Application Form for Safety-Related Infrastructure Improvements and Technology Implementation

APPLICANT IDENTIFICATION

Name of the Applicant:

Title:

Organization:

Address:

Phone number:

Email address

Federal riding:

1. Location of the project

Mile Subdivision Railway company Road City Province

2. Project proponent. Choose from the following list:

  • ☐ Governments (provinces, territories, municipalities and local and regional governments)
  • ☐ Road or transit authorities
  • ☐ Crown corporations or provincial agencies (e.g. VIA, Metrolinx, etc.)
  • ☐ For-profit organizations (e.g. railways operators, or owners, commercial entities, etc.)
  • ☐ Not-for-profit organizations
  • ☐ Indigenous communities, groups or organizations
  • ☐ Individuals
  • ☐ Others

3. Is the project/proposed work being submitted on behalf of multiple participants (i.e. railway company and road authority)?

  • ☐ Yes
  • ☐ No

4. Project participants (parties contributing to the project)

  • ☐ Railway company
  • ☐ Road authority
  • ☐ Others

5. Railway line

  • ☐ Provincially regulated
  • ☐ Federally regulated

6. Has the railway line or the rail crossing been in existence for a minimum of 3 years?

  • ☐ Yes
  • ☐ No

7. Railway design speed (mph). In the case of an existing crossing, indicate the railway equipment speed that corresponds to the current design of the grade crossing.

8. Road design speed (km/h).

9. Number of tracks: Indicate the total number of tracks at the crossing or project location

10. Number of lanes: Indicate the total number of existing lanes traversing the crossing (i.e. total number of lanes in both direction at the crossing)

11. Average daily railway movements (the total number of movements of engines, or engines coupled with railway equipment, across a grade crossing in both direction in a year, divided by the number of days in that year)

12. Average daily vehicle volume (the total number of motor vehicles that cross a grade crossing in both direction in a year divided by the number of days in that year)

13. Average daily pedestrian volume – if applicable (the total number of pedestrians that cross a grade crossing in a year divided by the number of days in that year)

14. Indicate the existing protection already in place – if applicable (such as active warning system, stop sign, etc…)

15. Description of the safety issues at the project location. Elaborate on the following as applicable:

  • ☐ Data related to collision history from last 10 years (i.e. accidents, injuries, fatalities)
  • ☐ Data related to public complaints (i.e. nature, and number)
  • ☐ Information related to TSB investigations, Rail Safety Advisories, Rail Safety Information letters.
  • ☐ Any Notices or Notices with Orders issued in the last 10 years.
  • ☐ Other identified safety issues

16. Select the proposed upgrades included in the proposed project.

  • ☐ Upgrade to LED (provide the number of LED's needed: )
  • ☐ Add Standard Railway Crossing Signs (SRCS)/ SRCS+STOP
  • ☐ Add Flashing Lights and Bells (FLB), and/or gates
  • ☐ Upgrade to Constant Warning Times (CWT)
  • ☐ Resurface crossing and approaches
  • ☐ Realign road approaches
  • ☐ Add median separation
  • ☐ Add street lighting at crossing
  • ☐ Add/Upgrade pedestrian protection at an existing crossing
  • ☐ Add/Upgrade other pedestrian safety measures
  • ☐ Improved signage (e.g Second Train Warning Event sign, Prepare to Stop at Railway Crossing sign, Emergency Notification sign, etc.)
  • ☐ Grade Separation
  • ☐ ITS (Intelligent Transportation Systems) (e.g. variable message signs)
  • ☐ Solutions to access control issues (e.g. authorize access to pedestrians, add fencing, maze barriers)
  • ☐ Other (specify):

17. Provide a description of proposed work. Include a list of major activities/tasks and attached any supporting documentation or plans.

18. Provide a detailed estimate of the total project cost of the work planned (including detailed breakdown of costs).

19. Amount of federal funding being requested:

20. If applicable, list all other source(s) of funding for the proposed project

21. Project schedule:

  • ☐ Expected start date:
  • ☐ Expected end date:

22. Project cashflow forecast (for multi-year projects)

Contributors 2016/2017 2017/2018 2018/19
Canada
Other Contributors
Total

23. Expected results of the projects. Indicate how the proposed work will improve safety (expected direct and indirect benefits, prevent collisions, prevent derailments, prevent fatalities, prevent injuries, prevent property damage, reduce risk-taking behaviors, etc.).

24. Describe the risk of not receiving federal funding

25. Is the crossing located in or in close proximity to any of the following: National Parks, National Park Reserves, National Historic Sites, or Historic Canals?

  • ☐ Yes
  • ☐ No

26. Does the crossing extend outside of the existing roadway or railway right-of-ways?

  • ☐ Yes
  • ☐ No

27. Will the closure be within 30m of a body of water?

  • ☐ Yes
  • ☐ No

28. Will the project result in the likely release of a polluting substance into a water body?

  • ☐ Yes
  • ☐ No

29. If applicable, provide the following environmental information.

  • ☐ Summary description of the local biophysical environment, including a description of the environmental components that are likely to be adversely affected by the project;
  • ☐ Other Environmental Assessments (EA) regimes to which the project has been or is likely to be subject to (i.e., provincial, territorial, etc.).

30. Information Sharing form to be completed for proposed works at crossings only (separate forms for railway and road authority)

Date modified: