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Safety Recommendation Details

Safety Recommendation R-09-011
Details
Synopsis: On May 28, 2008, about 5:51 p.m., eastern daylight time, westbound Massachusetts Bay Transportation Authority (MBTA) Green Line train 3667, traveling about 38 mph, struck the rear of westbound Green Line train 3681, which had stopped for a red signal. The accident occurred in Newton, Massachusetts, a suburb of Boston. Each train consisted of two light rail trolley cars and carried two crewmembers—a train operator at the front of the lead car and a trail operator in the second car. The operator of the striking train was killed; the other three crewmembers sustained minor injuries. An estimated 185 to 200 passengers were on the two trains at the time of the collision. Of these, four sustained minor injuries, and one was seriously injured. Total damage was estimated to be about $8.6 million.
Recommendation: TO 46 US RAIL TRANSIT AGENCIES: Establish a program to identify operators who are at high risk for obstructive sleep apnea or other sleep disorders and require that such operators be appropriately evaluated and treated.
Original recommendation transmittal letter: PDF
Overall Status: Open - Acceptable Response
Mode: Railroad
Location: Newton, MA, United States
Is Reiterated: No
Is Hazmat: No
Is NPRM: No
Accident #: DCA08MR007
Accident Reports: Collision Between Two Massachusetts Bay Transportation Authority Green Line Trains
Report #: RAR-09-02
Accident Date: 5/28/2008
Issue Date: 7/23/2009
Date Closed:
Addressee(s) and Addressee Status: Bay Area Rapid Transit District (Open - Acceptable Response)
Capital Metropolitan Transportation Authority (Closed - Acceptable Action)
Central Arkansas Transit Authority (Closed - Acceptable Action)
Central Puget Sound Regional Transit Authority (Closed - Unacceptable Action - No Response Received)
Charlotte Area Transit System (Closed - Acceptable Action)
Chattanooga Area Regional Transportation Authority (Closed - Acceptable Action)
Chicago Transit Authority (Closed - Acceptable Action)
Commonwealth of Pennsylvania, County of Allegheny, Port Authority (Closed - Acceptable Action)
Commonwealth of Pennsylvania, County of Cambria, Transit Authority (Closed - Acceptable Action)
Dallas Area Rapid Transit Authority (DART) (Closed - Acceptable Action)
Detroit People Mover (Closed - Unacceptable Action - No Response Received)
Fort Worth Transportation Authority (Closed - Acceptable Action)
Galveston Island Transit (Closed--No Longer Applicable)
Greater Cleveland Regional Transit Authority (Closed - Acceptable Action)
Hampton Roads Transit (Closed - Acceptable Action)
Jacksonville Transportation Authority (Open - Unacceptable Response)
Kenosha Transit (Closed - Reconsidered)
Massachusetts Bay Transportation Authority (Closed - Acceptable Action)
Memphis Area Transit Authority (Closed - Acceptable Action)
Metropolitan Atlanta Rapid Transit Authority (Closed - Unacceptable Action)
Metropolitan Transportation Authority New York City Transit (Closed - Acceptable Action)
Miami-Dade Transit Agency (Closed - Acceptable Action)
Nashville Metropolitan Transit Authority (Closed - Reconsidered)
New Jersey Transit Corporation (Closed - Acceptable Action)
New Orleans Regional Transit Authority (Closed - Acceptable Action)
Niagara Frontier Transit Authority (Closed - Acceptable Action)
Port Authority Transit Corporation (Closed - Unacceptable Action - No Response Received)
Portland Streetcar (Closed - Unacceptable Action - No Response Received)
Regional Public Transit Authority, Valley Metro Rail (Closed - Acceptable Action)
Regional Transportation District (Closed - Reconsidered)
Sacramento Regional Transit District (Closed - Acceptable Action)
San Diego Metropolitan Transit System (Closed - Reconsidered)
San Francisco Municipal Transportation Agency (Closed - Acceptable Action)
Santa Clara Valley Transportation Authority (Closed - Acceptable Action)
Seattle Monorail Services (Closed - Unacceptable Action - No Response Received)
Southeastern Pennsylvania Transportation Authority (Closed - Acceptable Action)
State of California, County of Los Angeles, Metropolitan Transportation Authority (Closed - Acceptable Action)
State of California, County of North, North County Transit District, Sprinter (Closed - Acceptable Action)
State of Maryland, Transit Administration (Closed - Acceptable Action)
State of Minnesota, Metro Transit (Closed - Acceptable Action)
State of Missouri, City of St. Louis, Metro Transit (Closed - Acceptable Action)
State of Texas, County of Harris, Metropolitan Transit Authority of Harris County (Closed - Acceptable Action)
State of Utah, Utah Transit Authority (Closed - Acceptable Action)
State of Washington, County of King, King County Metro Transit (Closed - Unacceptable Action - No Response Received)
Tri-County Metro Transit District of Oregon (Closed - Acceptable Action)
Washington Metropolitan Area Transit Authority (Closed - Acceptable Action)
Keyword(s): Fatigue

Safety Recommendation History
From: NTSB
To: State of Maryland, Transit Administration
Date: 3/6/2014
Response: We are pleased that you established the recommended sleep disorder program that includes guidelines for identifying, evaluating, and treating MTA light rail vehicle operators at risk for OSA. We note that your health care provider uses an employee’s results from a sleep evaluation worksheet together with those of the risk factor analysis discussed above to determine whether the employee is qualified for or disqualified from duty. A disqualified employee is required to obtain further medical evaluation and/or a sleep study and must provide your healthcare provider documentation of these evaluations. Because this policy satisfies Safety Recommendation R-09-11, the recommendation is classified CLOSED—ACCEPTABLE ACTION.

From: State of Maryland, Transit Administration
To: NTSB
Date: 1/7/2014
Response: -Robert L. Smith, MTA Administrator: MTA Response: MTA Response: MTA has identified classifications that require a Commercial Driver's License (CDL). As part of the pre-employment and continued employment process, the employee must be evaluated by our health care provider and be certified eligible to obtain medical certification. During the evaluation, the employee will answer questions regarding their health history and status regarding sleep disorders. The health care provider also conducts an evaluation utilizing a Sleep Evaluation Worksheet (attached for reference). Based the employee's results from the evaluation and risk factor analysis the employee is either qualified or disqualified. If the employee is disqualified, the employee is required to obtain the necessary medical evaluations. The employee must provide our health care provider appropriate records to document that the appropriate evaluation and/or study was completed and that the employee is in compliance with physician recommendations.

From: NTSB
To: State of Maryland, Transit Administration
Date: 11/22/2013
Response: We have never received a reply from the MTA regarding Safety Recommendation R 09 10 or -11; accordingly, both recommenations are currently classified OPEN—AWAIT RESPONSE.

From: NTSB
To: Regional Public Transit Authority, Valley Metro Rail
Date: 9/24/2014
Response: We are pleased that you established the recommended sleep disorder program, including guidelines for identifying, evaluating, and treating your light rail operators at risk for OSA. We understand that, as of May 1, 2014, your doctors administering the Department of Transportation (DOT) physicals must screen for OSA and, if it is suspected, further testing is required. Medical examiners question the operator about instances of daytime sleepiness, sleep-related distractions, and any previous sleep study or diagnosis of OSA. Medical examiners also record the operator’s body mass index, waist circumference, neck circumference, Mallampati score and Epsworth Sleepiness score. We note that 32 of your employees (22 operators and 10 supervisors) will have their DOT physicals recertified by the end of 2014, and the others will complete their DOT physicals according to their recertification schedules. These practices satisfy Safety Recommendations R-09-10 and -11, which are classified CLOSED—ACCEPTABLE ACTION.

From: Regional Public Transit Authority, Valley Metro Rail
To: NTSB
Date: 7/23/2014
Response: -From Ray Abraham, Chief Operations Officer: As of May 1, 2014 doctors administering DOT physicals are required to screen for sleep apnea, and if it is suspected further testing is required. • The most recent exam indicated additional medical examiner comments asked of the operator concerning day-time sleepiness, sleep related distractions and diagnosis of OSA or surveillance for symptoms of sleep disorder. There was additional information taken concerning BMI, waist circumference, neck circumference, Mallampati score and Epsworth Sleepiness score. This exam was done at Banner Health Clinic which is contracted by this rail transit contractor. • Currently, 22 Operators and 10 Supervisors are due to have their DOTs recertified by the end of the year with physical examinations performed on the remaining operators as their recertification become due.

From: NTSB
To: Regional Public Transit Authority, Valley Metro Rail
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our January 12, 2012, request for an update. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Regional Public Transit Authority, Valley Metro Rail
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that Valley Metro Rail has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Chicago Transit Authority
Date: 8/19/2010
Response: Although the self evaluation you mention in your letter does not satisfy the recommendation, Ms. Kovalan provided clarification regarding CTA policy that accomplishes the NTSB's intent. We note that the CTA requires an operator whose physical examination suggests or identifies a diagnosis of GSA or another sleep disorder to have the doctor complete a questionnaire evaluating him or her for such a condition. If the employee is found to have one of these disorders, the doctor must also determine treatment and whether the treatment is sufficient to enable the operator to safely operate a commercial vehicle. Drivers are prohibited from returning to work as operators until multiple sleep latency tests or repeat polysomnograms demonstrate successful treatment. As this policy meets the intent of Safety Recommendation R-09-11, the recommendation is classified CLOSED – ACCEPTABLE ACTION.

From: Chicago Transit Authority
To: NTSB
Date: 10/23/2009
Response: Letter Mail Controlled 11/3/2009 3:49:04 PM MC# 2090669 - From Richard L. Rodriguez, President, Chicago Transit Authority: A general bulletin was developed and distributed to rail and bus operators. The bulletin includes a fact sheet in a Q & A format and is accompanied by the Epworth Sleepiness Scale (ESS) test, which is commonly used to quantify excessive daytime sleepiness. The test allows employees to score themselves and use their score to determine if further medical evaluation is needed. The bulletin also reminds employees of the Website and phone number of the CTA's employee assistance provider, Guidance Resources. Instructions on how to log into the Website are given so employees can access additional information on sleeping disorders. The Website contains articles on subjects such as sleep apnea, narcolepsy and restless legs syndrome as well as articles on healthy sleep habits. It is our belief that these actions, in conjunction with existing CTA procedures, address NTSB recommendations R-09-10 and R-09-11. Please contact Amy S. Kovalan, Chief Safety and Security Officer at 3 12-681-2830 if additional information is required.

From: NTSB
To: Commonwealth of Pennsylvania, County of Allegheny, Port Authority
Date: 10/30/2014
Response: We are pleased that your contracted CDL-certified medical examiners use the Commercial Drivers/Safety Sensitive Fitness Determination form and Sleep Evaluation Worksheet when examining safety-sensitive applicants (including all bus and light rail vehicle operators) that require a CDL physical examination for preemployment, rehire, reinstatement or for any other reason. We are aware that the form includes direct questions, completed by the patient, relating to sleep disorders and that the responses are reviewed by the medical examiner and followed up with a physical examination and discussion of the patient’s health history. We note that the medical examiner reviews the patient’s body mass index and other factors in completing the evaluation. The examiner typically refers an employee reporting or suspected of a potential sleep disorder to his or her personal physician for a sleep study and recommended treatment, and all employees returning to work after the prescribed treatment are evaluated by the contracted examiner to determine fitness for work. No such employee is returned to work until being cleared by a certified medical examiner. Finally, we note that these requirements have been incorporated into a comprehensive fitness-for-duty policy that you planned to finalize and issue to all safety-sensitive employees effective October 1, 2014. These combined actions satisfy Safety Recommendations R-09-10 and -11, which are classified CLOSED—ACCEPTABLE ACTION.

From: Commonwealth of Pennsylvania, County of Allegheny, Port Authority
To: NTSB
Date: 8/22/2014
Response: -From Michael J. Zamiska, Director, System Safety, Port Authority of Allegheny County: As discussed this morning, Port Authority is in receipt of your August 14, 2014 letter received August 20, 2014 by Port Authority CEO Ellen McLean. We apologize for the miscommunications, but recent organizational changes and e-mail configurations placed your last e-mail in the CEO’s spam/blocked folder. This has been corrected and it is Port Authority’s intention to respond and update our position regarding sleep apnea and fatigue. We are targeting early September for our response and will address to the Acting Chairman, Christopher Hart.

From: NTSB
To: Commonwealth of Pennsylvania, County of Allegheny, Port Authority
Date: 8/18/2014
Response: Because we had received no information from you regarding any actions that PAAC had taken to address Safety Recommendation R-09-10 or -11, our November 1, 2013, letter and our recent e-mail also requested information about your actions to address these recommendations. As stated above, we have received no response; therefore, we conclude that you have neither taken nor planned any actions to address Safety Recommendation R 09 10 or 11. Consequently, they are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Commonwealth of Pennsylvania, County of Allegheny, Port Authority
Date: 11/1/2013
Response: To date, we have received no information regarding any actions that PAAC has taken to address Safety Recommendations R-09-10 and -11. Normally, we expect action to address NTSB safety recommendations to be completed within 5 years. Because these recommendations are now 4 years old and we do not know of any actions taken to satisfy them, and because Safety Recommendation R-01-27 is nearly 12 years old and we have not heard from PAAC in over 8 years about completion of action to address it, we would appreciate receiving a reply within 90 days of the receipt of this letter regarding any actions that PAAC has taken or planned to address these important safety issues. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public the highest level of safety and to identify creative solutions that can be shared with others. Pending our receipt of a reply to this request, Safety Recommendations R-09-10 and -11 remain classified OPEN—AWAIT RESPONSE.

From: Commonwealth of Pennsylvania, County of Allegheny, Port Authority
To: NTSB
Date: 9/3/2013
Response: -From Ellen M. McLean, Chief Executive Officer: Port Authority's Medical Examination Report for Commercial Drivers/Safety Sensitive Fitness Determination form and Sleep Evaluation Worksheet are utilized by Port Authority's contracted COL Certified Medical Examiners for safety sensitive applicants that require a COL for pre-employment, re-hire, reinstatement or upon request exams. This includes all Port Authority bus and light rail vehicle operator positions. Section 2 of the Commercial Driver Fitness form has direct questions relating to sleep disorders, which is completed by the individual, reviewed by the Medical Examiner and followed up with a physical examination and discussion of the individual's health history. The Medical Examiner also reviews the individual's BMI and other comments provided to complete their evaluation or require further assessment. Individuals who report or are otherwise suspected of potential sleep disorders are typically referred to their personal physician for sleep study and recommended treatment. All employees returning to work after the prescribed treatment are evaluated by the Authority's Certified Medical Examiners to determine return to work status, and these employees cannot be returned to work until being cleared to do so by a Certified Medical Examiner. The above requirements have been incorporated into a comprehensive Fitness for Duty Policy that Port Authority, after meeting and conferring with its labor union that represents its bus and light rail vehicle operators over the past year, is in the process of finalizing and issuing to all safety sensitive employees effective October 1, 2014. Last, please note that I did not receive NTSB's prior letter dated November 1, 2013 that previously sought a response and update from Port Authority concerning the above referenced recommendations and which I understand may have been sent to an incorrect e-mail address. I also did not realize that Mr. Marcus from the NTSB had sent me a follow-up e-mail concerning the November 1 letter in June of this year; unfortunately, it appears that e-mail was quarantined by Port Authority's spam filter and it was not located until Port Authority received your August 18, 2014 letter and began searching its records for the prior correspondence NTSB had indicated was sent in same. I do apologize for any miscommunication and prior lack of a response from Port Authority. I assure you that Port Authority's number one organizational goal is to maintain and continuously improve on the safety of its transportation system for the well-being of its employees and the public that we serve. We thus take any and all NTSB Safety Recommendations very seriously and strive to adopt practices and procedures that address same.

From: NTSB
To: San Diego Metropolitan Transit System
Date: 9/13/2012
Response: The NTSB notes that the San Diego Metropolitan Transit System (MTS) uses the California Department of Motor Vehicles Medical Examination Report for Commercial Driver Fitness Determination (DL 51), which is based on the Department of Transportation Medical Examination Report For Commercial Driver Fitness Determination (649-F), in examining MTS operators. We note that DL 51 includes questions in its “Health History” section regarding a history of sleep disorders, pauses in breathing while asleep, daytime sleepiness, and loud snoring. We further note that MTS physicians are trained in questioning and identifying operators who are at high risk for obstructive sleep apnea and other sleep disorders. In cases where sleep disorders are identified, MTS physicians take a variety of measures, including revoking the operator’s credentials during a period of further evaluation or permanently, if necessary. MTS physicians also have the ability to require more frequent medical evaluations for operators who have medical conditions, including sleep disorders, that may change over time and pose a safety risk. These procedures satisfy Safety Recommendations R-09-10 and R-09-11. Because the procedures were already in place before these recommendations were issued, the recommendations are classified CLOSED—RECONSIDERED. Thank you for your commitment to transit safety.

From: San Diego Metropolitan Transit System
To: NTSB
Date: 1/27/2012
Response: -From Paul C. Jablonski, Chief Executive Officer: In addition to our above-referenced procedure which allows our physicians to identify and treat Operators with sleep disorders, we train our supervision and Operators in the warning signs and dangers of fatigue and sleep apnea. All Bus and Train Operators report to a supervisor who has been trained in the dangers of fatigue, including fatigue caused by sleep apnea, at the beginning of every shift. The supervisor conducts a visual fit for duty evaluation of the employee by checking for signs of fatigue and other fitness criteria, such as potential Drug and Alcohol Policy violations. Supervisors prevent employees who exhibit signs of being unfit for duty from entering service and confer with our Human Resources Department regarding scheduling a fit-for-duty physical exam with one of the Agency's physicians. The Agency's supervisors also evaluate all Operators at regular intervals. For example, Train Operators are evaluated at least quarterly using the attached Supervisors Evaluation of Train Operators form. The evaluation contains six criteria that are designed to judge a Train Operator's alertness. These regular evaluations serve a number of operational purposes, one of which is identifying potential safety hazards such as Operators who are inattentive for any reason. Both our Bus and Train Operators receive training in the dangers of fatigue and potential causes, such as sleep disorders like sleep apnea. Operator training is an area where we are improving our training as a result of your recent letter. Our Training Departments for Bus and Train Operators are autonomous; however, the departments work together on topics where the Agency can benefit from their combined expertise. In evaluating our training on fatigue and sleep apnea, we have decided to combine the best elements of each curriculum and produce one set of training materials on the topic. Newly hired Bus and Train Operators receive the training on preventing and identifying fatigue regardless of the cause before entering service. Our Bus Operators are required to participate in eight hour Verification of Transit Training ("VTT") classes annually. Portions of the training material are highlighted more heavily in some years, but fatigue related problems such as sleep apnea are always included. In 2009 and 2010, significant focus was given to sleep apnea (-one hour) and the topic will be highlighted in this year's VTT training. Newly hired Train Operators receive training in the dangers of fatigue and potential causes. Our Train Operators also receive training on the same material during their biannual recertification. Prospectively, our Train Operator training program will incorporate in depth material from our VTT training that specifically addresses sleep apnea. If you have any questions after reviewing the attached information, please feel free to contact me.

From: NTSB
To: San Diego Metropolitan Transit System
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the San Diego Metropolitan Transit System has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Nashville Metropolitan Transit Authority
Date: 6/26/2014
Response: Although we have not received any information from you about your response to these recommendations in the 5 years since they were issued, we recently determined that you operate only bus transit vehicles. Because these recommendations were not issued to bus operators, Safety Recommendations R-09-10 and -11 are classified CLOSED—RECONSIDERED. The safety problems we discovered during our investigation of the May 28, 2008, accident in Newton, Massachusetts, associated with vehicle operators who have OSA or other sleep disorders likely affect bus operators as well as rail transit vehicle operators. If you do not currently have programs to identify and obtain treatment for your bus operators at risk for OSA or other sleep disorders, we believe that you could achieve safety benefits from implementing such a program.

From: NTSB
To: Nashville Metropolitan Transit Authority
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Nashville Metropolitan Transit Authority has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Regional Transportation District
Date: 7/21/2010
Response: The NTSB is pleased that the RTD uses the commercial driver’s license (CDL) medical qualification program to identify and evaluate operators every 2 years who may be at risk for OSA and other sleep disorders and requires that operators receive treatment to maintain their medical certification and CDL. Because the RTD’s program predates the issuance of Safety Recommendation R-09-11, the recommendation is classified CLOSED -- RECONSIDERED.

From: Regional Transportation District
To: NTSB
Date: 10/13/2009
Response: Letter Mail Controlled 10/16/2009 12:21:44 PM MC# 2090640 - From David A. Genova, Assistant General Manager, Safety, Security, and Facilities: RTD requires light rail and bus operators to maintain a current Commercial Driver's License. As part of the license requirement, operators are required to physically qualify under 49 CFR 391.41 by passing a medical examination performed by a certified medical examiner every two years. This physical examination process queries operators about their medical history including any sleep disorders, pause in breathing while asleep, daytime sleepiness or loud snoring. Additionally, the medical examiner evaluates other physical fitness characteristics and sleep disorder risk factors such as weight, blood pressure, and diabetes. This established medical qualification program provides a means for qualified medical examiners to evaluate operators every two years for risk factors associated with sleep disorders. The program also requires operators to qualify physically to maintain their medical certification and commercial driver's license. In addition to the medical qualification program, RTD utilizes operator supervision to assist in the evaluation of fitness for duty, Light rail operators currently check-in for work and sign for their daily train orders at the light rail division and are observed by a supervisor during their check-in process. RTD also utilizes operator ride checks conducted by field supervisors to evaluate the performance of operators. RTD will continue to use the commercial driver's license medical qualification program for a qualified medical examiner to identify and evaluate operators who may be at risk for sleep disorders, and require that operators receive treatment as required by the medical examiner to maintain their medical certification and commercial driver's license

From: NTSB
To: Commonwealth of Pennsylvania, County of Cambria, Transit Authority
Date: 3/29/2011
Response: On July 7, 2010, NTSB staff contacted Mr. Parks for further clarification about CamTran’s program to identify, evaluate, and treat operators at high risk for OSA. Mr. Parks indicated that the eight employees (three operators, three conductors, and two maintenance employees) involved in the operation of the Johnstown Inclined Plane must all undergo a physical examination that complies with the requirements of the U.S. Department of Transportation (DOT) for commercial motor vehicle drivers, the results of which are recorded on the Federal Motor Carrier Safety Administration’s (FMCSA) Medical Examination Report for Commercial Driver Fitness Determination form. To identify employees at risk for OSA or other sleep disorders, the medical examiner performing the examination discusses sleep disorders with the employee, measures the employee’s body mass index and neck circumference, and has the employee fill out an Epworth Sleepiness Scale to determine the employee’s level of daytime sleepiness. Mr. Parks also indicated that any employee identified as having OSA or another sleep disorder is required to see his or her primary physician for a followup examination and is prohibited from returning to work until an evaluation and treatment plan is approved by CamTran’s physician, who then requires periodic (either annual or biennial) physical examinations. On February 2, 2011, Dr. Mitch Garber, NTSB’s Medical Director, spoke with Mr. James A. Mendillo, MMS, PA-C, Director of Occupational Health Services for WorkPlace Health, the independent clinic that provides occupational health services, including DOT exams, to CamTran’s full-time employees. The NTSB has determined that WorkPlace Health uses an effective protocol for screening and evaluating operators at risk for OSA and other sleep disorders; accordingly, Safety Recommendation R-09-11 is classified CLOSED – ACCEPTABLE ACTION.

From: Commonwealth of Pennsylvania, County of Cambria, Transit Authority
To: NTSB
Date: 6/1/2010
Response: MC# 2100208 - From James E. Parks, Director of Safety and Risk Management: Pursuant to your letter dated April 27, 2010, I first want to thank you for the response regarding our fitness for duty physicals. It is our goal to achieve a safe and reliable transportation service along with providing a standard form of physical examinations for all Cambria County Transit Authority (CamTran) safety-sensitive employees. Pursuant to R-09-11 recommendation, we are identifying sleep apnea with the DOT physical examination. Our physician who is performing the examination will discuss sleep disorders with the employee and determine if there is a problem. Furthermore, all employees will complete an Epworth Sleepiness Scale, BMI and neck circumference are measured. In addition, a follow-up is done on a yearly or bi-annual basis. Presently, this is not a major problem at CamTran, but periodically an employee will identified himself/herself with some sort of sleep apnea. The employee is referred to their family physician for follow-up and then the employee will return to our physician for a final review. Further information regarding sleep apnea is provided upon request from the employee. Again, I appreciate NTSB's response and I will provide further updates on R-09-11. CamTran takes a strong commitment to ensure a safe and reliable transportation service for our community.

From: NTSB
To: Commonwealth of Pennsylvania, County of Cambria, Transit Authority
Date: 4/27/2010
Response: Although CamTran’s use of the FMCSA’s Medical Examination Report for Commercial Driver Fitness Determination form for its operator and conductor candidates is acceptable for identifying and initially evaluating operators who are at risk for OSA, CamTran conducts no annual followup physical examinations and has established no program to recognize operators who have, over time, developed an increased risk for OSA or other sleep disorders. The intent of the recommendation was for CamTran to develop written procedures to identify operators who are at high risk for OSA and to properly assess those operators and ensure they receive proper treatment. Pending CamTran’s development of such procedures and the NTSB’s review of them, Safety Recommendation R-09-11 is classified OPEN -- ACCEPTABLE RESPONSE.

From: Commonwealth of Pennsylvania, County of Cambria, Transit Authority
To: NTSB
Date: 8/11/2009
Response: Letter Mail Controlled 9/14/2009 4:52:31 PM MC# 2090519: - From James Parks, Director, Safety, Security, and Risk Management: Pursuant to the Safety Recommendation dated July 23, 2009, I have read and followed up on your recommendations. First of all, the Cambria County Transit Authority owns and operates an Inclined Plane and is the only rail service we operate. However, each Incline operator and conductor receive a DOT physical examine. The actual DOT form has a question on the form asking about sleep disorder. Should there be any checks to this question, they are referred to their family physician. Presently, there are no other follow-ups after completion of their physical. I have posted safety posters from time to time regarding sleep disorders. There are only three operators that operate the Incline Plane. Also, we do have a fitness for duty physical that is conducted should we discover an operator experiencing physical or emotional difficulties. I hope this is beneficial to your recommendations as described in your report.

From: NTSB
To: State of Minnesota, Metro Transit
Date: 9/14/2011
Response: On July 8, 2011, NTSB staff contacted Ms. Connie B. DeVolder, Human Resources Manager, Occupational Health, who described in detail Metro Transit’s program for identifying, evaluating, and treating operators who are at high risk for obstructive sleep apnea or other sleep disorders. Metro Transit’s current employees are required to obtain, at a minimum, biannual physical examination recertification, which includes a review for sleep apnea and other sleep disorders as discussed above. The NTSB is pleased that, depending upon the examination results, the contracted physician will deny a Medical Examiner’s Certificate or will issue one for a limited (3-month, 1-year, or 2-year) period, depending on the treatment plan. Metro Transit’s program satisfies this recommendation; accordingly, Safety Recommendation R-09-11 is classified CLOSED—ACCEPTABLE ACTION.

From: State of Minnesota, Metro Transit
To: NTSB
Date: 6/10/2011
Response: CC# 201100229: - From Michael Conlon, Director of Rail and Bus Safety: Attached, please find two documents: 1. DOT physical form 2. Sample Metro Transit sleep apnea questionnaire The first has a question that goes to sleep disorders on the right hand side of section 2 – Health History. The second is a questionnaire that was developed by our Occupational Health Nurse in response to the NTSB recommendations referenced herein. Our operators undergo sleep disorder evaluations at any of three levels: a preemployment physical, a DOT physical, or a fitness-for-duty physical. Further, we attempt, as far as possible, to evaluate operators for fitness-for-duty when they report. This is accomplished consistently on rail, but bus mode has some operators who relieve, and who are relieved, on the street. Finally, be advised that fatigue (regardless of type) is considered in all of our incident investigations. We send operators for fitness-for-duty physicals when we recognize the possibility that fatigue may be playing a role in an operator’s performance. We may learn about the hazard from customer comments, incident investigations, and self reporting. We have considered our response to recommendations R-09-10 and R-09-11 closed for some time. It is possible that our progress was not communicated properly back to NTSB. Please do not hesitate to call, should you have questions or comments.

From: NTSB
To: Tri-County Metro Transit District of Oregon
Date: 6/14/2011
Response: The NTSB notes that TriMet has included in its operator training program a fatigue awareness module that addresses various sleep disorders and has added to its DOT packets a letter addressed to all examining physicians detailing the importance of examining for sleep disorders. TriMet’s contracted physicians require all employees compelled to undergo a CDL medical examination to have their height, weight, body mass index (BMI), and neck circumference measured as part of the examination. Any employee whose duties include the movement of a train and who has a BMI of 35 or greater or a neck circumference of 17.5 inches or greater must undergo further evaluation. In addition, employees who choose to be examined by physicians other than those contracted by TriMet are instructed to give TriMet’s Sleep Apnea Education Sheet to their examining physician. Operators identified as having OSA are interviewed (at the time of their CDL recertification) for their compliance with prescribed treatment, and they complete an Epworth Sleepiness Scale test. TriMet estimates that approximately 80 percent of the operators have their CDL physicals performed by the contracted physicians. The exact percentage of operators who have undergone a sleep evaluation and been identified as having OSA is unknown, but TriMet physicians estimate that almost 95 percent of those sent for evaluation have OSA, and perhaps 70 percent of these have moderate to severe OSA. Employees in this latter group are required to use a continuous positive airway pressure machine whenever they are sleeping to maintain their CDL certification, and TriMet has recently begun tracking these individuals. The actions of TriMet, as detailed above, satisfy Safety Recommendation R-09-11, which is classified CLOSED – ACCEPTABLE ACTION.

From: Tri-County Metro Transit District of Oregon
To: NTSB
Date: 11/2/2009
Response: MC# 2090673- From Shelly Lomax, Director, Operations Support: TriMet requires light rail and bus operators to maintain a Commercial Drivers License. In order to hold a CDL Operators are required to undergo and pass a physical examination conducted by a trained physician every two years (more frequently if directed by physician) and obtain a DOT medical card. The medical examination includes a review of medical history including sleep disorders. Additionally the physician looks at the characteristics that are typically risk factors for sleep disorders and other health issues. TriMet will add a letter to our current DOT packets addressed to all examining physicians detailing the importance of examining for and treating sleep disorders. The vast majority of our DOT examinations are performed by our company contracted physician who has a full understanding of the importance of screening for and treating sleep disorders. Lastly, as part of our operator training program, TriMet has a fatigue awareness module that covers a variety of sleep disorders including; Apnea, Narcolepsy and Insomnia.

From: NTSB
To: Niagara Frontier Transit Authority
Date: 9/24/2014
Response: We are pleased to learn that all of your rail operators must meet prescribed physical requirements and must pass a New York Department of Motor Vehicles (DMV) examination using state DMV 19-A Pre-employment and Recertification physical assessment that includes an evaluation for OSA. We note that every operator is reassessed every 2 years, that operators diagnosed with OSA are reassessed annually, and that the assessment includes questions regarding fatigue. During your orientation for new employees, operators are given information regarding the dangers of fatigue, distraction, and the use of prescription and over the counter medications before and during equipment operation. We are also pleased that operators who are identified through a sleep study as having OSA are further evaluated by your health care provider, who determines whether the operator is complying with treatment. The procedures you describe satisfy Safety Recommendations R 09-10 and -11, which are classified CLOSED—ACCEPTABLE ACTION.

From: Niagara Frontier Transit Authority
To: NTSB
Date: 7/1/2014
Response: I am writing in response to your January 5, 2012, letter to Ms. Kimberly Minkel, Executive Director of the Niagara Frontier Transportation Authority (NFTA). I am the Medical Director for the NFT A and have been asked to report to you on the Medical Department's efforts to comply with the NTSB Safety Recommendations R-09-10 and R-09-11. R-09-10: Since I started acting as Medical Director in October of 2003, the NFTA has used the New York State Department of Motor Vehicles (DMV) "Medical Examination Report of Driver Under Article 19A" form DS-874 for all medical examinations on our drivers. While this form has been revised several times over the years, it has always included a "yes" or "no" question on "sleep problems" (see attachment A). Because the question on the DS-874 did not ask specifically about sleep apnea the NFTA began using a second questionnaire for the medical re-certifications asking specifically about "insomnia and use of sleeping pills," "sleep apnea," "narcolepsy" and "daytime sleepiness - difficulty staying awake" in April of 2006 (see attachment B). In January of 2009, The New York State DMV expanded the sleep question on the DS-874 to: "sleep disorders, pauses in breathing while asleep, daytime sleepiness, and. loud snoring" (see attachment C). There was no specific question about sleep apnea. In August of 2010 the DMV again revised the question on sleep to include "obstructive ·sleep apnea" (see attachment D). Each driver fills out both the DS-874 and the NFTA Medical questionnaire before employment and at the time of each medical re-'certification. Medical re-certification occurs · at least once every two years or on a yearly basis if there are any medical conditions that require more frequent follow-up (sleep apnea being one of those conditions). As Medical Director, I question each driver on any "yes" responses on the questionnaires to be sure there are no safety concerns as a result of a medical condition. 3 In August of 2009 Driver B was referred to the Medical Department because a passenger complained that he had dozed off behind the wheel of the bus at a stoplight. Driver B, also morbidly obese, denied falling asleep, denied excessive daytime sleepiness and scored a 3 on the Epworth Sleepiness Scale. Review of random bus videos over several days revealed no evidence of Driver B falling asleep while driving. No further action was taken. In September of 2010 Driver B rear-ended another vehicle after both vehicles had stopped at a traffic light. Bus video showed Driver B nodding off as his bus slowly moved forward to contact the rear bumper of the vehicle ahead of him. We sent driver B for a sleep medicine evaluation and he was diagnosed with severe obstructive sleep apnea. The experience with Driver B indicated that requesting voluntary information about sleep apnea symptoms was not effective in identifying drivers at risk for sleep apnea. This prompted review of screening criteria for sleep apnea and discussion with NFT A Management and the Amalgamated Transit Union Local 132. The NFTA Medical Department consulted with two sleep specialists in the community. Significant barriers to investigation of suspected sleep apnea had to be worked out between Management and the Union. Per a prior agreement, drivers removed from service because of suspected sleep apnea are to be paid their regular wages until a sleep study can be performed. In January of 2011 Driver C called dispatch reporting that his bus slid on black ice and hit the curb on the right side of the road. Review of bus video showed Driver C nodding off while driving at 30 miles per hour and neither steering nor braking the bus as it drifted left across the oncoming traffic lane, up the sidewalk on the opposite side of the street, went back across the lane for oncoming traffic and came to rest against the curb on the passenger side of the bus. No one was injured and only minor damage resulted from this accident. Driver C was sent for sleep studies and diagnosed with severe obstructive sleep apnea. Driver C was morbidly obese. Based upon these incidents of loss of control of the bus because of sleep apnea, the NFTA Medical Department and NFTA Management decided that a program was necessary to identify drivers at significant risk for sleep apnea and send them for evaluation by a sleep medicine specialist. Based upon our experience, all drivers involved in sleep apnea accidents were morbidly obese. A study by Lopez et al1 published in the September 2008 American Surgeon reported that the prevalence of sleep apnea in morbidly obese patients (BMI 40 to 40.9) presenting for bariatric surgery was 74 per cent while the prevalence in super-obese patients (BMI 50 to 60) is 77 per cent. Based upon this report and our past experience, the NFT A Medical Department began referring all drivers with a BMI of 40 or greater or other significant risk factors for sleep apnea (large neck size, loud snoring, witnessed apnea, small lower jaw, redundant posterior pharyngeal tissue, poorly controlled hypertension despite medication, Mallampati Class IV pharynx or complaints of excessive daytime somnolence) for evaluation by a sleep specialist.

From: NTSB
To: Niagara Frontier Transit Authority
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our January 5, 2012, request for an update. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Niagara Frontier Transit Authority
Date: 1/5/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Niagara Frontier Transportation Authority has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf.

From: NTSB
To: Charlotte Area Transit System
Date: 9/25/2012
Response: We note that CATS-contracted physicians are responsible for addressing sleep disorders and/or related risk factors. An operator identified as having risk factors has his or her certification placed on a medical hold and is removed from work pending a followup appointment with his or her personal physician to arrange for a sleep study. If the sleep study determines that the operator has a sleep disorder, the employee is treated with a continuous positive airway pressure machine and must follow up with the CATS physician to determine fitness for recertification and return to work. Any employee identified as having a sleep disorder is monitored for adherence to the prescribed treatment. These practices satisfy Safety Recommendation R-09-11, which is classified CLOSED—ACCEPTABLE ACTION.

From: Charlotte Area Transit System
To: NTSB
Date: 4/20/2012
Response: -From Bryan Leaird, GM Safety and Security: This letter is Charlotte Area Transit System’s (CATS) response to the National Transportation Safety Board’s (NTSB) safety recommendations R-09-10 and R-09-11. The recommendations were issued as a result of the NTSB’s investigation of the Mary 28, 2008 collision of two Massachusetts Bay Transportation Authority Green Line trains in Newton, Massachusetts. The recommendations requested two actions: 1. Review medical history and physical examination forms and modify them as necessary to ensure that they elicit specific information about any previous diagnosis of obstructive sleep apnea or other sleep disorders and bout the presence of specific risk factors for such disorders. 2. Establish a program to identify operators who are at high risk for obstructive sleep apnea or other sleep disorders and require that such operators be appropriately evaluated and treated. CATS –Bus Operations Division (BOD) - operators are required to possess a DOT medical card. Operators must renew the medical card every two years. The physician is responsible for addressing sleep disorders and/or related risk factors. Employees identified as having risk factors have their DOT medical certification placed on a “medical hold.” The operator is placed out of work pending a follow up with their personal physician to arrange for a sleep study. If the sleep study determines a sleep disorder, the employee is placed on a continuous positive airway pressure (CPAP) machine. The employee must follow up with a CATS physician to determine if the employee meets the criteria for return to work and issuance of the DOT medical card. CATS – Light Rail Operations – operators receive DOT cards annually. DOT and pre-employment physicals are performed by Presbyterian Urgent Care. Employees are evaluated for sleep disorders as part of the physical. Any employee identified as having a sleep disorder is monitored for adherence to the prescribed treatment. Included with this response are copies of the “BOD -Medical Examination Report”, “LRV Physical Forms”, which specifically list sleep disorders, and the “Sleep Evaluation Worksheet” used by the CATS BOD physician.

From: NTSB
To: Charlotte Area Transit System
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Charlotte Area Transit System has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: State of California, County of North, North County Transit District, Sprinter
Date: 8/18/2014
Response: We understand that Veolia Transportation has established a program to identify operators at high risk for OSA or other sleep disorders and requires that such operators be evaluated and treated. We note that all employees of Veolia and its subcontractor, Bombardier, have completed the Federal Transit Administration course “Fatigue and Sleep Apnea Awareness Training for Transit Employees,” which is also required at new employee orientation. Accordingly, Safety Recommendation R-09-11 is classified CLOSED—ACCEPTABLE ACTION.

From: NTSB
To: State of California, County of North, North County Transit District, Sprinter
Date: 6/25/2014
Response: On June 13, 2014, because we had received no reply from you regarding these recommendations in the 5 years since they were issued—despite our January 5, 2012, request for an update—Safety Recommendations R-09-10 and -11 were classified “Closed?Unacceptable Action/No Response Received.” We understand that you are reviewing your records of correspondence regarding these recommendations and will provide us further information by June 30, 2014. In the interim, Safety Recommendations R-09-10 and -11 remain classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: State of California, County of North, North County Transit District, Sprinter
To: NTSB
Date: 6/19/2014
Response: -From Matthew O. Tucker, Executive Director: This letter is in response to the following NTSB recommendations R-09-10 and R-09-11 for SPRINTER light rail operations. I have attached a copy of a letter and supporting documents received from our contractor for SPRINTER operations, Veolia Transportation, which are responsive and compliant with the recommendations of the NTSB. -From John H. Lee, General Manager-Sprinter: As previously stated, Veolia uses the Department of Motor Vehicles "Medical Examination Report for Commercial Drivers Fitness Determination" for screening our Train Operators for diagnosis of sleep apnea or other sleep disorders for pre-employment and in annual physicals. Veolia's procedures for identifying current employees for sleep disorders include: • Constantly monitoring our employees on their appearance, behavior and performance using our "Fitness for Duty" observations and we enter our findings in Veolia's Efficiency Tests system. These observations are made both in the office and in the field throughout the employee's shift. • Regularly tracking attendance, absenteeism and any instances of reporting late to work. • Training our employees in Sprinter Code of Operational Rules both prior to operating and in annual rules training. • Veolia Sprinter employees along with its sub-contractor Bombardier have successfully completed the Federal Transit Administration's Fatigue and Sleep Apnea Awareness training for Transit Employees. This course is now a requirement for all new employee training and orientation.

From: State of California, County of North, North County Transit District, Sprinter
To: NTSB
Date: 6/16/2014
Response: -From Matthew O. Tucker, Executive Director: The letter stated that North County Transit District had not provided a formal response to NTSB’s recommendations. I want to assure you that NCTD understands the importance of recommendations issued by the NTSB. It has been our practice to immediately respond to all NTSB requests for information. To that end, I have immediately requested that our staff review our records related to this NTSB request and we will commit to provide a formal close-out of this request by not later than June 30, 2014 in the event that we are not able to provide a copy of prior transmitted information related to the requests.

From: NTSB
To: State of California, County of North, North County Transit District, Sprinter
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our January 5, 2012, request for an update. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: State of California, County of North, North County Transit District, Sprinter
Date: 1/5/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Sprinter (North County Transit District) has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: State of Utah, Utah Transit Authority
Date: 9/5/2012
Response: We note that the UTA administers the U.S. Department of Transportation (DOT) physical exam to all its train operators every 2 years. The information specified is gathered through questionnaires and examinations of the operators’ physical characteristics. If an operator is prescribed treatment for obstructive sleep apnea or another sleep disorder and is under active treatment, the operator’s DOT medical certificate must be revalidated every 30 days. Once the condition has been stabilized, the operator is monitored via a yearly DOT exam. These practices satisfy Safety Recommendations R-09-10 and -11, which are classified CLOSED—ACCEPTABLE ACTION.

From: State of Utah, Utah Transit Authority
To: NTSB
Date: 7/6/2011
Response: CC# 201100259: - From Martin Cocker, Utah Transit Authority FrontRunner Rail Safety Administrator: This recommendation is part of the required DOT exam. When an operator is evaluated and is at high risk for a sleep disorder, then appropriate treatment is administered to them to retain their operator medical certificate.

From: NTSB
To: Fort Worth Transportation Authority
Date: 8/2/2012
Response: The NTSB notes that, when the medical evaluation of an FWTA operator identifies symptoms that could indicate the employee may have a sleep disorder, he or she is required to provide the onset date, a physician’s positive diagnosis, the treating physician’s name and address, and any current limitations related to the disorder. The NTSB notes that, upon interviewing and physically examining the employee, the Concentra Medical Center physician determines the severity of the sleep disorder. If the employee is diagnosed with OSA, the physician determines whether the employee can safely be certified for a 3-month period (pending further treatment and reevaluation at the end of that period), a 1-year period (if the employee is complying with treatment that is proving to be effective), or cannot be certified (the OSA is too severe, is not responding to treatment, or the employee is not complying with treatment). These practices satisfy Safety Recommendation R-10-11, which is classified CLOSED—ACCEPTABLE ACTION. Thank you for your commitment to transportation safety.

From: Fort Worth Transportation Authority
To: NTSB
Date: 1/24/2012
Response: -From Kelli Shields, PHR, Human Resources Leave Specialist: The Medical Examiner upon interviewing and physically examining the employee determines the severity of the particular sleep disorder. If the employee is diagnosed with OSA and is using a CPAP machine, the Medical Examiner reviews the CPAP reading. If the CPAP reading determines that the employee is being treated effectively and complying with treatment, the Medical Examiner will issue a DOT card for one year. Depending on the physical exam, interview and CPAP reading, the Medical Examiner may issue a 3 month DOT card so they can review the CPAP reading after that 90 days. If the Medical Examiner determines that the Sleep Apnea is severe or the employee is not complying with treatment, no DOT card will be issued. Attached is an example of the Medical Examination Report for Commercial Driver Fitness Determination that was completed for an employee diagnosed with OSA and a copy of the original letter for reference.

From: NTSB
To: Fort Worth Transportation Authority
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Fort Worth Transportation Authority has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Capital Metropolitan Transportation Authority
Date: 5/26/2016
Response: We are aware that, since at least 2012, you have used the Department of Transportation physical examination forms for employees and that these forms include a questionnaire to elicit information regarding previous diagnoses of OSA or other sleep disorders and information regarding risk factors for these disorders. We are pleased to learn that, on December 17, 2015, you instituted a fatigue management program that includes not only screening for OSA and other sleep disorders, but also the Federal Transit Administration E Learning course on fatigue and OSA awareness, and a treatment program that a medical examiner administers. We note that the medical examiner determines an employee’s condition and treatment before clearing the employee for service. These practices satisfy Safety Recommendation R-09-11, which is classified CLOSED—ACCEPTABLE ACTION.

From: Capital Metropolitan Transportation Authority
To: NTSB
Date: 2/19/2016
Response: -From Melvin Clark, Vice President, Rail, Capital Metro: Capital Metro contracts with Herzog Transit Services, Inc. (HTSI) to operate and maintain its commuter operation. On December 17, 2015, HTSI placed in service a Fatigue Management Program which complies with NTSB Safety Recommendation R-09-11. The program includes the Federal Transit Administration sponsored E-Learning course "Fatigue and Sleep Apnea Awareness for Transit Employees". HTSI Transportation Management personnel have been trained to identify engineers who are at a high risk for obstructive sleep apnea or other sleep disorders. In accordance with the training, a transportation manager who identifies an engineer that is at a high risk for obstructive sleep apnea or a sleep disorder, must remove the engineer from service and refer them to the HTSI medical examiner. The HTSI medical examiner determines the engineer's condition and treatment before they are cleared for service.

From: NTSB
To: Capital Metropolitan Transportation Authority
Date: 10/27/2015
Response: Completing actions to address our safety recommendations usually takes recipients 3 to 5 years, and this recommendation is now more than 6 years old. Of the 46 addressees, you are 1 of only 6 for which R-09-11 remains open. To date, we have received no information regarding your actions or plans for addressing Safety Recommendation R-09-11 since CAPMETRO’s September 23, 2011, letter. In our September 4, 2012, response to that letter, we noted that your contractor was working toward the implementation of a fatigue management program. However, we did not know whether the fatigue management program included a means for identifying operators at high risk for sleep disorders or a requirement that such operators be evaluated and treated, as appropriate. We urged CAPMETRO to include these components in your fatigue management program and provided information on the programs developed by other transit authorities. Pending the establishment of a program to identify operators at high risk for sleep disorders and to ensure that they are evaluated and receive effective treatment before they are allowed to operate trains, Safety Recommendation R-09-11 was classified OPEN—ACCEPTABLE RESPONSE on September 4, 2012. As 3 years have elapsed since then, we would appreciate receiving an update on your actions to satisfy this recommendation. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public the highest level of safety and to identify creative solutions that can be shared with others. Although Safety Recommendation R 09 11 will retain its current classification pending your timely reply, unless we hear from you promptly, we may have to classify the recommendation in an unacceptable status. Copies of our July 23, 2009, letter issuing the recommendation; your September 23, 2011, response; and our September 4, 2012, reply are enclosed. The full investigation report of the May 28, 2008, Massachusetts Bay Transportation Authority train accident in Newton, Massachusetts, is available at http://www.ntsb.gov/investigations/AccidentReports/Pages/RAR0902.aspx.

From: NTSB
To: Capital Metropolitan Transportation Authority
Date: 9/5/2012
Response: The NTSB is encouraged that HTSI is working toward the implementation of a fatigue management program. However, the information we have received does not indicate that the fatigue management program will include a means for identifying operators who are at high risk for sleep disorders nor a requirement that such operators be evaluated and treated, as appropriate. We urge you to include these components in your fatigue management program. For this purpose, you may find it helpful to know some aspects of these programs developed by other transit authorities. Many other programs include the following practices: • Physicians are trained in questioning and identifying operators who are at high risk for obstructive sleep apnea and other sleep disorders. • If a sleep disorder is identified, the physician may refer the patient for a sleep study. The patient does not operate trains until a sleep disorder is ruled out or treatment has begun. • If necessary, appropriate treatment is prescribed, and the patient is monitored for compliance. • The patient’s credentials are approved for limited periods (such as 3 months, 6 months, or 1 year) during treatment evaluation and may be revoked permanently if the disorder cannot be managed or the patient does not comply with treatment. • Physicians require more frequent medical evaluations for operators who have medical conditions, including sleep disorders, that can change over time and pose a safety risk. Pending the establishment of a program to identify operators who are at high risk for sleep disorders and to ensure they are evaluated and receive effective treatment before operating trains, Safety Recommendation R-09-11 is classified OPEN—ACCEPTABLE RESPONSE.

From: Capital Metropolitan Transportation Authority
To: NTSB
Date: 9/23/2011
Response: From Melvin Clark, Vice President, Rail Operations: Capital Metropolitan Transportation Authority began commuter rail operations on March 22,2010. Capital Metro contracts with Herzog Transit Services, Inc. (HTSI) to operate and maintain its commuter operation. All HTSI Locomotive Engineers are required to pass a Department of Transportation physical. Please note that Section 2 of the Medical Examination Report questionnaire for this physical (attached) includes questions that elicit specific information about any previous diagnosis of sleep apnea or other sleep disorders and the presence of risk factors for such disorders. HTSI strongly believes in monitoring and implementing fatigue management programs. Upcoming changes to the FRA Passenger Hours of Service Regulation will require railroads to utilize a computer program to monitor and address fatigue management through analyzing crew runs. HTSI is prepared to implement all appropriate programs dealing with fatigue management.

From: NTSB
To: Central Arkansas Transit Authority
Date: 9/13/2012
Response: We note that, on behalf of CATA, the Baptist Medical Center Occupational Health Group uses the U.S. Department of Transportation (DOT) form to administer physical exams to all CATA’s bus and rail operators prior to their beginning employment, every 2 years thereafter, and more frequently if they are identified as having a medical condition that dictates such action. The DOT form includes the recommended questions intended to identify operators at high risk for sleep disorders. Accordingly, Safety Recommendation R-09-10 is classified “Closed—Acceptable Action.” We note that operators are referred to their personal physicians for treatment and monitoring of identified sleep disorders before they are certified for bus or train operation. This practice, in combination with the more frequent physical examinations for such operators, satisfies Safety Recommendation R-09-11, which is classified CLOSED—ACCEPTABLE ACTION. Thank you for your cooperation.

From: Central Arkansas Transit Authority
To: NTSB
Date: 1/10/2012
Response: -From Betty Wineland, Executive Director: In reference to your recent letter concerning sleep disorders among transit vehicle operators, the Central Arkansas Transit Authority (CATA) follows these procedures: All applicants for bus and rail operator positions, and all maintenance applicants who will drive transit vehicles in the course of their employment, are required to pass a pre-employment physical, the U. S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination. Once employed, each individual is required to pass the exam every two (2) years or more often if there are indications that a problem may exist. This examination addresses sleep disorders. The exams are administered by the Baptist Medical Center Occupational Health Group. If there is evidence of a disorder that may place the employee at risk, including sleep disorders, the employee is referred to his or her family physician for further examination. Until the Occupational Health Group receives verification from the family physician that the examination has occurred and treatment prescribed, if indicated, the employee cannot receive certification. In addition, CATA provides informational materials on health care, including high-risk conditions such as high blood pressure and sleep disorders through health and workers compensation insurance providers.

From: NTSB
To: Central Arkansas Transit Authority
Date: 1/5/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Central Arkansas Transit Authority has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Sacramento Regional Transit District
Date: 7/12/2012
Response: On January 17, 2012, the NTSB contacted Mr. Rufus Francis, Director of Safety, who provided further clarification regarding the SRT OSA program. When the SRT physician finds indications of a potential sleep disorder (primarily OSA) in an employee, the physician refers the employee to his or her personal medical provider for further assessment, which usually includes a sleep study. The NTSB notes that the SRT uses the Berlin questionnaire, a voluntary survey to determine whether candidates for employment or employees may be at risk for OSA, in addition to the medical examination. If an employee or a candidate for employment is identified to be at risk for OSA, the individual is referred to his or her personal physician with the findings and, if OSA is diagnosed, the employee must begin treatment and provide confirmation of compliance and effectiveness after a period of time, usually 1 month. The medical examiner will determine whether the employee can be given a 3-month medical card or must be restricted from operating a train until the evaluation is completed. These provisions, and the others described in your letter in response to this recommendation, satisfy Safety Recommendation R-09-11; accordingly, the recommendation is classified CLOSED—ACCEPTABLE ACTION.

From: Sacramento Regional Transit District
To: NTSB
Date: 6/23/2011
Response: CC# 201100258: - From Michael R. Wiley, General Manager/ CEO: A voluntary survey (Berlin questionnaire) was made available to employees to assist individuals in determining whether or not s/he may be at risk for EDS/Sleep Apnea. The survey was presented in two formats; a written self-test, and an on-line computer screening tool. Following completion of the chosen screening method, the employee receives feedback as to their risk of having a sleep disorder. Those individuals scoring in the moderate to high risk range are informed and encouraged to consult with their personal physician.

From: NTSB
To: Galveston Island Transit
Date: 5/13/2014
Response: We are aware that the Galveston Island Trolley has not operated since Hurricane Ike damaged the system on September 13, 2008. We recently checked to see whether the repairs were nearing completion and when operations were scheduled to resume, and learned that operations would not likely resume any time soon. Although you previously stated that you would incorporate our safety recommendations into your policies and procedures when operations resumed, because more than 5 years have passed since operations were suspended and the resumption of operations is not imminent, Safety Recommendations R-09-10 and -11 are classified CLOSED—NO LONGER APPLICABLE. If you are able to resume operations in the future, please implement the recommendations at that time.

From: NTSB
To: Galveston Island Transit
Date: 8/2/2012
Response: Your e-mail indicated that the Galveston Island Trolley has not operated since Hurricane Ike damaged the system on September 13, 2008, but that, once the trolley resumes operations, Galveston Island Transit will incorporate our safety recommendations into its policies and procedures for approval by the state of Texas. During a June 26, 2012, telephone discussion with NTSB staff, you stated that the Galveston Island Trolley is tentatively scheduled to be returned to service in late 2013. Thank you for your cooperation. Pending implementation of Safety Recommendation R-09-10 and -11 upon the trolley’s resuming operations, these recommendations are classified OPEN—ACCEPTABLE RESPONSE.

From: Galveston Island Transit
To: NTSB
Date: 1/18/2012
Response: -From Michael Worthy, Galveston Island Transit: Currently Galveston Island Trolley is not operable. It has not operated since Hurricane Ike September 13, 2008. However, we do plan to restore the system and have been informed by TXDOT and FTA that we must submit New System Safety and Security Plans prior to re-start. With that being said we will incorporate all NTSB Safety Recommendations into policy and procedures for State approval.

From: NTSB
To: Galveston Island Transit
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that Galveston Island Transit has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Detroit People Mover
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our January 5, 2012, request for an update. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Detroit People Mover
Date: 1/5/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Detroit People Mover has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: San Francisco Municipal Transportation Agency
Date: 3/24/2014
Response: We understand that, in 2009, you worked with the San Francisco Department of Public Health to establish strict guidelines, awareness programs, and testing protocols for employees who may be at risk for OSA. We note that you reviewed the medical records of all employees and that employees whose body mass index was over 30 were required to undergo further evaluation for OSA. In addition, during their required biannual Department of Transportation medical examination, all operators are evaluated for OSA, and those who have symptoms of OSA are referred for sleep studies and medical treatment. Employees who are found to have OSA are denied DOT medical certificates and are removed from driving status until their condition can be successfully treated. Your policies and procedures regarding OSA and other sleep disorders fully satisfy Safety Recommendations R-09-10 and -11, which are classified CLOSED—ACCEPTABLE ACTION.

From: San Francisco Municipal Transportation Agency
To: NTSB
Date: 1/22/2014
Response: -From Edward D. Reiskin, Director of Transportation: The following information responds to your letter dated December 18, 2013 regarding National Transportation Safety Board Safety Recommendations R-01-26, R-01-27, R-09-10, and R-09-11. Our organization, the San Francisco Municipal Transportation Agency (SFMTA), is very attentive to any recommendation issued by the NTSB, and does its best to respond to and implement such recommendations. In the case of these four, we have made considerable efforts, which I describe in this letter, to place programs into effect in response; however, after researching all the available internal records, we are unable to locate copies of any responses we may have sent your organization. When the first of these recommendations appeared in 2001, R-01-26, the San Francisco Municipal Railway (Muni) had already included the need for safety-sensitive employees to report both prescription and non-prescription drug use to their immediate supervisors. We first established such a program with the adoption of our first “Substance Abuse Program” in 1994. We have continued to refine and strengthen that policy with detailed entries in our operator rule book and specific forms and procedures applicable to employees’ use of all medications. In 2002, R-01-27, Muni developed its first Hours of Service policy and training program. In that training program, we covered sleeping disorders and their symptoms. That policy and corresponding training program has been revised and improved. Fatigue awareness, including sleep disorder awareness, is part of our new operator and annual refresher training programs. In 2009, in response to NTSB recommendations R-09-10 and R-09-11, Muni, working with the San Francisco Department of Public Health, established strict guidelines, awareness programs, and testing protocols for employees who may be at risk for sleep apnea. The medical records of all employees were reviewed and those employees who Body Mass Index was over 30 were required to undergo evaluation for sleep apnea. That sleep apnea program still remains in effect at this agency. Moreover, all operators who report for their biannual Department of Transportation (DOT) Medical Examination are mandatorily evaluated for sleep apnea. Those who have symptoms of sleep apnea are referred for sleep studies and medical treatment. Under the program, those employees who are found to have sleep apnea are denied DOT Medical Certificates and removed from driving status until their condition can be successfully treated. Attached are copies of various documents that demonstrate SFMTA’s implementation of these NTSB Safety Recommendations. If you have questions concerning our programs, please feel free to contact me.

From: NTSB
To: San Francisco Municipal Transportation Agency
Date: 12/18/2013
Response: In the more than 4 years since we issued these recommendations to Muni, we have received no information regarding action to address them. Currently, Safety Recommendations R-09-10 and -11 are classified “Open—Await Response.” We are interested in knowing whether and how our recommendations are implemented, both to ensure that the traveling public is provided the highest level of safety and to identify creative solutions that might be shared with others. Normally, we expect action to address our safety recommendations to be completed within 5 years. Given the ages of these four recommendations, we would appreciate receiving a response from you within 90 days indicating actions you have taken or plan to take to implement them, preferably electronically at the following e-mail address: correspondence@ntsb.gov. If a response, including attachments, exceeds 10 megabytes, please e-mail us at the same address for instructions. To avoid confusion, please do not submit both an electronic copy and a hard copy of the same response. Safety Recommendations R-01-26 and -27, and R-09-10 and -11 will retain their current classification pending our timely receipt of your reply. For your convenience, a copy of our letter issuing Safety Recommendations R-01-26 and -27 is available at http://www.ntsb.gov/doclib/recletters/2001/R01_26_27.pdf. The full report of the 2001 Baltimore accident is available at http://www.ntsb.gov/doclib/safetystudies/SIR0102.pdf. A copy of our July 23, 2009, letter issuing Safety Recommendations R-09-10 and -11 is available at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the 2009 Newton, Massachusetts, accident is available at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. Thank you for your assistance in this matter.

From: NTSB
To: Metropolitan Transportation Authority New York City Transit
Date: 4/6/2011
Response: In a letter to the NTSB on January 26, 2010, the NYCT reported it uses supplemental occupational health and safety questionnaires regarding snoring, tiredness during daytime, observed OSA, and high blood pressure to determine the medical condition of train operators during their biennial physical examinations. The NTSB noted that these questionnaires address any prior history of OSA or other sleep disorders, as well as risk factors for those disorders. NYCT train operators identified at high risk for OSA are required to have an evaluation by a sleep specialist and, if diagnosed, (1) provide the results of that sleep study to the NYCT and (2) be treated for the disorder and supply evidence of satisfactory treatment. Thank you for the additional information you provided in your recent letter. The NTSB notes that NYCT employees are required to provide periodic documentation of continued treatment compliance at least every 3 to 6 months and any employee who fails to do so is restricted from train/vehicle operation. The NYCT has identified 64 active train operators who have been diagnosed with OAS or other sleep disorders since implementation of the new program. The NYCT’s actions fully satisfy Safety Recommendation R-09-11, which is classified CLOSED – ACCEPTABLE ACTION. Thank you for your commitment to rail transit safety.

From: Metropolitan Transportation Authority New York City Transit
To: NTSB
Date: 11/4/2010
Response: CC# 201100025: - From Thomas F. Prendergast, President: This is in response to your letter dated September 28, 2010. Please let me assure you that New York City Transit (NYCT) is first and foremost concerned with the safety of our employees and customers. We provide service 24 hours per day and ridership on our system is approximately seven million daily - more than 2 billion annually. Past is not prologue but it should be noted that we have never had an accident where sleep apnea was deemed to have been a contributing factor. This is due in part to our aggressive Occupational Health Services Unit and its diligence in detecting sleep disorders before they become a safety issue. Currently we are working on updating our medical standards and job profiles to strengthen our efforts in this regard. We have recently developed and implemented a program to identify Bus and Train Operators who may be at risk for sleep disorders such as sleep apnea. The program is summarized below: • All Bus and Train Operators must submit to periodic medical examinations every two years. During these exams they are asked specific questions regarding their possible history of sleep disorders/symptoms. These questions are routinely asked both electronically during the intake process (see R-09-10) and by our physician staff. • If there is an affirmative response, then in order to continue in service, those operators must provide our medical department with sleep specialist evaluations and sleep study test results. Those who have been identified with a sleep disorder must then bring in evidence of satisfactory treatment, such as successful CPAP titration. • These employees are then required to provide documentation of continued treatment compliance at least every three to six months. This is much more frequent than the annual rechecks recommended by the FMCSA Medical Review Board in 2008. Anyone who fails to prove satisfactory compliance is restricted from train/vehicle operation. NYCT has identified 64 active Train Operators who have been diagnosed with obstructive sleep apnea or other sleep disorders. This is almost double the number of Train Operators documented with these diagnoses prior to the implementation of the new program.

From: NTSB
To: Metropolitan Transportation Authority New York City Transit
Date: 9/28/2010
Response: The NTSB notes (l) that NYCT train operators identified at high risk for OSA are required to have an evaluation by a sleep specialist and, if diagnosed, to be treated for the disorder but (2) that concerns about employee availability and budgetary constraints have limited the ability of the NYCT to phase in additional assessment. Although the NYCT has established a program for identifying OSA, it appears to have fallen short on the implementation of that plan. We appreciate the budgetary and operational challenges inherent in an effective screening and treatment program but ask that you also consider the cost and disruption associated with transit accidents. Regarding steps that the NYCT has taken, the NTSB is interested in knowing how many train operators have been identified thus far with OSA or other sleep disorders that require evaluation and treatment, and what timeline has been established for providing this medical care. Accordingly, pending a response including this information and implementation of the recommended program, Safety Recommendation R-09-11 is classified OPEN – ACCEPTABLE RESPONSE.

From: Metropolitan Transportation Authority New York City Transit
To: NTSB
Date: 5/20/2010
Response: MC# 2100206 - From Thomas F. Prendergast, President: Since the January26, 20I0 update letter, the financial constraints on New York City Transit (NYCT) have become much more severe, leading to layoffs and service cuts. Those employees giving affirmative answers to the additional sleep disorder related questions are being required to be evaluated by a sleep specialist. However, budgetary problems have made implementation of a more extensive screening program based on risk from elevated BMI levels much more challenging. Any extension of screening which could impact on employee availability will need to be phased in slowly after collaboration with the operating departments and the unions.

From: NTSB
To: Metropolitan Transportation Authority New York City Transit
Date: 4/28/2010
Response: The NTSB understands that establishing a program to identify operators who are at high risk for OSA is challenging, given the percentage of bus and train operators with a body mass index (BMI) of 33 or higher, the need to identify specialists and sleep testing centers available to operators, the need for union cooperation, and the availability of financial resources. However, because 33.7 percent of NYCT operators have a BMI index greater than 33, implementing a screening program for OSA is critical. We are pleased that NYCT has taken the first step of identifying at-risk operators and encourage you to proceed with the development of the recommended program and requirement. Pending our review of NYCT’s program, Safety Recommendation R-09-11 is classified OPEN -- ACCEPTABLE RESPONSE.

From: Metropolitan Transportation Authority New York City Transit
To: NTSB
Date: 1/26/2010
Response: Letter Mail Controlled 2/3/2010 2:07:59 PM MC# 2100041: - From Thomas F. Prendergast, President: NYCT's program for identifying, evaluating, and treating Train and Bus Opcrators with obstructive sleep apnea and other sleep disorders includes a physical examination, and the completion and physician review of the above notcd questionnaire. Those employees that are identified as being high risk are then required to have an evaluation by a sleep specialist. The employees are then evaluated, diagnosed and treatment is prescribed, if appropriate, by a specialist. Operators are required to return to irle NYCI physicians with thr, iesults of the evaluation. If treatment is appropriate employees are required to report hack to the NYCT physicians periodically to ensure cornpliance with the treatment process.

From: NTSB
To: Metropolitan Atlanta Rapid Transit Authority
Date: 8/19/2014
Response: On October 23, 2009, we received a letter from Mr. Timothy K. White, CSP, MARTA’s Acting Executive Director of Safety, describing actions you were taking in response to these recommendations. On July 21, 2010, we replied that, if the final medical history and physical examination forms you were using elicited information about the presence of specific risk factors (for example, high blood pressure, body mass index, neck circumference) and any previous diagnosis of sleep disorders, they would satisfy Safety Recommendation R-09-10. Accordingly, we classified that recommendation “Open—Acceptable Response” pending our review of MARTA’s completed evaluation forms. We classified Safety Recommendation R-09-11 “Open—Acceptable Response” pending finalization and approval of the planned identification and treatment programs for MARTA operators at high risk for OSA. We asked that you supply a detailed description of your programs for our review. In the 4 years since, we have received no further information from you, despite our December 20, 2011, letter requesting an update. Accordingly, we conclude that you have not finished the actions described in Mr. White’s October 23, 2009, letter. Consequently, Safety Recommendations R 09 10 and 11 are classified CLOSED—UNACCEPTABLE ACTION.

From: NTSB
To: Metropolitan Atlanta Rapid Transit Authority
Date: 12/20/2011
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Metropolitan Atlanta Rapid Transit Authority has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf.

From: NTSB
To: Metropolitan Atlanta Rapid Transit Authority
Date: 7/21/2010
Response: The NTSB is satisfied that the actions MARTA has completed and planned are responsive to this recommendation. Pending finalization and approval of the planned identification and treatment programs for MARTA operators at high risk for OSA, Safety Recommendation R-09-11 is classified OPEN—ACCEPTABLE RESPONSE. The NTSB would appreciate receiving a copy of MARTA’s programs for review with your reply.

From: Metropolitan Atlanta Rapid Transit Authority
To: NTSB
Date: 10/23/2009
Response: CC# 2090659: - From Timothy K. White, CSP, Acting Executive Director of Safety: We have had several meetings with the current medical services provider to discuss the recommendations and develop the necessary procedures to address the issue of sleep disorders, including obstructive sleep apnea. As a result of such meetings as well as internal discussions, a number of actions have been identified and are poised for implementation. Such actions include: R-09-10 1. Sleep Apnea Assessment Form is in final draft format and includes evaluation based on 6 criteria. R-09-11 2. Sleep Apnea Assessment to be incorporated into pre-employment physical exam. 3. Sleep Apnea Assessment to be incorporated into Operators' (Rail, Bus and Mobility) bi-annual exams and off-year medical briefing exam. 4. Program after assessment/screening has been identified 5. Budgetary/funding considerations completed 6. Identification of wellness programs to support diagnosis of or propensity to obstructive sleep apnea. Such programs to be incorporated into MARTA'S regular wellness programs. As of this date, we are finalizing these recommendations and will circulate them through the established approval protocols. Some of these actions have the potential to impact employees and represent a significant change to policy. In addition, recognizing that the workforce who will be subject to such screening is unionized, it will be necessary to discuss such with the union leadership prior to implementation. I will provide you with an update on the status of MARTA'S response to your recommendations within 90 days (by January 23, 2010). Please contact me if you require any additional information in the interim.

From: NTSB
To: Central Puget Sound Regional Transit Authority
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our January 12, 2012, request for an update. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Central Puget Sound Regional Transit Authority
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that Sound Transit has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Bay Area Rapid Transit District
Date: 8/22/2017
Response: We note that you are working with the California Public Utilities Commission (CPUC), BART’s state safety oversight agency, to incorporate the medical fitness-for-duty requirements that currently apply to light rail transit operators into your heavy rail system. These medical fitness requirements are contained in CPUC General Order (GO) 143B, “Safety Rules and Regulations Governing Light-Rail Transit.” We further note that you are developing procedures to comply with various sections of GO 143B, with a focus on the physical fitness qualifications currently required for California Department of Motor Vehicle class B commercial driver licensees. You have also formed an interdisciplinary team that will use the American Public Transportation Association’s (APTA’s) “Rail Standard: Fitness for Duty Program (FFD) Requirements” (RT OP S 018 12) to develop rules and policies to address medical fitness-for-duty issues. You have written that, after the GO 143B requirements and the APTA guidance are incorporated into your safety program, employees in safety-sensitive positions will be subject to regular physical fitness for duty examinations that will screen for, among other things, symptoms of sleep apnea and other sleep disorders, and will include procedures for addressing these medical issues. Pending completion of the CPUC’s rulemaking, which will apply the requirements of GO 143B to your heavy rail operations (including subjecting all employees in safety-sensitive positions to regular physical fitness-for-duty examinations and ensuring continuing treatment for those employees with sleep disorders), Safety Recommendation R-09-11 remains classified OPEN--ACCEPTABLE RESPONSE.

From: Bay Area Rapid Transit District
To: NTSB
Date: 8/5/2016
Response: -From Grace Crunican, General Manager: The San Francisco Bay Area Rapid Transit District (BART) submits this response to the NTSB request for an update regarding BART's actions to satisfy NTSB Recommendation R-09-11, dated September 16,2015. BART is working with the California Public Utilities Commission (CPUC), BART's state safety oversight agency, to comply with CPUC's safety audit recommendation to incorporate medical fitness for duty requirements that currently apply to light rail transit operators (See CPUC General Order (G0)143B: Safety Rules and Regulations Governing Light-Rail Transit). Because BART is a heavy rail system, revisions may need to be made through a CPUC rulemaking process in order to ensure the medical fitness requirements that were intended only for light rail transit operators apply to heavy rail operators as well. BART and CPUC agree that medical fitness for duty relative to train operator recertification is important towards maintaining a safe operating environment for both passengers and employees. In that regard, BART is in the process of developing procedures to comply with various sections of GO 143B, with a focus on the physical fitness qualifications currently required for California Department of Motor Vehicle Class B Commercial Driver Licensees. Specifically, BART has formed an interdisciplinary team which includes staff from the District's Transportation, Labor Relations, Human Resources, Legal, and System Safety departments to address the issue of medical fitness for duty. The interdisciplinary team will rely on the American Public Transportation Association's (APTA) "Rail Standard: Fitness for Duty Program (FFD) Requirements" (RT-OP-S-018-12) to guide and develop such rules and policies. This group will provide guidance to the District on the issue while BART and CPUC collaborate on the pending GO 143B rulemaking process. Once the GO 143B requirements and APTA guidance regarding 'Fitness for Duty' are incorporated into BART's safety program, BART contemplates that certain safety sensitive employees, including train operators will be subject to regular physical fitness-for-duty examinations which will screen for, among other things, symptoms of sleep apnea disorders. The safety program will also include procedures for addressing medical issues as well as suspension or revocation of train operator certifications.

From: NTSB
To: Bay Area Rapid Transit District
Date: 9/16/2015
Response: Completing actions to address our safety recommendations usually takes recipients 3 to 5 years, and this recommendation is now more than 6 years old. Of the 46 addressees, you are 1 of only 6 for which R-09-11 remains open. To date, we have received no information regarding your actions or plans for addressing Safety Recommendation R-09-11 since BART’s July 25, 2011, letter. In our September 4, 2012, response to that letter, we noted (1) that your program included operator self-evaluation and self-referral to appropriate resources for corrective action, (2) that transportation fore-workers were trained on the signs, symptoms, and risks posed by sleep disorders as part of their recertification, and (3) that you had supplied your fore-workers with intervention techniques to engage an employee suspected by them as having a problem. We also asked for the following information: • Whether your train operators are required to complete physical examinations after hiring • If so, how often such examinations are administered • What steps you take to ensure that operators who are diagnosed with a sleep disorder are being treated and that such treatment has proven effective • Whether operators who are just beginning treatment, are not compliant with treatment, or for whom treatment has not proven effective are given certificates of limited duration or have their operating certificates revoked, if necessary Because these are all aspects of the programs of other transit agencies, we were concerned that self-evaluation, self-referral, and intervention by your transportation fore-workers, who are not licensed physicians, may not be sufficient to ensure that operators who have a sleep disorder are adequately treated. Pending receipt of additional information regarding these issues, Safety Recommendation R-09-11 was classified OPEN—ACCEPTABLE RESPONSE on September 4, 2012. As 3 years have elapsed since then, we would appreciate receiving an update on your actions to satisfy this recommendation. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public the highest level of safety and to identify creative solutions that can be shared with others. Although Safety Recommendation R 09 11 will retain its current classification pending your timely reply, unless we hear from you promptly, we may have to classify the recommendation in an unacceptable status.

From: NTSB
To: Bay Area Rapid Transit District
Date: 9/4/2012
Response: We note that BART has reviewed the forms it uses in the hiring process and has confirmed that, since mid-2008, all candidates for positions as train operators are given a physical examination by a licensed physician who uses the Medical Examination Report for Commercial Driver Fitness Determination, California Department of Motor Vehicles Form DL51. This form includes a comprehensive health history and specific questions about sleep disorders, along with other questions about risk factors for sleep disorders such as weight, blood pressure, and diabetes. Because these practices, which satisfy Safety Recommendation R-09-10, were in place before the recommendation was issued, it is classified “Closed—Reconsidered.” We also note that BART incorporated a module on sleep disorders into its mandatory train operator recertification program, which includes a review of sleep disorders and their causes, effects, identification, and treatment and was completed by all operators in 2009 or 2010. Each operator was provided with tools and the time to complete a self-assessment during the session. These tools included the Epworth Sleepiness scale, a method to measure neck circumference, and a body mass index chart. Operators were then given information about treatment for sleep apnea and information about how life style choices can impact sleep quality and the development of sleep disorders. Finally, information about specific resources for treatment was provided. BART’s program consists of operator self-evaluation and self-referral to appropriate resources for corrective action. Additionally, transportation fore-workers have been trained on the signs, symptoms, and risks posed by sleep disorder as part of their recertification. BART has supplied its fore-workers with intervention techniques to engage an employee suspected by them as having a problem. However, your letter did not state the following information: • Whether train operators are required to complete physical examinations after hiring • If so, how often such examinations are administered • What steps you take to ensure that operators who are diagnosed with a sleep disorder are being treated and that such treatment has proven effective • Whether operators who are just beginning treatment, are not compliant with treatment, or for whom treatment has not proven effective are given certificates of limited duration or have their operating certificates revoked, if necessary These are all aspects of the programs of other transit agencies. We are concerned that self-evaluation, self-referral, and intervention by transportation fore-workers, who are not licensed physicians, may not be sufficient to ensure that operators who have a sleep disorder are adequately treated. Accordingly, pending our receipt of additional information regarding these issues, Safety Recommendation R-09-11 is classified OPEN—ACCEPTABLE RESPONSE.

From: Bay Area Rapid Transit District
To: NTSB
Date: 7/25/2011
Response: CC# 201100297: From Sherwood G. Wakeman, Interim General Manager: BART has received the subject recommendations and offers the following response. Regarding Recommendation R-09-011, BART incorporated a module on sleep disorders into its mandatory train operator recertification program. The training program consisted of a review of sleep disorders, causes and effects, identification and treatment. Each operator was provided with tools and the time to complete a self assessment during the session. These tools included the Epworth Sleepiness scale, a method to measure neck circumference and a BMI chart. The operators were then provided with information about treatment for sleep apnea and information about how life style choices can impact sleep quality and the development of sleep disorders. Finally, information about specific resources for treatment was provided. Every BART train operator went through this class between 2009 and 2010. Additionally, Transportation Foreworkers have been trained on the signs, symptoms, and risks posed by sleep disorder as part of their recertification. They were provided with appropriate intervention techniques to engage an employee with a problem.

From: NTSB
To: New Orleans Regional Transit Authority
Date: 1/29/2013
Response: The NTSB notes that, if a streetcar operator is identified as being at high risk for OSA, Concentra uses a comprehensive sleep evaluation worksheet to determine whether the operator is fit for duty. The worksheet includes multiple questions related to sleep disorders, includes an Epworth Sleepiness Scale for the patient to complete, and includes sections for Mallampati Class, a body mass index calculation, neck circumference, age, compliance with treatment, and disposition. Mr. Breun explained that the RTA’s program identifies operators at high risk for OSA or other sleep disorders, through either the physical exam process or the summary of the evaluation results of the sleep worksheet, and then disqualifies them from duty, limits their certification, or recommends a sleep study for further information, depending upon the results. A sleep study includes an in-laboratory sleep test, post-study consultation, and positive airway pressure therapy initiation, if indicated. Concentra provides consultation and management, including a visit with a sleep specialist to evaluate and treat the streetcar operator. The program also includes followup to determine whether the operator has been appropriately evaluated and treated. This course of action satisfies Safety Recommendation R-09-11; accordingly, the recommendation is classified CLOSED—ACCEPTABLE ACTION.

From: New Orleans Regional Transit Authority
To: NTSB
Date: 1/18/2012
Response: -From Derrick Breun, COO: I have been provided with a letter from Deborah Hersman, concerning an outstanding issue related to sleep disorders. The letter states that in mid-2009, RTA should have been in receipt of documentation from the NTSB in relation to sleep disorders recommendations. I am unaware of said document, but am more than willing to provide a response at this time. Response: All operators are required to perform standard DOTD Medical Examinations no less than every two years, and may not operate a vehicle without having an up to date DOTD physical. The medical history section of the physical form allows for commenting on sleep disorders, pauses in breathing while asleep, daytime sleepiness, and loud snoring specifically. The agency implemented Fatigue Awareness for all operators, and all operators have received approximately 90 minutes of fatigue specific training. Station clerks, as well as all supervisors, operations management, and maintenance management, all of which oversee the operators each morning prior to pull out have received comparable training, determining for what to look. Please let me know if you require more information.

From: NTSB
To: New Orleans Regional Transit Authority
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the New Orleans Regional Transit Authority has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Southeastern Pennsylvania Transportation Authority
Date: 4/13/2016
Response: We note that your voluntary OSA program, discussed in SEPTA’s initial 2009 response, was never implemented. We are pleased, however, to learn that you now address fatigue and OSA issues through many other means that involve either your medical officer directly or traditional health benefits and wellness programs that your employees access. We are aware that your medical officer accesses the medical information of known at-risk employees (new hires as well as existing personnel) from various sources, including US Department of Transportation physical forms, to determine these employees’ fitness for duty. We are also aware that fatigue awareness initiatives have been incorporated into your wellness and employee assistance programs. Further, we note that you initiated a formal fatigue awareness training module that informed all your operating personnel of the signs and symptoms of fatigue and OSA in July 2014, which you expected was to be completed by all personnel by December 2015. Mr. Sauer informed my staff in his e-mail that, as of early March 2016, all but 267 of the 3,000 operating employees that are required to be trained had completed their training, and the remaining employees include recently hired employees and those who had missed their scheduled training because of absence. Mr. Sauer expected that all initial training for the remaining employees would be completed by April 1, 2016. He also stated that the training has been made part of an ongoing program. In addition, we note that your operational accident reports include an hours-of-service review of the previous 72 hours, to determine whether the involved employee(s) had sufficient time off duty to obtain adequate rest. These combined actions satisfy the intent of Safety Recommendation R-09-11, which is classified CLOSED--ACCEPTABLE ACTION.

From: Southeastern Pennsylvania Transportation Authority
To: NTSB
Date: 9/8/2015
Response: -From Joseph M. Casey, General Manager: In response to the referenced letter from NTSB, the Southeastern Pennsylvania Transportation Authority provides the following information on the status of activities to address the recommendation contained therein: R-09-11 Establish a program to identify operators who are at high risk for obstructive sleep apnea or other disorders and require that such operators be appropriately evaluated and treated. The voluntary Obstructive Sleep Apnea Pilot Program referenced in SEPTA's initial August 26, 2009 response to the subject recommendation was initiated in CY2010 via a 3rd Party contract with the University of Pennsylvania's Center for Sleep & Respiratory Neurobiology. The services provided by the 2-year Pilot Program included, but were not limited to: • Health education about sleep apnea- emphasizing occupational effects and issues • Sleep Apnea Screening- Berlin Questionnaire and BMI assessments • Diagnostic Sleep Study • Therapy Recommendations and Follow-up SEPTA's expectation was that if the outcome of the 2-year study proved beneficial and promising, the Authority would expand the program to cover a larger employee population. Disappointingly, voluntary participation was meager. The Program allotted 250 slots for SEPTA Operation employees to seek screening and, as needed, respective treatment modalities. Only fifty (50) employees availed themselves of Program and were screened -with approximately 50 % exhibiting some degree of sleep apnea. Based upon this very limited sample of Pilot Program participants, the salient common finding was that conventionally known risk factors for sleep apnea were confirmed. These risk factors included but were not limited to obesity, male gender, small airways, family history of sleep apnea, as well as known at-risk ethnic groups. The number of Program participants was insufficient and not statistically significant to offer any definitive empirical findings or conclusions that SEPTA could apply, or used to revise, its existing sleep disorder screening protocols. However, subjective feedback from the Program substantiated SEPTA's conviction that its present screening protocols - albeit derived from multiple decentralized diagnostic sources- are effective. Further, the Pilot Program feedback also warranted SEPTA's confidence in its current aggregate methods to vet both new hires and current employees for sleep disorders. As a result, the Berlin Questionnaire was fully adopted as SEPTA's formal screening protocol. Since the voluntary Obstructive Sleep Apnea Pilot Program was not embraced by employees, SEPTA neither sustained its participation beyond the initial two (2) year period, nor expanded the Program elements into an on-going screening and diagnostic tool for existing employees. However, OSA issues are nonetheless addressed through a myriad of independent activities either performed by SEPTA, or available to its employees through traditional health benefits and wellness programs. SEPTA reiterates its prior position that its total human resource initiatives, in aggregate, provide both reasonable corporate knowledge of the employee population's fitness for duty; and individual employee awareness of their own health and fitness. SEPTA Medical currently accesses personnel medical information sources in order to evaluate the medical fitness status of known at-risk SEPTA employees. These medical data sources include: • Sick Benefits • Employee reporting of medical restrictions imposed by personal physician • Directive Examinations • Return-to-Duty Medical Exams • Employee self-reporting of medications SEPTA currently monitors several source metrics to identify employees who would require fitness for duty monitoring and/or determinations. Specific categories of source protocols that monitor the fitness of SEPTA's work force- and the average number of affected employees- include: • New Hire Physicals 800 o All New Hires (and current employee Transfers from non-safety-sensitive positions to Safety Sensitive jobs) • Prescribers Reports 500 o Each employee is required to submit a prescriber's report listing medication they are taking. • Return to Work Evaluations 500 • Medical Directives 500 o Employees who are out on an extended leave, or have been denied FMLA are required to be seen by a doctor. • Sick Benefit Application 1,000 o Any Non-Railroad employee assigned to SEPTA's transit modes and represented by Local 234 requesting sick pay must complete a sick benefit application - that shall include a diagnosis by the employee's personal physician. They are reviewed, and if they have certain identified "red flag" conditions, they are given to SEPTA's Medical Director. If necessary, additional medical documentation is requested. If appropriate, they are then entered into the applicable monitoring program • FMLA Medical Certifications 2,000 o SEPTA's Third Party Administrator has been instructed to review all medical certifications to see if any employee has any of the "red flag" conditions. If so, SEPTA medical department is notified. • Weekly Sick Reports 50 o Reports are run for SAM, IBT and FOTP employees that have been out for at least 2 weeks. Those employees are sent FMLA paperwork which in turn will either disclose a medical issue, or they will be subject to the medical directive process. Specific medical conditions presently monitored by SEPTA- and the average annual number of affected employees- include: Blood Pressure 2,000 Employees are required to report to SEPTA Medical periodically- ranging between every 3 months to annually- depending on their readings. If they miss an appointment, their supervision is advised. If an employee misses 4 appointments, they are pulled from service. Diabetes 2,000 Employees are required to submit current A1C reports every 3-6 months depending on their readings. If their numbers remain under 9, they are seen annually. Above, they are seen more frequently. Sleep Apnea 180 Employees are required to submit documentation from their sleep specialist annually. Heart 50 Employees are required to submit documentation from their cardiologist annually. Bi-Polar Confidential Employees are required to submit documentation from their mental health professional annually. In the first six months of CY 2015, the number of employees monitored in the aforementioned programs is detailed in the following matrix: Blood Pressure 570 Diabetes 557 Heart 54 Sleep Apnea 55 Additionally, please note that SEPTA previously advised NTSB about Fatigue awareness initiatives incorporated into the Authority's Wellness and EAP Programs. The circa 2007 Fatigue Awareness Program previously forwarded to NTSB1 as evidence of the initiative was subsequently updated in 2014 and attached herewith in Attachment 1. Instead of relying solely on the Wellness Program to disseminate information about the effects of sleep disorders and fatigue, SEPTA initiated a proactive, formal Fatigue Awareness Training module that will be delivered to all operating personnel. Training commenced in July 2014, and target completion for all affected employees is December 2015. This training includes advising employees about the signs and symptoms of Obstructed Sleep Apnea (OSA). Additionally, operational accident reports now include an Hours-of-Service (HOS) review (previous 72 hours) to determine if the subject employee had sufficient time off-the-clock in order to obtain adequate rest. It is anticipated that this information should provide an acceptable response to the NTSB request for an update on SEPTA's remedial actions to address the recommendation. Therefore, SEPTA requests that NTSB consider recommendation R-09-11 as "Closed- Acceptable Action".

From: NTSB
To: Southeastern Pennsylvania Transportation Authority
Date: 8/18/2015
Response: We learned from SEPTA’s August 26, 2009, letter (1) that you were developing a voluntary Obstructive Sleep Apnea Pilot Program to screen operators and other safety-sensitive employees through clinical medical assessments for specific causes of OSA and (2) that you were soliciting proposals from professional groups for the purpose of beginning a 2-year OSA pilot program in 2010. Because these actions constituted acceptable first steps in implementing our recommendation, Safety Recommendation R-09-11 was classified OPEN--ACCEPTABLE RESPONSE on April 27, 2010, pending completion of the pilot program and implementation of the recommended actions. Completing actions to address our safety recommendations usually takes recipients 3 to 5 years, and this recommendation is now 6 years old. To date, we have received no further information about SEPTA’s plans or actions to satisfy Safety Recommendation R-09-11. Of the 46 recipients of this recommendation, SEPTA is one of only six for which the recommendation is still open. Accordingly, we would appreciate receiving a prompt update on the status of your plans and actions to satisfy this recommendation. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public the highest level of safety and to identify creative solutions that can be shared with others. Pending your timely reply, Safety Recommendation R-09-11 will retain its current classification.

From: NTSB
To: Southeastern Pennsylvania Transportation Authority
Date: 4/27/2010
Response: The NTSB is pleased that SEPTA is developing a voluntary Obstructive Sleep Apnea Pilot Program to screen operators and other safety-sensitive employees through clinical medical assessments for specific causes of OSA and that SEPTA is soliciting proposals from professional groups and intends to begin a 2-year OSA pilot program in 2010. These steps outlined by SEPTA constitute an acceptable response to the recommendation; accordingly, pending completion of the pilot program and implementation of the recommended actions, Safety Recommendation R-09-11 is classified OPEN -- ACCEPTABLE RESPONSE.

From: Southeastern Pennsylvania Transportation Authority
To: NTSB
Date: 8/26/2009
Response: MC# 2090579: - From James Fox, Director, System Safety and Risk Management: SEPTA is developing a voluntary Obstructive Sleep Apnea Pilot Program for operations personnel that will include clinical medical assessments of safety sensitive employees. The initial program aim is to screen a volunteer employee population for specific causes of excessive daytime somnolence (obstructive sleep apnea). The end goal is to foster employee buy-in and assess a comprehensive program that screens, diagnoses, and manages employees with sleep apnea. At this time, SEPTA is soliciting technical proposals from qualified professional groups - and targets initiation of the pilot program in CY 2010. The Pilot Program duration is two (2) years. Anticipated services that will be provided include, but are not limited to: Health education presentations about sleep apnea - emphasizing occupational effects and issues Development of sleep apnea screening procedures Diagnostic testing for sleep apnea Eanagement of sleep apnea Evaluating employee conformance to therapies Population data analysis Other Disorders The SEPTA Medical Department utilizes a myriad of authorized sources of employee medical information to help identify, evaluate, and monitor employees with at-risk physiological conditions. The medical data sources include: Sick Benefits Employee self-reporting of medical restrictions imposed by personal physician Directive Examinations Return-to-Duty Medical Exams Employee self-reporting of medications From these sources, the SEPTA Medical Department stratifies at-risk medical conditions - and the associated populations - into categories that include, but are not limited to: diabetes, hypertension, coronary artery disease, and sleep apnea. At this time, approximately 1200 employees are included in the monitored population. Additionally, please note that SEPTA previously advised NTSB about Fatigue awareness initiatives incorporated into the Authority’s Wellness and EAP programs.Fatigue awareness and sleep disorders seminars were formally and systematically introduced in February 2001. The goal of these employee awareness activities was to: Identify the symptoms and causes of fatigue Explore issues related to fatigue Identify strategies to reduce fatigue and increase alertness. The Fatigue Awareness lesson plan is provided in Attachment 2, and includes modules on the signs and symptoms of sleep disorders such as insomnia, sleep apnea, and narcolepsy. SEPTA intends periodic follow-up initiatives to reacquaint its employees with fatigue and sleep disorder issues - by integrating the subject matter into monthly joint Human Resources / EAP site visits. Additionally, since 2007, new employees are issued a Fatigue Awareness wallet card (Attachment 3) during their drug and alcohol policy orientation, and must sign for both the D&A Policy manual and the awareness card. Employees are also advised that information regarding fatigue and sleep disorder issues is available through the SEPTA Medical Department. Wellness orientations are provided to all new hires, and cover topics ranging from general self-care to subjects related to stress and fatigue. Conclusion It is anticipated that this information should provide an acceptable response to these two (2) recommendations. Therefore, SEPTA requests that the NTSB consider recommendations R-09-10 and R-09-11 as, Closed - Acceptable Action.

From: NTSB
To: Hampton Roads Transit
Date: 9/2/2014
Response: We note that you require your light rail employees to have a current commercial operator’s license, as well as regular physical examinations conducted in accordance with Federal Motor Carrier Safety Administration (FMCSA) regulations by medical examiners listed on the FMCSA’s national registry. We also note that these examiners use the Department of Transportation’s (DOT) physical examination form and assess an operator’s medical history regarding sleep disorders, pauses in breathing while asleep, daytime sleepiness, and loud snoring. We further note that, after reviewing the employee’s medical history, the examiner determines whether additional evaluation is required and, if so, the employee is not permitted to operate one of your vehicles until he or she qualifies for DOT certification through treatment and management of the sleep disorder. These policies and practices satisfy Safety Recommendations R-09-10 and -11, which are classified CLOSED—ACCEPTABLE ACTION.

From: Hampton Roads Transit
To: NTSB
Date: 6/19/2014
Response: -From William E. Harrell, President and CEO: This letter is in response to your letter dated June 13, 2014, which I received yesterday (attached for easy reference). HRT has made your safety recommendations (R-09-1 0 and R-09-11) regarding monitoring of Light Rail employees for sleep apnea and other sleep related disorders. Our Light Rail employees (who are required to have a COL) must maintain a current DOT (Department of Transportation) physical. The DOT physical examinations are conducted in accordance with the Federal Motor Carrier Safety Administration (FMCSA) regulations and conducted by medical examiners listed on the National Registry with FMCSA. Our medical examiners use the DOT physical form provided by the FMCSA to ensure that Drivers meet the criteria to receive a DOT medical certification. An important element of the certification process is an assessment of the Driver's medical history regarding sleep disorders, pauses in breathing while asleep, daytime sleepiness and loud snoring. The medical examiner, after reviewing the employee's medical history, will make a determination as to whether further testing is required. If additional testing is required the Driver is not permitted to operate an HRT vehicle until they are able to obtain a DOT certification. HRT is committed to safety. The DOT medical certification is a crucial step in ensuring safe transportation for our customers and our employees. Please reconsider reclassifying safety recommendations R-09-10 and 11. Please let me know if you need additional information in order to make your decision. Thank you in advance for your assistance in this matter.

From: NTSB
To: Hampton Roads Transit
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our request for an update on January 12, 2012. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Hampton Roads Transit
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that Hampton Roads Transit has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Washington Metropolitan Area Transit Authority
Date: 10/23/2013
Response: We are pleased with WMATA’s current program to identify and treat operators at high risk for OSA: that all employees and applicants subject to an OSA assessment receive a copy of the FMCSA’s OSA guidelines and a letter of referral for further assessment, and that the program requires operators diagnosed with OSA to comply with treatment year round, to undergo annual followup examinations, and to provide regular compliance reports to maintain their certification. This program satisfies Safety Recommendation R-09-11, which is classified CLOSED—ACCEPTABLE ACTION.

From: Washington Metropolitan Area Transit Authority
To: NTSB
Date: 6/6/2013
Response: -From James M. Dougherty, WSO-CSSD, Chief Safety Officer: I want to personally thank you for taking the time out of your schedule to meetwith members of my staff on May 23, 2013, to discuss the WashingtonMetropolitan Area Transit Authority's (WMATA), National Transportation SafetyBoard (NTSB) recommendations that are currently classified "Open AcceptableAction". It is my belief that the dialogue, along with the documentation that wasprovided to support the closure of several recommendations, will assist theNTSB in its evaluation of WMATA's progress and move these recommendationsto closure. Enclosed is a listing of all of the items in which closure documentation wasprovided during the meeting. WMATA would like to thank the NTSB for its consideration and support as wecontinue to demonstrate our goal of making safety a top priority for both ouremployees and patrons. We look forward to continued meetings with the NTSBwhere we can exchange technical information in support of our common goal. Provided copy of plan that was developed to educate, evaluate and identify operators who are at risk for sleep disorders.

From: Washington Metropolitan Area Transit Authority
To: NTSB
Date: 6/10/2011
Response: CC# 201100318: - From James M. Dougherty, WSO-CSSD, Chief Safety Officer: Consistent with the discussions held on May 3,2011 in a collective review of the Washington Metropolitan Area Transit Authority (WMATA) "Open Acceptable" National Transportation Safety Board (NTSB) recommendations, the attached documentation is provided to support the closure of recommendations R-09-010 and R-09-011. Attached, WMATA is providing a copy of the Medical Examination Report for Commercial Driver's Fitness Determination form. It is mandatory that this form be completed by the driver and WMATA medical examiner. The Health History section includes questions essential to the Obstructive Sleep Apnea process. In addition, all employees and applicants subject to Obstructive Sleep Apnea assessment receive a copy of the Federal Motor Carrier Safety Administration's Guideline 5, regarding the "Clinical Evaluation-Identification of Individuals with Undiagnosed Obstructive Sleep Apnea".

From: NTSB
To: Washington Metropolitan Area Transit Authority
Date: 4/28/2010
Response: The NTSB is pleased that WMATA is currently developing written procedures to identify operators at high risk for OSA for the purpose of properly assessing and treating such operators. These efforts constitute a first step toward establishing the recommended program; accordingly, Safety Recommendation R-09-11 is classified OPEN ACCEPTABLE RESPONSE.

From: Washington Metropolitan Area Transit Authority
To: NTSB
Date: 10/14/2009
Response: Letter Mail Controlled 10/20/2009 5:51:07 PM MC# 2090646: - From John B. Catoe, Jr., General Manager: WMATA's Response: Currently, WMATA does not have a program to identify operators who are at high risk for sleep apnea or other sleep disorders. WMATA is currently developing written procedures to identify, evaluate, and appropriately treat such operators. Once final written procedures are approved, WMATA will submit to the NTSB for acceptance.

From: NTSB
To: State of Washington, County of King, King County Metro Transit
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our request for an update on January 12, 2012. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: State of Washington, County of King, King County Metro Transit
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that King County Metro Transit has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Miami-Dade Transit Agency
Date: 4/14/2014
Response: We are pleased that you established the recommended sleep disorder program, including guidelines for identifying, evaluating, and treating MDT light rail vehicle operators at risk for OSA. We understand that the program requires Bus and Train Operators to undergo pre employment and biannual physical examinations that evaluate the operators for OSA or other sleep disorders. We note that, in addition, a county medical contractor screens employees for OSA when such screening appears to be necessary. Further, we note that, whenever bus or train operators present medical information on OSA when requesting time off, the MDT human resources division asks the employee for proof that his or her continuous positive airway pressure mask has been fitted within the previous 2 years. Your supervisors must evaluate operators’ fitness-for-duty when they report to work; you strictly adhere to operating time restrictions for all rail operations, as specified in Florida Administrative Code, Chapter 14-90; and transit operating and on-duty time standards are reviewed during accident or incident investigations to rule out fatigue-related causal factors. These actions satisfy Safety Recommendation R-09-11, which is classified CLOSED—ACCEPTABLE ACTION.

From: Miami-Dade Transit Agency
To: NTSB
Date: 3/8/2012
Response: -From Ysela Llort, Director: MDT maintains a program that requires Bus and Train Operators to undergo pre-employment and bi-annual physical examinations which evaluate obstructive sleep apnea or other sleep disorders. Sleep apnea screenings, via a County medical contractor, are conducted for employees when it appears to be clinically necessary. Additionally, when bus or train operators present medical information on sleep apnea as part of a request to receive time off, e.g., the Family and Medical leave Act (FMLA), the MDT Human Resources Division requests that the employee provide proof that they have had their Continuous Positive Airway Pressure (CPAP) mask fitted within the last two years, as recommended by our medical contractor. The CPAP mask is considered by our medical contractor to be the most effective treatment for sleep apnea. For further oversight, MDT supervision is responsible for evaluating operators for fitness-for-duty when they report to work. MDT also incorporates strict adherence to operating time restrictions across both rail and bus operations, as specified in the Florida Administrative Code, Chapter 14- 90. These transit operating and on-duty time standards have been incorporated in the Metrobus and Metrorail Operational Rule and Procedures Manual and are reviewed during accident or incident investigations to rule out fatigue-related causal factors. Copies of the current and past questionnaire and the informational packet regarding sleep apnea are enclosed. We believe that the responses and actions taken by MDT as described in this letter will satisfy the NTSB's recommendations, minimize fatigue-related incidents and ensure that the highest level of operational safety is maintained.

From: NTSB
To: Miami-Dade Transit Agency
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Miami-Dade Transit Agency has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Port Authority Transit Corporation
Date: 10/30/2014
Response: We note that you plan to respond to us regarding Safety Recommendations R-09-10 and 11 in other correspondence. Pending our timely receipt and review of detailed information regarding your actions or plans regarding these recommendations, they will retain their current classification, CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED, which we assigned on August 13, 2014.

From: Port Authority Transit Corporation
To: NTSB
Date: 8/28/2014
Response: -From John D. Rink, General Manager: We will respond to these issues via separate correspondence.

From: NTSB
To: Port Authority Transit Corporation
Date: 8/27/2014
Response: Because we had not received a reply from you regarding actions either taken or planned in response to these recommendations since we issued them, they were classified “Closed?Unacceptable Action/No Response Received,” on August 13, 2014. We are encouraged that your August 21, 2014, e-mail states that you plan to respond in the near future to us regarding R-01-26 and -27; we would also welcome a response regarding your actions or plans concerning Safety Recommendations R-09-10 and -11. Because your reply did not include any substantive information, pending our timely receipt and review of detailed information regarding your actions or plans, Safety Recommendations R-01-26 and -27, and R-09-10 and 11, will retain their current classification.

From: Port Authority Transit Corporation
To: NTSB
Date: 8/21/2014
Response: -From John D. Rick, General Manager, PATCO: In regards to the attached letter, PATCO plans to respond in the near future.

From: NTSB
To: Port Authority Transit Corporation
Date: 8/13/2014
Response: We have received no reply from you regarding actions you have taken or planned to take in response to these recommendations since we issued them, despite our February 13, 2003, and December 27, 2013, followup requests for such information regarding Safety Recommendations R-01-26 and -27. Our December 27, 2013, letter also requested that you update us about any actions you had taken or planned regarding Safety Recommendations R-09-10 and -11. Because we have received no reply from you to any of our requests, we conclude that you have not acted to date, nor do you plan to address these safety issues. Consequently, Safety Recommendations R 01 26 and 27 and R 09 10 and 11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Port Authority Transit Corporation
Date: 12/27/2013
Response: This letter addresses Safety Recommendations R-01-26 and -27, which the NTSB issued to the Port Authority Transit Corporation (PATCO), on January 23, 2002, as a result of our special investigation of the February 13 and August 15, 2000, Maryland Transit Administration light rail vehicle accidents at the Baltimore-Washington International Airport transit station near Baltimore, Maryland. We also issued Safety Recommendations R-09-10 and -11 to PATCO on July 23, 2009, as a result of our investigation of the May 28, 2008, collision between two Massachusetts Bay Transportation Authority Green Line trains near Newton, Massachusetts. To date, we have received no information regarding any actions that PATCO has taken to address Safety Recommendations R-01-26, R-01-27, R-09-10, or R-09 -11. Normally, we expect action to address an NTSB safety recommendation to be completed within 5 years. Because two of these recommendations are almost 12 years old and we do not know of any actions taken to satisfy them, we would appreciate receiving a reply within 90 days of the receipt of this letter regarding any actions that PATCO has taken or planned to address these important safety issues. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public the highest level of safety and to identify creative solutions that can be shared with others. Pending our receipt of a timely reply to this request, Safety Recommendations R 01 26 and -27, and R-09-10 and -11 are classified “Open?Await Response.” A copy of our January 23, 2002, letter issuing Safety Recommendations R-01-26 and -27 is available at http://www.ntsb.gov/doclib/recletters/2001/R01_26_27.pdf. The full report of the Baltimore, Maryland, accident is available at http://www.ntsb.gov/doclib/safetystudies/SIR0102.pdf. A copy of our July 23, 2009, letter issuing Safety Recommendations R-09-10 and -11 is available at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident is available at: http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We encourage you to respond electronically to this letter at the following e mail address: correspondence@ntsb.gov. In your reply, please refer to the recommendation by number. If a response, including attachments, exceeds 10 megabytes, please e-mail us at the same address for instructions. To avoid confusion, please do not submit both an electronic copy and a hard copy of the same response. Thank you for your assistance in this matter.

From: NTSB
To: State of California, County of Los Angeles, Metropolitan Transportation Authority
Date: 6/20/2012
Response: On January 6, 2012, NTSB contacted Ms. Carol Holben, Principal Human Resources Analyst, who provided further clarification regarding LACMTA’s OSA program. The NTSB is satisfied that LACMTA’s current employees are required to obtain, at a minimum, biannual physical examination recertification, which includes a review for sleep apnea and other sleep disorders, as discussed above, and that the examiner denies certification, if warranted, or provides only a limited (3-month, 6-month, or 1-year) certificate, depending on an individual’s treatment plan. As these policies satisfy Safety Recommendation R-09-11, it is classified CLOSED—ACCEPTABLE ACTION.

From: State of California, County of Los Angeles, Metropolitan Transportation Authority
To: NTSB
Date: 6/20/2011
Response: CC# 201100252: - From Stefan E. Chasnov, C.P.A. (inactive), CCP, Deputy Executive Officer, Human Resources: Regarding recommendation R-09-011, LACMTA relies primarily on its contracted clinics to perform complete and thorough examinations on bus and rail operators each time they are medically recertified. LACMTA Human Resources staff members meet regularly with clinic providers and review these expectations. All examinations are also reviewed by the LACMTA Clinic Project Manager to ensure they are complete and that all history items have been addressed by the examiner with particular concern regarding sleep disorders. LACMTA currently follows all guidance set forth by the FMCSA and will add further screening protocols as they are established by the FMCSA.

From: NTSB
To: Kenosha Transit
Date: 7/10/2017
Response: We note that the Kenosha Transit Streetcar System is a 1.9-mile oval track that operates with one streetcar and a single operator on a daily basis. To address the risks posed by OSA among your operators, you require new operators to undergo a US Department of Transportation commercial driver’s license (CDL) physical exam upon being hired. The CDL physical exam form has questions related to OSA and other sleep disorders. We further note that you require all of your operators to undergo an annual health assessment. The risks OSA poses to operators exist regardless of an operation’s size. We believe that you should ensure that each operator’s annual health assessment includes checking for common OSA risk factors to help identify employees who would benefit from a more thorough examination by a sleep specialist. Among these common risk factors are a body mass index over 30, a neck circumference over 17 inches, daytime sleepiness, and reports of loud snoring while asleep. Although we believe that OSA is a risk to any vehicle operator, the type of formal program that we recommended to identify, evaluate, and treat operators who are at high risk for OSA is not appropriate for an organization of the size of the Kenosha Streetcar System. Consequently, Safety Recommendation R-09-11 is classified CLOSED--RECONSIDERED.

From: NTSB
To: Kenosha Transit
Date: 10/28/2015
Response: Completing actions to address our safety recommendations usually takes recipients 3 to 5 years, and this recommendation is now more than 6 years old. Of the 46 addressees, you are 1 of only 6 for which R-09-11 remains open. To date, we have received no information regarding your actions or plans for addressing Safety Recommendation R-09-11 since July 2012, after which we requested clarification as to whether you had taken the recommended actions. Pending such clarification, Safety Recommendation R-09-11 was classified “Open—Await Response” on September 25, 2012. To assist you in addressing this issue, we provided information at that time about the programs developed by other transit authorities. As 3 years have elapsed since then, we would appreciate receiving an update on your actions to satisfy this recommendation. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public the highest level of safety and to identify creative solutions that can be shared with others. Although Safety Recommendation R 09 11 will retain its current classification pending your timely reply, unless we hear from you promptly, we may have to classify the recommendation in an unacceptable status. Copies of our July 23, 2009, letter issuing the recommendation; your January 24, 2012, e mail; and our September 25, 2012, reply are enclosed. The full investigation report of the May 28, 2008, Massachusetts Bay Transportation Authority train accident in Newton, Massachusetts, is available on our website at http://www.ntsb.gov/investigations/AccidentReports/Pages/RAR0902.aspx.

From: NTSB
To: Kenosha Transit
Date: 9/19/2012
Response: We were not able to determine from either of your e-mails whether Kenosha Area Transit has established a program to identify operators at high risk for obstructive sleep apnea or other sleep disorders or whether you require that such operators be appropriately evaluated and treated. In establishing such a program, you may find it helpful to know some aspects of programs that other transit authorities have developed that have satisfied this safety recommendation. Many of these programs include the following practices: • Transit agency physicians who conduct operator physical examinations are trained in questioning and identifying operators who are at high risk for obstructive sleep apnea and other sleep disorders. • If a sleep disorder or its risk factors are identified, the physician refers the patient for a sleep study. The patient does not operate trains until a sleep disorder is ruled out or treatment has begun. • If necessary, appropriate treatment is prescribed, and the patient is monitored for compliance with the treatment. • The patient is medically approved for limited periods (such as 3 months, 6 months, or 1 year) during treatment evaluation; medical certification may be revoked permanently if the disorder cannot be managed or the patient does not comply with treatment. • Physicians require more frequent medical evaluations for operators who have medical conditions, including sleep disorders, that can change over time and pose a safety risk. Pending our receipt of detailed information regarding such a program for Kenosha Area Transit operators, Safety Recommendation R-09-11 is classified OPEN—AWAIT RESPONSE.

From: Kenosha Transit
To: NTSB
Date: 1/24/2012
Response: -From Ron Piorkowski, Kenosha Transit: The Kenosha Transit Streetcar System is a 1.9 mile oval track that operates with one streetcar and a single operator on a daily basis. Each streetcar has a built in automatic dead man switch so if the Operator would lose consciousness the car would automatically stop. The operators are given a DOT/CDL physical exam when hired. The physical exam form has questions related to sleep disorders and sleep apnea that every operator must fill out. The City of Kenosha also has yearly health assessments that are given to all operators. The Kenosha Transit system shares a Nurse Practitioner that is available to all City of Kenosha employees. She is located on staff at our building and is available to help identify any operators medical concerns. We also have video cameras on the streetcar system that can help to identify or verify any potential operations concerns relating to any health issues. The route supervisor also does spot checks to review the Kenosha Streetcar operation. The procedures and policies listed for the Kenosha Transit Streetcar System do address the concerns of National Transportation Safety Board recommendations of R-09-10 and R-09-11.

From: NTSB
To: Kenosha Transit
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that Kenosha Transit has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Massachusetts Bay Transportation Authority
Date: 8/19/2010
Response: The NTSB is pleased that the MBTA has reviewed and updated its medical history and physical examination forms and has implemented a sleep disorder screening questionnaire that employs the Epworth Sleepiness Scale to assist employees in determining their level of sleepiness. We are also pleased with the updated MBTA process that you describe for evaluating an employee's risk for OSA or other sleep disorders. The actions that the MBTA has taken to modify its forms and establish a program to address this issue satisfy Safety Recommendations R-09-10 and R-09-11, which are classified CLOSED – ACCEPTABLE ACTION.

From: Massachusetts Bay Transportation Authority
To: NTSB
Date: 10/23/2009
Response: Letter Mail Controlled 11/3/2009 12:24:17 PM MC# - From William A. Mitchell, Jr., Acting General Manager: I am writing in response to the recommendations the National Transportation Safety Board (NTSB) issued on July 23,2009 to the Massachusetts Bay Transportation Authority (MBTA), in connection with the May 28,2008 accident that occurred on the MBTA's Green Line. On July 14,2009, the NTSB held a public hearing on the investigation regarding the collision of two MBTA Green Line light rail vehicles that occurred in May 2008. Subsequent to this hearing, the NTSB issued a report outlining both findings and recommendations arising from the investigation. Pursuant to your letter of July 23,2009, MBTA provides a response to each of the recommendations directed to the Authority. Let me begin by stating that the safety of our customers and employees is a priority to the MBTA. Additionally, we are committed to the implementation of sound technological advancements, as well as practical interventions to identify and mitigate any human factor that may have an adverse impact on our operations. The MBTA fully embraces the spirit of all recommendations issued by the NTSB. The Authority seeks to implement each recommendation because they will enhance the Authority's safety culture and performance. R-09-11: "Establish a program to identify operators who are at high risk for obstructive sleep apnea or other disorders and require that such operators be appropriately evaluated and treated. " In addition to the information provided in response to R 09-10, the Authority has programmatically instituted the following: - Limit "Operator Hours of Work" in accordance with the APTA standard. Operators may not work more than fourteen (14) hours in one workday, including overtime. Operators must have ten (10) hours off before their next work shift. - Conduct "Fitness for Duty Checks" Supervisory staff is required to assess each operator's Fitness for Duty when hetshe reports for work. If an operator appears drowsy or exhibits other signs that could adversely affect safety critical work performance, helshe will be subject to additional 'duty check" assessments up to and including a medical review. - Additionally, the MBTA provides information and training to MBTA Green Line and Bus Operators as part of driver recertification training. This information is also included in the Defensive Driving Manual provided to operators. Furthermore, the MBTA Training Departments and the Medical Clinic provides educational awareness material, which is derived from various sources including the National Sleep Foundation, NHTSA, US Department of Health & Human Services, and AAA, on fatigue and sleep related disorders to operators.

From: NTSB
To: New Jersey Transit Corporation
Date: 9/13/2012
Response: The NTSB notes that New Jersey Transit administers three light rail systems within the state of New Jersey: the Newark Light Rail (NLR), the Hudson-Bergen Light Rail Transit System (HBLR), and River LINE (RVL), and that New Jersey Transit has reviewed these systems’ programs for addressing potential sleep disorders in its operators. We also note that operators are examined every 2 years by a licensed physician using the U.S. Department of Transportation form, which includes the recommended questions regarding symptoms of sleep disorders. As part of the physical, each operator completes a health history form that elicits information about symptoms of sleep disorders, and the examining physician identifies operators at risk for sleep apnea. In some cases, operators are also rated using the Epworth Sleepiness Scale. These procedures satisfy the requirements of Safety Recommendation R-09-10, which is classified “Closed—Acceptable Action.” The NTSB notes that any operator determined to have a sleep disorder may not operate a New Jersey Transit light rail vehicle until cleared by a physician. Followup treatment for such conditions includes counseling and referral to a family physician for treatment. Efficiency checks and undercover programs also help ensure that sleep disorders are not going undetected or untreated. This policy satisfies Safety Recommendation R-09-11, which is classified CLOSED—ACCEPTABLE ACTION.

From: New Jersey Transit Corporation
To: NTSB
Date: 3/13/2012
Response: -From John F. Squitieri, Deputy General Manager, Light Rail Operations: These two recommendations have resulted from NTSB's investigation of the May 28,2008 collision of two Massachusetts Bay Transportation Authority Green Line trains in Newton, MA. In NTSB's letter of January 12, 2012, NTSB enquired in knowing about whether and how their recommendations have been implemented by NJ Transit. NTSB is requesting NJ Transit for specific information regarding policies for mitigating risks associated with operators' unidentified and untreated sleep disorders. NJ Transit administers three light rail systems within the state of New Jersey. NJ Transit owns and operates Newark Light Rail (NLR). Hudson-Bergen Light Rail Transit System (HBLR) and River LINE (RVL) are contracted out for operations and maintenance to URS Corporation and Southern New Jersey Light Rail System, respectively as part of Design-Build-Operate and Maintain contract. NTSB states in their letter of January 12, 2012 that other transit agencies have implemented NTSB recommendations through agencies' medical history and physical examination forms, employee training programs, and requirements for periodic medical examinations and have identified operators who are at high risk for sleep disorders. NJ Transit has reviewed the programs of NLR, HBLR and RVL, concerning sleep disorders in regard to their operators. Every operator in each transit system is given a DOT physical every two (2) years, at a minimum, by a licensed "Medical Examiner". As part of the physical, each operator has to complete a 'Health History' form that requires information on sleep apnea. During this physical, the Medical Examiner identifies operators at risk for sleep apnea. They counsel the individual(s) and provide them with informational handouts. The individual is then referred to their family Physician. In some cases, NJ Transit also screen operators using "Epworth Sleepiness Scale. The Medical Examiner provides a "medical certificate" for the DOT physical. Any operator deemed to have a sleeping disorder is not permitted to operate a Light Rail Vehicle until cleared by the Medical Examiner. In addition, to informational handouts, each operator is given fatigue and sleep apnea training. In this training symptom(s) of sleep apnea, sleep disorders and fatigue are discussed along with recommendations to receive medical assistance for sleep apnea. Efficiency checks and under cover programs also assist NJ Transit in identifying operators with sleep disorders. If you need any further information regarding NJ Transit's programs, please contact me directly.

From: New Jersey Transit Corporation
To: NTSB
Date: 1/23/2012
Response: -From John F. Squitieri, Deputy General Manager, Light Rail Operations: New Jersey Transit has received the NTSB's January 12, 2012 letter addressed to Mr. Joseph North, General Manager Light Rail, One Penn Plaza East, Newark, NJ 07105. This letter refers to previous correspondence that was sent to New Jersey Transit on July 23, 2009. Unfortunately, we have made a thorough search of our documents and did not find any communication from NTSB to New Jersey Transit, dated July 23, 2009. As a further complication, please note that Mr. Joseph North, the person your letter was addressed to, retired from New Jersey Transit later that year, in 2009. New Jersey Transit is requesting that your office kindly address all future correspondence, to the following: Mr. John F. Squitieri Deputy General Manager, Light Rail Operations NJ TRANSIT One Penn Plaza East Newark; NJ 07105 In the meanwhile, New Jersey Transit is presently in the process of reviewing the safety recommendations from the NTSB and will report our progress under separate cover. Thank you for your help with this request. If you need any further information or documentation regarding our programs, please contact me at the above address.

From: NTSB
To: New Jersey Transit Corporation
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that New Jersey Transit has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf.

From: NTSB
To: Seattle Monorail Services
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our January 12, 2012, request for an update. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Seattle Monorail Services
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that Seattle Monorail Services has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Santa Clara Valley Transportation Authority
Date: 7/21/2010
Response: The NTSB is pleased that VTA has established a program requiring drivers identified as being at high risk for a sleep disorder to undergo a sleep study and, if diagnosed with such a disorder, to subsequently provide proof of treatment before receiving either initial certification or biennial recertification. We are satisfied that VTA has taken the recommended action; accordingly, Safety Recommendation R-09-11 is classified CLOSED -- ACCEPTABLE ACTION.

From: Santa Clara Valley Transportation Authority
To: NTSB
Date: 10/21/2009
Response: Letter Mail Controlled 10/26/2009 1:23:36 PM MC# 2090657 - From Michael T. Burns, General Manager: When the possibility of a sleep disorder is identified, the driver is required to submit to a sleep test to determine if the disorder is present. If the test is positive, the driver is referred for treatment. The medical provider will not give an initial license certification or a new two-year recertification to drivers who test positive until the driver can show proof that they have received treatment. VTA is also designing an educational campaign to inform all of our commercial drivers about the symptoms and dangers of sleep disorders. The program will direct those who self-identify with the symptoms to see their doctor now for an exam and possible treatment to protect their own health, and to avoid delays and loss of pay if the disorder is discovered at the time they go for their recertifications.

From: NTSB
To: Memphis Area Transit Authority
Date: 12/17/2010
Response: The NTSB is pleased that MATA’s current employees are required to obtain annual physical exam recertification, which includes a review for OSA and other sleep disorders. Depending upon the findings of the assessment of risk factors, the employee may be referred to Priority Sleep Diagnostics for additional consultation or further diagnosis using the Physician Order Form. This form elicits patient information, symptoms/purpose of the sleep study, the name of the referring physician, and the services requested, which could include a diagnostic sleep study, a continuous positive airway pressure/bi-level titration study; a split-night polysomnogram; a multiple sleep latency test/maintenance wakefulness test, and/or consultation and management to evaluate for possible sleep disorders. The NTSB notes that MATA’s consulting physician, who specializes in sleep disorders, will report the employee’s exam results and treatment plan, if necessary, and send that information to the company’s MRO. Depending upon the results, the examining physician may deny a U.S. Department of Transportation (DOT) medical card or issue a DOT medical card only for a 3-month, 6-month, 1-year or 2-year period, depending upon the treatment plan. MATA’s development of such a program and implementation of the recommended actions satisfies this recommendation; accordingly, Safety Recommendation R-09-11 is classified CLOSED -- ACCEPTABLE ACTION.

From: Memphis Area Transit Authority
To: NTSB
Date: 9/23/2010
Response: CC# 201000365: - From William Hudson, Jr., President and General Manager: Annual employee re-certification is required by 101.3 Operator Certification and Identification. Employees must maintain a current DOT medical card. Additionally, all such employees must keep a current medical DOT card on their person while in service. The re-certification examination includes the review of sleep apnea and other sleep disorders. Based upon the findings of the appropriate risk factors, the employee will be referred for additional consultation or further diagnosis. The forms identified below are the same forms referenced in R-09-10. Forms: Medical Examination Report: sections 1 and 2 are completed by the employee; the remaining portions are completed by the physician. Epworth Sleepiness Scale, (sample of a determining factor). Physician Order Form. The consulting physician, specializing in sleep disorders, will report the employee’s exam results and treatment plan, if necessary, and send that information to attention to the company’s MRO. Depending upon the results the examining physician will deny a Medical DOT card or issue a Medical DOT card for a 3 month, 6 month, 1 year or 2 year period.

From: NTSB
To: Memphis Area Transit Authority
Date: 7/21/2010
Response: The NTSB is pleased that MATA's current employees are required to obtain annual physical exam certification, which includes a review for sleep disorders, and that MATA has taken the first step of identifying at-risk operators. We encourage you to proceed with the development of the recommended program and requirement. Pending our review of MATA's program, Safety Recommendation R-09-11 is classified OPEN – ACCEPTABLE RESPONSE.

From: Memphis Area Transit Authority
To: NTSB
Date: 10/2/2009
Response: Letter Mail Controlled 10/9/2009 3:25:41 PM MC# 2090633 - From William Hudson, Jr., President and General Manager: Current employees are required to obtain an annual physical exam certification, which includes a satisfactory review for sleep disorders.

From: NTSB
To: Portland Streetcar
Date: 6/13/2014
Response: In the 5 years since these recommendations were issued, you have not responded to us regarding them, despite our request for an update on January 12, 2012. We normally expect recommended actions to be completed within 3 to 5 years after a recommendation is issued. As we have received no reply from you for almost 5 years, despite our request for information, Safety Recommendations R-09-10 and -11 are classified CLOSED—UNACCEPTABLE ACTION/ NO RESPONSE RECEIVED.

From: NTSB
To: Portland Streetcar
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that Portland Streetcar has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: Chattanooga Area Regional Transportation Authority
Date: 8/2/2012
Response: We note that, as a preliminary condition of employment and continued employment, all CARTA operators are required to pass the DOT physical examination every 1-2 years; this exam is administered by a company physician, who identifies operators at high risk for obstructive sleep disorders. We also note that a CARTA operator identified as having a sleep disorder must receive treatment and undergo monitoring before being permitted to drive a commercial motor vehicle. In addition, CARTA uses fliers, posters, and driver training to raise employee awareness of fatigue and sleep disorders. These practices satisfy Safety Recommendation R-09-11, which is classified CLOSED—ACCEPTABLE ACTION. These practices satisfy Safety Recommendation R-09-11, which is classified CLOSED—ACCEPTABLE ACTION.

From: Chattanooga Area Regional Transportation Authority
To: NTSB
Date: 2/24/2012
Response: -From Jeff Smith, Director of Human Resources: In response to the Safety Recommendations R-09-10 and R-09-11 please note that as a condition of employment, and continued employment, all of CARTA’s operators are required to pass the U.S. Department of Transportation (DOT) physical examination every 1–2 years. CARTA has a company physician who administers the DOT physical exam and identifies operators who are at high risk for obstructive sleep disorders. An operator who has been identified as having a sleep disorder is required to receive treatment and undergo monitoring before being permitted to drive a Commercial Motor Vehicle. Also, CARTA is raising awareness of fatigue and sleep disorders through flyers, posters, and driver training.

From: NTSB
To: Chattanooga Area Regional Transportation Authority
Date: 1/12/2012
Response: Although Safety Recommendations R-09-10 and -11 are over 2 years old, the NTSB has received no reply to date regarding actions that the Chattanooga Area Regional Transportation Authority has taken to address them. We are interested in knowing whether and how our recommendations are implemented, both to ensure the public is provided the highest level of safety and to identify creative solutions that might be shared with others. Accordingly, we would appreciate receiving specific information regarding your policies for mitigating the risks associated with unidentified and untreated sleep disorders among your operators. Other transit agencies receiving the same safety recommendations have completed actions and reported their accomplishments to the NTSB. Through their medical history and physical examination forms, their employee training programs, and their requirements for periodic medical examinations, they have identified operators who are at high risk for sleep disorders. Many of the transit agencies reported that they require operators to pass the U.S. Department of Transportation Physical Exam for Commercial Driver Fitness Determination (http://www.fmcsa.dot.gov/documents/safetyprograms/Medical-Report.pdf) every 1-2 years; this examination specifically addresses sleep disorders. Some agencies also administer the Epworth Sleepiness Scale (http://www.stanford.edu/~dement/epworth.html) to identify potential sleep disorders among their operators. In addition, many transit agencies now require their operators who exhibit risk factors for sleep apnea or other sleep disorders to undergo a diagnostic sleep evaluation. Common risk factors include the following: • excessive weight • a neck circumference greater than 17 inches • pauses in breathing while asleep • daytime sleepiness • loud snoring, dry mouth/throat upon awakening • morning headaches • insomnia • smoking If the operator is diagnosed with a sleep disorder and treatment is deemed necessary, these transit agencies require the individual to be reevaluated and to periodically provide proof of treatment compliance; for example, the consistent use of a continuous positive airway pressure (CPAP) machine for obstructive sleep apnea. To see the actions taken by specific transit agencies, please visit our safety recommendations website at http://www.ntsb.gov/safetyrecs/private/QueryPage.aspx and enter the safety recommendation numbers referenced above. A copy of the original safety recommendation issuance letter is posted on the NTSB’s website at http://www.ntsb.gov/doclib/recletters/2009/R09_10_11.pdf. The full report of the Newton, Massachusetts, accident investigation (Report Number RAR-09/02) is available on our website at http://www.ntsb.gov/doclib/reports/2009/RAR0902.pdf. We look forward to hearing about your agency’s actions to address the safety risks associated with transit operators who have sleep disorders.

From: NTSB
To: State of Missouri, City of St. Louis, Metro Transit
Date: 4/28/2010
Response: The NTSB is pleased with Metro’s guidelines for identifying, evaluating, and treating Metrolink light rail vehicle operators at risk for OSA. Metro’s health care vendor, Concentra, offers a satisfactory program, described in Metro’s letter, that meets the intent of this recommendation. Accordingly, Safety Recommendation R-09-11 is classified CLOSED -- ACCEPTABLE ACTION.

From: State of Missouri, City of St. Louis, Metro Transit
To: NTSB
Date: 9/15/2009