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Safety Recommendation Details

Safety Recommendation R-76-038
Details
Synopsis: ON JANUARY 9, 1976, AT 8:06 A.M., CHICAGO TRANSIT AUTHORITY (C TRAIN NO. 315 STRUCK THE REAR END OF TRAIN NO. 104 WHILE IT WAS STANDING AT THE ADDISON STREET STATION PLATFORM IN CHICAGO, ILLINOIS. THE IMPACT FORCES EXTENSIVELY DAMAGED THE LEAD CAR OF THE MOVING TRAIN AND THE REAR CAR OF THE STANDING TRAIN, AND SLIGHTLY DAMAGED THE OTHER CARS IN EACH TRAIN. DAMAGE TO THE EQUIPMENT AND TRACK WAS ESTIMATED TO BE $267,000. OF THE 381 PASSENGERS WHO WERE INJURED IN THE COLLISION, 1 PASSENGER DIED.
Recommendation: THE NTSB RECOMMENDS THAT THE CHICAGO TRANSIT AUTHORITY: INSURE THAT THE TRAIN PHONE SYSTEM PROVIDES DEPENDABLE, RELIABLE, AND BACKUP COMMUNICATION FOR OPERATIONAL CONTROL AND THAT PROPER PROCEDURES ARE IN EFFECT TO PROVIDE EMERGENCY WARNINGS AND INSTRUCTIONS.
Original recommendation transmittal letter: PDF
Overall Status: Closed - Unacceptable Action
Mode: Railroad
Location: Chicago, IL, United States
Is Reiterated: Yes
Is Hazmat: No
Is NPRM: No
Accident #: 80015
Accident Reports: Chicago Transit Authority Collision of Trains No. 104 and No. 315 at Addison Street Station
Report #: RAR-76-09
Accident Date: 1/9/1976
Issue Date: 8/23/1976
Date Closed: 11/12/1993
Addressee(s) and Addressee Status: Chicago Transit Authority (Closed - Unacceptable Action)
Keyword(s): Transit

Safety Recommendation History
From: NTSB
To: Chicago Transit Authority
Date: 11/12/1993
Response: IN A LETTER DATED AUGUST 2, 1993, THE BOARD ASKED TO BE ADVISED OF ACTIONS TAKEN BY CTA TO IMPLEMENT THE OPEN RECOMMENDATIONS. OUR RECORDS INDICATE THAT WE HAVE NOT RECEIVED A RESPONSE. BASED ON THE LACK OF RESPONSE FROM THE CTA, THE BOARD HAS CLASSIFIED RECOMMENDATIONS R-76-38, R-85-88, AND R-85-91 THROUGH -97 "CLOSED--UNACCEPTABLE ACTION." COPIES OF OUR AUGUST 23, 1976, OCTOBER 16, 1985, AND AUGUST 2, 1993, LETTERS ARE ENCLOSED FOR YOUR REFERENCE.

From: NTSB
To: Chicago Transit Authority
Date: 8/24/1987
Response: Based on your response which addresses the train phone system in existence prior to the implementation of the current portable radio system, the Board believes that the CTA might have misinterpreted the Board's intent in reiterating Safety Recommendation R-76-38. Irrespective of the type of train or radio equipment used, the Board believes that proper procedures should be in place to ensure that immediate and efficient communication is always possible, particularly in the event of an emergency situation. The Board's investigation of the accident on August 17, 1985, revealed that because motormen and conductors have been discouraged by CTA supervisors from using their portable radios for intratrain communications, the motorman and conductor of train 135, which was involved in the accident, did not use their portable radios to clarify between them what had happened and to coordinate their activities following the accident. Further, communications between the motorman of train 135 and the controller were poor. When the motorman initially contacted the controller on the radio, he could not establish clear, effective communications with the controller because of interference of other users on the same frequency. The motorman of train 143 had similar trouble contacting the controller after the collision. There were no CTA procedures for clearing the air of nonessential traffic during the emergency or for switching to a discrete emergency frequency. Consequently, our intent in reiterating Safety Recommendation R-76-38 was for the CTA to formulate procedures to ensure efficient communication during emergency situations between train crewmembers and between the train crew and the controller. Pending consideration of the Board's comments, Safety Recommendation R-76-38 will remain in an "Open-Unacceptable Action" status.

From: Chicago Transit Authority
To: NTSB
Date: 5/12/1987
Response: ON FEBRUARY 7, 1979, THE CHICAGO TRANSIT AUTHORITY AUTHOR IZED THE AWARDING OF CONTRACT FOR A TWO-WAY PORTABLE RADIO SYSTEM NETWORK. ON MARCH 24, 1980 THE USE OF PORTABLE RADIOS FOR PRIMARY OPERATIONAL COMMUNICATION WAS IMPLEMENTED ON THE WEST-SOUTH ROUTE. THEIR IMPLEMENTATION ON THE RE MAINING ROUTES WERE AS FOLLOWS: MARCH 5, 1980 RAVENSWOOD ROUTE, APRIL 24, 1980 EVANSTON AND SKOKIE ROUTES, FEBRUARY 15, 1981 WEST-NORTHWEST ROUTE, MARCH 1, 1981 NORTH-SOUTH ROUTE. DURING THE IMPLEMENTATION PHASE OF THE PROJECT, THE TRAIN PHONE SYSTEM WAS STILL OPERATIONAL. HOWEVER, IN 1981 CTA MANAGEMENT AT THAT TIME MADE A DECISION TO PHASE OUT THE TRAIN PHONE SYSTEM BASED ON THE PERFOMRNACE OF THE PORTABLE RADIOS. THE TRAIN PHONE SYSTEM HAD SEVERAL INHERENT SHORT COMINGS. INCIDENTS SUCH AS A DERAILMENT OR BROKEN OVERHEAD TROLLEY, POWER SYSTEM FAULT, WIRING FAULT OR BLOWN FUSE IN SOME CASES RENDERED THE TRAIN PHONE SYSTEM USELESS. IM PROVED TECHNOLOGY MADE SUCH PIONEERING TRAIN PHONE SYSTEM OBSOLETE. CTA RAPID TRANSIT COMMUNICATIONS NETWORK HAS STEADILY IMPORVED SINCE IMPLEMENTATION OF THE PORTABLE RADIO SYSTEM.

From: NTSB
To: Chicago Transit Authority
Date: 7/3/1986
Response: Safety Recommendation R-76-38 will be addressed in the future in connection with the other Safety Recommendations, R-85-88 through -95, which were also issued as a result of the Board's investigation of that accident. The Board points out also that in its report of the Montrose Avenue Station accident, the following Safety Recommendation R-76-41 was placed in a "Closed--Unacceptable Action" status.

From: NTSB
To: Chicago Transit Authority
Date: 8/20/1985
Response: From the accident report of the rear-end collision of two Chicago Transit Authoirty trains near the Montrose Avenue station in Chicago, IL on August 17, 1984. The Board adopted this report on 8/20/1985. As a result of this investigation, the National Transportation Safety Board reiterates Safety Recommendation R-76-38 issued to the Chicago Transit Authority on July 8, 1976.

From: NTSB
To: Chicago Transit Authority
Date: 10/7/1981
Response: On August 23, 1976, the National Transportation Safety Board issued Safety Recommendations R-76-35 through -41 to the Chicago Transit Authority (CTA) as a result of our investigation of the rear-end collision of two southbound CTA passenger trains at the Addison Street Station platform in Chicago, Illinois. Additionally, on June 29, 1977, the Safety Board issued Safety Recommendations R-77-14 through -17 to the CTA as a result of our investigation of the rear-end collision of two northbound CTA passenger trains at the intersection of Wabash Avenue and Lake Street. Based on previous responses by the CTA, the Safety Board has classified R-77-14 and R-77-16 as "Closed-Acceptable Action." We note, however, that the remaining nine recommendations are in various open categories pending completion of action by the CTA. The latest correspondence on these recommendations is 2 years old. We would appreciate being apprised of the progress made by the CTA toward fulfilling these recommendations.

From: Chicago Transit Authority
To: NTSB
Date: 9/21/1976
Response: CHICAGO TRANSIT AUTHORITY LTR: MAINTENANCE PROCEDURES HAVE BEEN INTENSIFIED FOR BOTH CARBORNE AND WAYSIDE TRAIN PHONE EQUIPMENT. A SURVEY OF TRAINPHONE SIGNAL STRENGTH HAS LED TO THE INSTALLATION OF ADDITIONAL WAYSIDE EQUIPMENT. MORE TRAINPHONES ARE BEING ACQUIRED TO PROVIDE A GREATER RESERVE OF SPARES. ADDITIONALLY, A RADIO SYSTEM IS BEING DESIGNED TO SUPLEMENT THE EXISTING TRAIN PHONE SYSTEM WHICH OPERATES OVER THE ELECTRIFIED POWER RAIL.