N D A T I O N S 

A s a result o f its investigation o f this accident, the National Transportation S a f e t y 
Board r e c o m m e n d e d that the C h i c a g o , South Shore and South Bend R a i l r o a d : 

P r o v i d e for a 3-minute delay similar t o that in rule 83a for a l l operations 
involving s i n g l e - t r a c k operating rules at locations where the a r r i v a l and 
departure t i m e s o f opposing trains a r e in c o n f l i c t . (Class I I , P r i o r i t y 
A c t i o n ) ( R - 8 5 - 1 0 6 ) 

Require that "call orders" be issued to trainerews t o c a l l the dispatcher 
b e f o r e a train enters the s i n g l e - t r a c k section when s i n g l e - t r a c k 
o p e r a t i n g procedures and rules a r e established t e m p o r a r i l y in 
double-track t e r r i t o r y . (Class I I , P r i o r i t y A c t i o n ) ( R - 8 5 - 1 0 7 ) 

Install a t a p e - m o n i t o r i n g system to record and p r e s e r v e a record o f 
communications to and from the dispatcher on the dispatcher's telephone 
and radio circuits. (Class I I , P r i o r i t y A c t i o n ) ( R - 8 5 - 1 0 8 ) 

Establish a r e l i a b l e reporting system to p r o v i d e the dispatcher more 
a c c u r a t e passing t i m e s o f trains entering upon the C h i c a g o , South Shore 
and South Bend tracks at Kensington Interlocking for use in estimating 
the m o v e m e n t o f trains. (Class I I , P r i o r i t y A c t i o n ) ( R - 8 5 - 1 0 9 ) 

Modify the p o w e r - m o n i t o r i n g system so that the t i m e trains pass the 
substations can be identified more readily, and require the dispatcher to 
record those t i m e s promptly on his train sheet. (Class I I , P r i o r i t y 
A c t i o n ) ( R - 8 5 - 1 1 0 ) 



- 3 1 -

P r o v i d e w r i t t e n instructions t o operating personnel concerning the action 
required when a train encounters a s t o p - a n d - p r o c e e d signal aspect in a 
section o f track where no propulsion p o w e r is a v a i l a b l e . (Class I I , 
P r i o r i t y A c t i o n ) ( R - 8 5 - 1 1 1 ) 

D e v e l o p a comprehensive curriculum c o v e r i n g the c r i t i c a l e l e m e n t s and 
job skills, including communication skills and manner for each position, 
and require that an e m p l o y e e pass a uniform examination b e f o r e being 
advanced to a new position. (Class I I , P r i o r i t y A c t i o n ) ( R - 8 5 - 1 1 2 ) 

B Y T H E N A T I O N A L T R A N S P O R T A T I O N S A F E T Y B O A R D 

/ s / JIM B U R N E T T 
Chairman 

/ s / P A T R I C I A A . G O L D M A N 
V i c e Chairman 

/ s / G . H . P A T R I C K B U R S L E Y 
Member 

O c t o b e r 21, 1985 



-33-

A P P E N D I X E S 

A P P E N D I X A 

I N V E S T I G A T I O N 

Personnel in the National Transportation Safety Board's Chicago Field Office heard 
a news media report of the collision on January 21, 1985, and a field investigator was 
dispatched to the scene immediately. The following day an investigator-in-charge was 
assigned from the Safety Board's Washington, D . C . , headquarters. He arrived at the scene 
early on the afternoon of January 22, and he was joined later by a team from headquarters 
comprised of a human performance specialist, an operations specialist, and a survival 
factors specialist. 

On April 14, 1985, the Chief, Railroad Accident Division, and staff members of the 
Safety Board took depositions at Michigan City, Indiana. Parties to the deposition 
proceeding were the Federal Railroad Administration, the Chicago, South Shore and South 
Bend Railroad, the American Train Dispatchers Association, and the United 
Transportation Union. Sworn testimony was taken from 10 witnesses. 



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A P P E N D K B 

C R E W M E M B E R I N F O R M A T I O N 

James C . Thompson, 32, was e m p l o y e d by the C h i c a g o , South Shore and South Bend 
Railroad as a c o l l e c t o r / b r a k e m a n on January 3, 1980, and his seniority dates from 
January 17, 1980. B e was promoted t o engineer on O c t o b e r 30, 1981, and worked his first 
assignment as a train dispatcher on A p r i l 27, 1984. He successfully passed his last 
operating rules examination on May 11, 1984. His last triennial m e d i c a l examination was 
passed on June 28, 1982. He had s a t i s f a c t o r i l y passed the operating e f f i c i e n c y and rules 
c o m p l i a n c e tests he was g i v e n . 

Conductor, Train N o . 123 

John D . Gardner, 52, was e m p l o y e d by the C h i c a g o , South Shore and South Bend 
Railroad as a c o l l e c t o r / b r a k e m a n on March 26, 1962. A f t e r a b r i e f absence during which 
t i m e he was e m p l o y e d by the Elgin, J o l i e t and Eastern R a i l r o a d , he was r e e m p l o y e d by the 
South Shore on March 11, 1965. He was qualified for passenger s e r v i c e on A p r i l 24, 1962, 
and was p r o m o t e d to conductor on July 23, 1966. He s a t i s f a c t o r i l y passed his last 
o p e r a t i n g rules examination on May 10, 1984, and his last triennial m e d i c a l examination 
on N o v e m b e r 11, 1982. He had s a t i s f a c t o r i l y passed the operating e f f i c i e n c y and rules 
c o m p l i a n c e tests he was g i v e n . 

C o l l e c t o r / B r a k e m a n , Train N o . 123 

R o b e r t T . C l a y , 30, was e m p l o y e d by the C h i c a g o , South Shore and South Bend 
Railroad as a c o l l e c t o r / b r a k e m a n on August 9, 1980, and his seniority dates from 
August 25, 1980. He qualified as a rear brakeman on February 24, 1981, and was 
p r o m o t e d to engineer on A p r i l 25, 1983. He s a t i s f a c t o r i l y passed his last operating rules 
examination on May 22, 1984, and his last triennial m e d i c a l examination on July 18, 1983. 
He had s a t i s f a c t o r i l y passed the operating e f f i c i e n c y and rules c o m p l i a n c e tests he was 
g i v e n . 

Engineer, Train N o . 218 

Jon N . M i l l e r , 45, was e m p l o y e d by the C h i c a g o , South Shore and South Bend 
Railroad as a c o l l e c t o r / b r a k e m a n in 1975. A f t e r a b r i e f period o f s e r v i c e as a trainman, 
he e n t e r e d engine s e r v i c e in 1976. He s a t i s f a c t o r i l y passed his last operating rules 
examination on May 15, 1984, and his last triennial m e d i c a l examination on March 21, 
1984. He had s a t i s f a c t o r i l y passed the operating e f f i c i e n c y and rules c o m p l i a n c e tests he 
was g i v e n . 

Conductor, Train N o . 218 

Dennis A . Burke, 35, was e m p l o y e d by the C h i c a g o , South Shore and South B 

pril 15, 1975. He qualified as a conductor on N o v e m b e r 7, 
1975. He s a t i s f a c t o r i l y passed his last o p e r a t i n g rules examination on May 9, 1984, and 
his last triennial m e d i c a l examination on June 2, 1982. He had s a t i s f a c t o r i l y passed the 
o p e r a t i n g e f f i c i e n c y and rules c o m p l i a n c e examinations he was g i v e n . 

Engineer, Train N o . 123 



- 3 5 -

C o l l e c t o r / B r a k e m a n Train N o . 218 

M i c h a e l E. L e n o i r , 33, was e m p l o y e d by the C h i c a g o , South Shore and South Bend 
Railroad as a c o l l e c t o r / b r a k e m a n on August 23, 1978. He was p r o m o t e d to rear brakeman 
on July 2, 1979, and t o conductor on July 19, 1980. He s a t i s f a c t o r i l y passed his last 
operating rules e x a m i n a t i o n on May 16, 1984, and his last triennial m e d i c a l examination 
on D e c e m b e r 21, 1984. H e had s a t i s f a c t o r i l y passed the operating e f f i c i e n c y and rules 
c o m p l i a n c e tests he was g i v e n . 

Dispatcher 

David L . Riordan, 34, was e m p l o y e d by the C h i c a g o , South Shore and South Bend 
Railroad on June 15, 1976, as a c o l l e c t o r /brake man. He was qualified for passenger 
s e r v i c e on June 29, 1976, for rear brakeman in f r e i g h t s e r v i c e on D e c e m b e r 30, 1976, and 
p r o m o t e d t o engineer on June 6, 1978. He established his seniority as a train dispatcher 
on N o v e m b e r 12, 1979. He s a t i s f a c t o r i l y passed his last o p e r a t i n g rules examination on 
May 10, 1984, and his last triennial m e d i c a l e x a m i n a t i o n on March 17, 1979. His 
disciplinary r e c o r d has no remarkable e v e n t s r e c o r d e d . T h e r e a r e no records o f his having 
been g i v e n e f f i c i e n c y or rules c o m p l i a n c e tests since he has been working in the 
dispatcher's o f f i c e . 



-36-

A P P E N D I X C 

E X C E R P T S F R O M 
C H I C A G O , S O U T H S H O R E A N D S O U T H B E N D R A I L R O A D 

O P E R A T I N G R U L E S 

DEFINITIONS 

T R A I N — A n engine or more than one engine cou 
pled, with or without cars, displaying markers 

REGULAR T R A I N . — A train authorized by a time 
table schedule. 

S U P E R I O R T R A I N — A train having precedence over 
another train. 

TRAIN O P S U P E R I O R RICHT — A train given precedence 
by train order. 

TRAIN O F S U P E R I O R CLASS — A train given precedence 
by timetable 

T R A I N O F S U P E R I O R D I R E C T I O N — A train given pre 
cedence in the direction specified by time-table as 
between opposing trains of the same class. 

T I M Z - T A B L E . — T h e authority lor the movement ol 
regular trains subject to the rules. It contains the 
classified schedules with special instructions r e ­
lating to the movement of trains. 

S C H E D U L E . — T h a t part of a time-table which pre­
scribes class, direction, number and movement for 
a regular train. 

M A I N T R A C K . — A track extending through yards 
and between stations, upon which trains are oper­
ated by time-table or train order, or both, or the 
use of which is governed by block signals. 

S I N G L E T R A C K . — A main track upon which trains 
are operated in both directions. 

T w o O R MORE T R A C K S —Two or more main tracks, 
upon any of which the current of traffic may be in 
either specified direction. 

* * * 

5. Not more than two times are given for a train 
at any station; where one is given, it is unless other­
wise indicated, the leaving time; where two, they 
are the arriving and the leaving time. 

The time applies to the switch where an oppos­
ing train enters the siding; where there is no siding, 
it applies to the place from which fixed signals are 
operated; where there Is neither siding nor fixed 
signal, It applies to the place where traffic Is re­
ceived or discharged. 

Schedule meeting or passing stations are indi­
cated by figures in full-faced type. 

Both the arriving and leaving time of a train 
are in full-faced type when both are meeting or pass­
ing times, or when one or more trains are to meet 
or pass it between those times. 

Where there are one or more trains to meet or 
pass a train between two times, or more than one 
train to meet a train at any station, attention Is 
called to it by figures In small type. 

When trains are to be met or passed at a siding 
extending between two adjoining stations, the time 
at each end of the siding will be shown in full-faced 
rype. 

* * * 
S 7 1 . A t r a i n i s s u p e r i o r t o a n o t h e r 
t r a i n b y r i g h t , c l a s s o r d i r e c t i o n . 

R i g h t i s c o n f e r r e d b y t r a i n o r d e r ; 
c l a s s and d i r e c t i o n b y t i m e t a b l e . 

R i g h t i s s u p e r i o r t o c l a s s o r 
d i r e c t i o n . 

D i r e c t i o n i s s u p e r i o r as b e t w e e n 
t r a i n s o f t h e same c l a s s . 

* * * 

m S 83. A train must not leave its initial station on any 
division, or a junction, or pass from one of two or more 
tracks to single track, until it has been ascertained 
whether all trains due, which are superior, have arrived 
or left 

S 87. An inferior train must keep out of the way of 
opposing superior trains and failing to clear the main 
track by the time required by Rule, must be protected 
as prescribed by Rule 99. 

Extra trains must clear the time of opposing regular 
trains not less than five minutes, unless otherwise pro­
vided, and will be governed by train orders with respect 
to opposing extra trains. 

S 88. At meeting points between trains of the same 
class, the inferior train must clear the main track before 
the leaving time of the superior train. 

At meeting points between extra trains, the train in 

the inferior time-table direction must take the siding 
unless otherwise provided 

Trains must pull into the siding when practicable; if 
necessary to back in, the train must first be protected as 
prescribed by Rule 99, unless otherwise provided. 

* * * 

S 90. Trains must stop at schedule meeting points, if 
the train to be met is of the same class unless the switch 
is properly lined and the track clear. 



-37- A P P E N D I X C 

Trains must stop clear of the switch used by the train 
to be met in going on the siding. 

When the expected train of the same class is not found 
at the schedule meeting point, the superior train must 
approach all sidings prepared to stop, until the expected 
train is met. 

The engineer of each train will give Signal 14 (n) at 
least one mile before reaching a meeting or waiting point 
and conductor will acknowledge with Signal 16 (k) 
Should the engineer fail to give Signal 14 (n) the Con­
ductor must take immediate action to stop the train 

93 Within yard limits the main track may be used, 
clearing the time an approaching designated first class 
train is due to leave the nearest station where time is 
shown. 

93(b) T r a i n s and engines occupying the main track 
within y a r d limits must be protected in accordance with 
Rule 99 ( F l a g m a n ) during fogs, storms or other unfavor­
able conditions, also where the view of an approaching 
train is obstructed b y curvature or other conditions 
Trainmen and yardmen will be held for any failure to 
exercise reasonable precaution in protecting their trains 
or engines under such conditions. 

99 When a train is moving on a main track at 
less than one-half the maximum authorized time­
table speed for any train at that location, under 
circumstances in which it may be overtaken, a crew 
member must put off single burning fusees at rear of 
train at intervals that do not exceed the burning 
time of the fusee. 

When a train is moving on a main track at more 
than one-half the maximum authorized timetable 
speed for any train at that location, under circum­
stances in which it may be overtaken, crew mem­
bers responsible for providing protection must 
consider grade, track curvature, weather conditions, 
sight distance, and speed of the train relative to 
following trains, when deciding if burning fusees 
should be put off. 

When a train stops on a main track, under cir­
cumstances in which it may be overtaken, protec­
tion against following trains on the same track must 
be provided A crew member must go back imme­
diately with flagman's signal equipment one-half 
the required distance where he will place two tor­
pedoes on the rail, and continue to the required 
distance from rear of train, where he will place two 
torpedoes on the rail, and place a burning fusee If 
no following train is seen or heard, he may return 
one-half the distance to the rear of his train where 
he must remain until he has stopped a following 
train or is recalled When recalled and no following 
train is seen or heard, he must leave a burning fusee, 
and while returning to train, must leave burning 
fusees at intervals that do not exceed the burning 

time of the fusee 
When the train departs, a crew member must 

leave a burning fusee and put off single burning 
fusees at intervals that do not exceed the burning 
time of the fusee until train attains a speed not less 
than one-half the maximum authorized timetable 
speed for any train at that location 

When rules require protecting the front of the 
train, a crew member with flagman's signal equip­
ment must immediately go forward one-half the 
required distance, place two torpedoes on the rail, 
and continue to the required distance from front of 
tram, where he will place two torpedoes on the rail, 
and place a burning fusee. If no approaching train 
is seen or heard, he may return one-half the dis­
tance to the front of his train, display a burning 
fusee, and remain at that location until he has 
stopped an approaching train or is recalled 

Should a train be seen or heard approaching be­
fore the crew member has reached the required 
distance, he must at once place two torpedoes on the 
rail, leave a burning fusee, and at night, or in o b ­
scure weather, or if the view is obscured, he will 
in addition, display a lighted fusee and continue 
toward the approaching train, displaying stop sig­
nals until they are answered. 

When flagman is recalled he may, if safety to 
his train will permit, remove from the rail the two 
torpedoes placed nearest the train 

In placing torpedoes they will be securely fas­
tened to the top of the rail on the Engineer's side at 
least on hundred feet apart, and when practicable, 
not closer than five hundred feet from a whistling 
post 

9 9 ( a ) . Following are the minimum flagging 
distances corresponding with the maximum author­
ized speed of approaching trains: 

Maximum Minimum 
Authorized Speed Flagging Distance 

0 - 1 5 mph y 4 mile 
1 5 - 3 0 m p h %mile 
30 - 45 mph 1 mile 
4 5 - 70 mph l % m i l e 

A crew member providing flag protection must not 
permit other duties to interfere with the protection 
of his train 

1005. Enginemen must know their time on the 
road, and will not start from a station, even though 
they receive a signal from the conductor, unless 
they can reach the next station In time to properly 
clear superior trains. 

SPECIAL INSTRUCTIONS 

S-71 Westward t r a i n s a r e s u p e r i o r t o 
E a s t w a r d t r a i n s o f t h e same c l a s s . 

83a. Trains must not leave South Bend without obtaining train orders or 
clearance card issued by Train Dispatcher If meeting point is designated by full 
face type and opposing train has not arrived, superior train will wait three (3) 
minutes before leaving South Bend Station 



A P P E N D I X C -38-

RULE C O L O R L I G H T N A M E I N D I C A T I O N S 

281 If? C l e a r Proceed. 
285 Iff A p p r o a c h 

P r o c e e d p r e p a r i n g t o stop a t next signal. T r a i n ex­
ceeding medium speed must a t once reduce t o t h a t speed. 

290 Restricting P r o c e e d at restricted speed. 

M l Stop and Proeeed Stop, then p r o c e e d a t r e s t r i c t e d speed. 



- 3 9 -

A P P E N D I X D 

C A T E N A R Y I N F O R M A T I O N 

T h e primary messenger (support w i r e ) is a 0.72 inch d i a m e t e r c a b l e . The secondary 
messenger is a 0.629-inch d i a m e t e r c a b l e . T h e t w o t r o l l e y or c o n t a c t w i r e s a r e 
0.482-inch d i a m e t e r ( 4 / 0 A W G ) . T h e t r o l l e y w i r e and the c a t e n a r y messengers a r e not 
usually pulled t o the same d e g r e e of tension. T h e tension for a 3 0 0 - f o o t span of t r o l l e y 
w i r e a t 0 ° F would be 4,907 pounds, whereas the tension for the same span at 90° F would 
be 2,659 pounds. A shorter span would e n t a i l higher tension f o r c e s . T h e system does not 
have a constant tension construction. 24/ 

24/ A n arrangement o f w e i g h t s and pulleys in the catenary system which compensates for 
variations in t e m p e r a t u r e and maintains a constant tension on the t r o l l e y w i r e . 



- 4 0 -

A P P E N D I X E 

E X C E R P T F R O M 
C H I C A G O , S O U T H S H O R E A N D S O U T H B E N D R A I L R O A D 

T I M E T A B L E N O . 5 

4 E A S T W A R D T R A I N S 

F I R S T C L A S S 

S T A T I O N S 

F I R S T C L A S S 

111 113 
S T A T I O N S 

213 115 117 

D A I L Y E X C E P T S A T . S U N A N D H O L I D A Y S 

S T A T I O N S 

D A I L Y E X C E P T S A T „ S U N A N D H O L I D A Y S 

• • • . . . . 
P M 

L 12 15 
s 12 39 P M 

PM 
L 2 15 
$ 2 39 P M 

(RANDOLPH S T ) 
C H I C A G O , 

KENSINGTON 

PM 
i 3 15 
s 3 39 P M 

P M 
L 3 58 
$ 4 23 P M 

PM 
L 4 2B 
$ 4 52 P M 

- • 

s 12 45 
s 12 50 
s 12 55 
F 1 00 

1 02 
s 105 

$ 2 45 
s 2 5 0 
$ 2 55 
F 3 00 

3 02 
s 305 

HECEWECH 
H A M M O N D 

EAST C H I C A G O 
CLARK X O V E R 

AMBRIDCE 
G A R Y 

• 

$ 3 45 
$ 3 5 0 
$ 3 55 
f 400 
f 4 02 
A 4 05 P M 

$ 4 2 9 
$ 4 3 3 
$ 4 37 

$ 4 4 5 

$ 4 59 
$ 504 
$ 5 0 9 
F 5 13 

5 15 
$ 5 20 

• 

1 07 
F 1 10 

F 1 15 

V 17 
11 20 

F 1 22 
F 1 24 

1 26 
F 1 27 
F 1 32 

1 33 
1 35 

s 1 40 
A 1 45 PM 

3 07 
F 3 10 

i S i ! * " 
F 3 1 5 
( 3 17 
13 20 

F 3 2 2 
F 3 24 

3 26 
F 3 27 
F 3 32 

3 33 
3 35 

s 3 40 
A 3 45 P M 

END DOUBLE TRACK 
MILLER 

(WstEnd 
WAGNER ] C , , , ) Eat End 
OGDEN DUNES 

( Wot End 

8A1LLY 
DUNE ACRES 

TREMONT SIDING 

TREMONT 
BEVERLY SHORES 

T A M A R A C K 
SHERIDAN 

MICHIGAN CFTY 
SHOPS 

. . . 

4 47 
F 4 51 
J453 
1454 

F 4 5 6 
J458 
15 01 

5 03 
F 5 05 

5 07 
f 508 
F 5 1 4 

5 16 
5 20 us 

$ 5 25 
A 5 30 P M 

5 22 
F 5 25 
15 27 
15 28 

F 5 30 

I I 1 1 ™ 
F 5 37 
F 538 

5 40 
F 5 41 
F 5 45 

5 46 
550 

$ 5 55 
A 6 00 PM 

. . . 

B1RCHIM 
HUDSON LAKE 
N E W CARLISLE 

OUVE 
SOUTH BEND 

(BENDIX) 

. . . 
. .. 

. . . • • 

*U S GOVERNMENT PRINTING OFFICE; 1985-il'91-093i20056