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Needed to Determine Impact' which was released on January 26, 2007. 

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Report to Congressional Committees: 

United States Government Accountability Office: 

GAO: 

January 2007: 

Rail Safety: 

The Federal Railroad Administration Is Taking Steps to Better Target 
Its Oversight, but Assessment of Results Is Needed to Determine Impact: 

GAO-07-149: 

GAO Highlights: 

Highlights of GAO-07-149, a report to congressional committees 

Why GAO Did This Study: 

Since 1980, the train accident rate has improved significantly, but 
progress has leveled off over the past 10 years. Recent serious 
accidents—such as one in Graniteville, South Carolina, that led to 9 
deaths and 292 injuries—elevated concerns. The Federal Railroad 
Administration (FRA) develops safety standards and inspects and 
enforces railroads’ compliance with these standards. 

This report addresses how FRA (1) focuses its efforts on the highest 
priority risks related to train accidents in planning its oversight, 
(2) identifies safety problems on railroad systems in carrying out its 
oversight, and (3) assesses the impact of its oversight efforts on 
safety. To complete this work, GAO reviewed FRA regulations, planning 
and policy documents, and safety data. GAO also contacted FRA officials 
in headquarters and three regional offices and others. 

What GAO Found: 

In planning its safety oversight, FRA is focusing its efforts on the 
highest priority risks related to train accidents through initiatives 
aimed at addressing their main causes—human behaviors and defective 
track—as well as through improvements in its inspection planning 
approach. In its May 2005 National Rail Safety Action Plan, the overall 
strategy for targeting its oversight at the greatest risks, FRA 
provides a reasonable framework for guiding these efforts. Its 
initiatives to address the most common causes of accidents are 
promising, although the success of many of them will depend on 
voluntary actions by the railroads. In addition, the action plan 
outlined the agency’s development of a new inspection planning 
approach. Under this approach, inspectors focus their efforts on 
locations that data-driven models indicate are most likely to have 
safety problems. 

In carrying out its safety oversight, FRA identifies a range of 
specific and broad-scale safety problems on railroad systems mainly by 
determining whether operating practices, track, and equipment are in 
compliance with minimum safety standards. However, FRA is able to 
inspect only about 0.2 percent of railroads’ operations each year and 
its inspections do not examine how railroads are managing safety risks 
throughout their systems that could lead to accidents. Such an 
approach, as a supplement to traditional compliance inspections, is 
used in the oversight of U.S. commuter railroads and pipelines and of 
Canadian railroads. While this type of approach can provide additional 
assurance of safety, GAO is not recommending that FRA adopt it because 
its various initiatives to reduce the train accident rate have not yet 
had time to demonstrate their effects on safety. 

FRA uses a broad range of goals and measures to assess the impact of 
its oversight. For example, it has developed (1) new goals to target 
its inspection and enforcement programs at reducing various types of 
railroad accidents and (2) related measures to monitor its progress. 
These measures include the rate of train accidents caused by human 
behaviors, track defects, and equipment defects. However, FRA’s ability 
to make informed decisions about these programs is limited because it 
lacks measures of their direct results, such as the correction of 
identified safety problems. Furthermore, FRA has not evaluated the 
effectiveness of its enforcement program. 

Figure: Track Inspector Examining Rail to Assess Its Safety Compliance: 

[See PDF for Image] 

Source: FRA. 

[End of Figure] 

What GAO Recommends: 

GAO is recommending that FRA develop measures of the direct results of 
its oversight and evaluate the effectiveness of its enforcement 
program. The Department of Transportation did not provide overall 
comments on these recommendations but did provide several technical 
comments, which were incorporated as appropriate. 

[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-149]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Katherine Siggerud at 
(202) 512-2834 or siggerudk@gao.gov. 

[End of Section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

FRA Has Made Progress in Targeting Its Oversight Efforts on the Basis 
of Risk: 

FRA Relies Primarily on Direct Inspections to Identify Safety Problems 
and Does Not Oversee Railroads' Management of Safety Risks: 

FRA Measures Its Progress in Achieving a Variety of Safety Goals, but 
Has Limited Information on the Direct Results of Its Oversight: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments: 

Appendix I: Scope and Methodology: 

Other Aspects of Our Work: 

Appendix II: FRA Addresses Safety Problems through Cooperation and 
Enforcement: 

Appendix III: Oversight of Risk Management in the U.S. Commuter 
Railroad, U.S. Pipeline, and Canadian Railroad Industries: 

Appendix IV: GAO Contact and Staff Acknowledgments: 

Tables: 

Table 1: FRA's Inspection Disciplines: 

Table 2: Key FRA Initiatives Aimed at Addressing Main Causes of Train 
Accidents: 

Table 3: FRA's Safety Performance Measures: 

Table 4: Description of FRA Enforcement Actions and Frequency of Use, 
January 2005 through July 2006: 

Table 5: Risk Management Framework: 

Figures: 

Figure 1: Train Accident Rates, 1980 through 2005: 

Figure 2: Train Miles Traveled, 1996 through 2005: 

Figure 3: Train Injuries and Deaths, 1980 through 2005: 

Figure 4: Primary Causes of Train Accidents, 2005: 

Figure 5: Human Factor and Track Accident Rates, 1980 through 2005: 

Figure 6: FRA Inspector Measuring Track Gauge: 

Figure 7: FRA Inspector Inspecting Train Cars: 

Figure 8: Inspections Conducted and Defects and Violations Cited, by 
Inspection Discipline, in 2005: 

Figure 9: How FRA's Inspection and Enforcement Programs Contribute to 
Rail Safety: 

Figure 10: FRA's Civil Penalties, 1996 through 2005, in 2005 Dollars: 

Abbreviations: 

APTA: American Public Transportation Association: 

FRA: Federal Railroad Administration: 

NTSB: National Transportation Safety Board: 

PHMSA: Pipeline and Hazardous Materials Safety Administration: 

United States Government Accountability Office: 
Washington, DC 20548: 

January 26, 2007: 

The Honorable Patty Murray: 
Chairman: 
The Honorable Christopher Bond: 
Ranking Minority Member: 
Subcommittee on Transportation, Housing and Urban Development, and 
Related Agencies: 
Committee on Appropriations: 
United States Senate: 

The Honorable John Olver: 
Chairman: 
The Honorable Joe Knollenberg: 
Ranking Minority Member: 
Subcommittee on Transportation, Housing and Urban Development, and 
Related Agencies: 
Committee on Appropriations: 
House of Representatives: 

Since 1980, the overall safety record in the railroad industry, as 
measured by the rate of train accidents, has improved markedly. (See 
fig. 1.) However, during the past decade, the rate of improvement has 
leveled off, and a number of serious accidents in 2004 and 2005 
elevated concerns about railroad safety. For example, in January 2005, 
a train carrying hazardous materials collided with a standing train in 
Graniteville, South Carolina, resulting in 9 deaths and 292 injuries 
and requiring the evacuation of 5,400 people. In response to the 
leveling off of the train accident rate, this accident, and other 
serious train accidents, in May 2005, the federal railroad safety 
regulator, the Federal Railroad Administration (FRA), announced a 
National Rail Safety Action Plan to improve its safety oversight. The 
plan outlines strategies for FRA to target the most frequent, highest- 
risk causes of accidents, focus federal oversight and inspection 
resources, and research the use of technologies in order to improve 
rail safety. 

Figure 1: Train Accident Rates, 1980 through 2005: 

[See PDF for image] 

Source: FRA. 

[End of figure] 

Citing concerns over several serious accidents that occurred in 2005, 
the Senate Appropriations Committee directed that we assess FRA's 
oversight approach. Accordingly, this report concentrates on how FRA 
(1) focuses its efforts on the highest priority risks related to train 
accidents in planning its safety oversight, (2) identifies safety 
problems on railroad systems in carrying out its oversight, and (3) 
assesses the impact of its oversight efforts on safety. 

To determine how FRA focuses its efforts on the highest priority risks 
related to train accidents in planning its safety oversight, we 
reviewed the agency's National Rail Safety Action Plan, plans for 
developing new regulations, inspection planning documents, and other 
key planning documents related to targeting its oversight at these 
risks. We also discussed oversight planning efforts with FRA officials. 
To assess how FRA identifies safety problems on railroad systems in 
carrying out its oversight, we reviewed FRA's statutory authority; 
regulations; and policies, procedures, and guidance for conducting 
inspections and identifying safety issues. We reviewed data from FRA on 
its inspection activities for the period from 1996 through 2005. We 
also examined risk management principles and safety oversight 
approaches used by other modal administrations within the Department of 
Transportation and elsewhere that have similar safety missions in order 
to determine their possible application to FRA. To determine how FRA 
assesses the impact of its oversight efforts on safety, we examined FRA 
safety performance measures and evaluations of its oversight 
activities, determined how FRA uses this information in making 
decisions about its oversight, and reviewed our products on performance 
measurement and evaluation. 

As part of our work in each of these areas, we interviewed program and 
enforcement officials at FRA headquarters, as well as at three regional 
offices covering states with the highest train accident rates. We also 
discussed FRA's approach to safety oversight with representatives of 
railroads, unions, and state railroad safety organizations. Our work 
focused on FRA oversight efforts to reduce the rate of train accidents 
rather than those to reduce highway-rail crossing and trespassing 
accidents because (1) the Department of Transportation's Inspector 
General has recently assessed efforts to reduce highway-rail crossing 
accidents[Footnote 1] and (2) trespassing accidents primarily involve 
issues not related to railroad safety performance. We also focused on 
FRA's oversight of railroads rather than its oversight of nonrailroad 
companies (such as shippers of hazardous materials by rail) because the 
agency's oversight efforts focus primarily on railroads. In addition, 
according to FRA, most recent serious train accidents involving the 
release of hazardous materials have resulted from problems with 
railroad operations. As part of our review, we assessed internal 
controls and the reliability of FRA's data on its inspection activities 
and enforcement actions that were pertinent to these efforts. We 
determined that the data elements were sufficiently reliable for our 
purposes. We conducted our work from November 2005 through January 2007 
in accordance with generally accepted government auditing standards. 
(See app. I for additional information on our scope and methodology.) 

Results in Brief: 

In planning its safety oversight, FRA is focusing its efforts on the 
highest priority risks related to train accidents through various 
initiatives aimed at addressing the main causes of these accidents as 
well as through improvements in its inspection planning approach. The 
agency's overall strategy for targeting its oversight at the greatest 
risks is the National Rail Safety Action Plan. This plan provides a 
reasonable framework for guiding the agency's efforts to improve its 
oversight. It includes initiatives to address the two main causes of 
train accidents--human factors and defective track--and FRA has pursued 
some additional initiatives to address these causes since issuing the 
plan.[Footnote 2] These initiatives--which include new regulations, 
research on new technologies and approaches for improving safety, and 
new vehicles for inspecting track--have the potential to reduce the 
risks associated with these causes and thereby reduce the rate of train 
accidents. For example, FRA has recently issued proposed regulations 
that, if finalized, will enable the agency to take enforcement actions 
when railroad employees do not follow key railroad operating procedures 
for ensuring safety and, therefore, may help to reduce some common 
types of accidents caused by human factors. However, most of these 
initiatives have not yet been fully implemented, and, while some may 
start showing results in the next year or two, their overall impact on 
safety will probably not be apparent for a number of years. 
Furthermore, the ability of many of these efforts to improve safety 
will depend on voluntary actions by railroads, such as the adoption of 
a model FRA has developed to improve train crew scheduling practices in 
order to prevent worker fatigue. In addition, the National Rail Safety 
Action Plan announced a new approach for planning inspections that 
relies on greater use of accident and inspection data and other data. 
Under this approach, which FRA has been using for over a year, 
inspectors focus their efforts on locations that, according to data- 
driven models, are likely to have safety problems. This new planning 
approach allows FRA to use its inspectors more effectively and better 
target the greatest safety risks. 

In carrying out its safety oversight, FRA identifies safety problems on 
railroad systems mainly through routine inspections that determine 
whether operating practices, track, and equipment, such as signals and 
locomotives, are in compliance with safety standards. Through this 
approach, FRA inspectors identify a range of safety problems at various 
sites on railroads' systems. FRA also identifies some broad-scale 
problems that affect multiple sites, primarily through analyses of 
accident and inspection data, internal discussions, and some nonroutine 
inspections. However, the number of FRA and state inspectors is small 
relative to the size of the industry and FRA inspections are able to 
cover only about 0.2 percent of railroads' operations each 
year.[Footnote 3] Also, these inspections focus on compliance with 
minimum standards and are not designed to determine how well railroads 
are managing safety risks throughout their systems that could lead to 
accidents. The American Public Transportation Association (APTA), the 
Pipeline and Hazardous Materials Safety Administration (PHMSA), and 
Transport Canada have implemented approaches to oversee the management 
of safety risks by U.S. commuter railroads, U.S. pipelines, and 
Canadian railroads, respectively. Risk management can be described as a 
continuous process of managing--through the systematic identification, 
analysis, and control of risks associated with safety hazards (such as 
train collisions)--the likelihood of hazards' occurrence and their 
negative impact.[Footnote 4] These oversight approaches complement, 
rather than replace, traditional compliance inspections and, therefore, 
provide additional assurance of safety. However, because we believe 
that FRA's initiatives to reduce train accident rates need time to 
mature and demonstrate their effects on safety, we are not recommending 
that FRA adopt an approach for overseeing railroads' management of 
safety risks. 

FRA uses a broad range of goals and measures to assess the impact of 
its oversight efforts on safety. For example, it has developed new 
goals to target its inspection and enforcement efforts at reducing 
various types of railroad accidents and related measures to track its 
progress. These measures include the level of train accidents caused by 
human factors, track defects, and equipment defects, both nationwide 
and within each of its eight regions. These safety performance measures 
provide FRA with much information that it uses to make decisions about 
its oversight approach. However, its ability to make informed decisions 
is limited because it lacks measures of the direct results of its 
inspection and enforcement programs, such as measures of the extent to 
which these programs have resulted in the correction of identified 
safety problems or improvements in compliance. We have found that it is 
a useful practice for agencies to establish measures of programs' 
direct results to help show their contributions to the ultimate results 
the agencies seek to achieve. Furthermore, while FRA has made some 
changes in its oversight approach in response to external and internal 
evaluations, the agency has not evaluated the effectiveness of its 
enforcement program in achieving desired results. Evaluations can 
provide a broader range of information on program performance and how 
to improve it than performance measures alone. Both performance 
measures and evaluations can provide valuable information on program 
results that helps hold agencies accountable for the performance of 
their programs. 

To improve FRA's ability to determine the extent to which its 
inspection and enforcement programs are contributing to rail safety and 
whether changes in these programs are needed, we are recommending that 
FRA develop and implement measures of the direct results of its 
inspection and enforcement programs and evaluate its enforcement 
program. We provided a draft of this report to the Department of 
Transportation for its review and comment. The department did not offer 
overall comments on the draft report or its recommendations. It did 
offer several technical comments, which we incorporated where 
appropriate. 

Background: 

Railroads are an important component of the transportation system, 
transporting about 42 percent of the nation's freight (as measured by 
weight). For passenger movement, railroads play a much smaller role 
than do highway and air travel; however, communities are looking to 
different forms of public transit for relief, particularly as highways 
become increasingly congested. Demand continues to grow for both 
freight and passenger transportation on railroads. In 2005, railroads 
traversed 790 million train miles,[Footnote 5] an increase of 18 
percent since 1996. (See fig. 2.) Moreover, the Department of 
Transportation estimates that between 1998 and 2020, the amount of 
freight transported by rail (as measured by weight) will increase by 
about 50 percent. Commuter and intercity passenger railroads have also 
grown--providing over 522 million passenger trips in 2005, compared 
with 385 million in 1995. According to the Federal Transit 
Administration, as of 2006, seven more commuter rail systems throughout 
the country were being planned or designed. 

Figure 2: Train Miles Traveled, 1996 through 2005: 

[See PDF for image] 

Source: FRA. 

[End of figure] 

The railroad industry is primarily composed of 7 large freight 
railroads (called Class I railroads); about 560 smaller freight 
railroads (called Class II and III railroads); and 118 passenger, 
commuter, tourist, excursion, and other railroads.[Footnote 6] Within 
the industry, Class I freight railroads predominate, representing about 
93 percent of railroad freight revenue and 69 percent of the total U.S. 
rail mileage. Class II and Class III railroads include a number of 
regional and short line railroads that provide freight transportation. 
Class II regional railroads typically operate 400 to 650 miles of track 
in a region spanning two to four states, whereas Class III short lines 
typically perform point-to-point service over short distances. 

On average, about 446 people have been injured and 14 people have been 
killed each year over the past decade, from 1996 through 2005, 
exclusive of highway-railroad grade crossing and trespassing accidents. 
Despite overall improvements since 1980, gains have tapered off. Since 
1992, the accident rate has remained at about or sometimes more than 
four accidents per million train miles. (See fig. 1.) In recent years, 
a number of serious accidents raised concerns about the level of safety 
in the railroad industry. Train accidents resulted in 1,884 injuries 
and 15 deaths in 2002, and 733 injuries and 33 deaths in 2005. (See 
fig. 3.) FRA officials attributed the large rise in number of injuries 
and deaths in 2002, and subsequently in 2005, to one or two major 
accidents, as opposed to a series of accidents. For example, in 2002, a 
derailment in Minot, North Dakota, led to the release of approximately 
200,000 gallons of anhydrous ammonia, 1,442 injuries and 1 death. In 
2005, a train collision in Graniteville, South Carolina, resulted in 
the evacuation of 5,400 people, 292 injuries and 9 deaths. 

Figure 3: Train Injuries and Deaths, 1980 through 2005: 

[See PDF for image] 

Source: FRA. 

Note: Injuries were far more common than deaths during the period of 
1980 through 2005; deaths ranged from 4 to 67 per year. Figures do not 
include highway-railroad crossing and trespassing incidents. 

[End of figure] 

Although Class I railroads have a lower rate of accidents than Class II 
and III railroads, because of their size, they account for most train 
accidents; in 2005, Class I railroads were involved in 76 percent of 
train accidents.[Footnote 7] Moreover, Class I railroads were involved 
in 53 percent of injuries and 58 percent of deaths during that year. 

According to FRA data, the majority of train accidents are attributable 
to either human factors or track defects. (See fig. 4.) For 2005, FRA 
data show that human factors and track defects were the primary causes 
of 72 percent of all train accidents. Those accidents caused by human 
factors often result from actions such as improperly positioning 
switches, shoving cars without properly checking for safe conditions, 
leaving cars in a position that obstructs track, and failing to secure 
a sufficient number of handbrakes. Those accidents caused by defective 
track often result from defective or ineffective crossties; broken or 
worn switch points; and broken, fissured or fractured rail components. 

Figure 4: Primary Causes of Train Accidents, 2005: 

[See PDF for image] 

Source: GAO analysis of FRA data. 

[A] Interaction of lateral and vertical forces refers to a specific 
type of accident that occurs when a lateral, or sideways, force exceeds 
a vertical force, or gravity, by 50 percent or more. Lateral force may 
be caused by travel through curves and alignment imperfections in the 
track. 

[B] The miscellaneous category of accident causes contains a number of 
subcategories, none of which exceeds 1.5 percent. 

[End of figure] 

As have overall accident rates, improvements in human factor and track 
accident rates have leveled off over the past decade, achieving their 
lowest rates in 1996 and 1995, respectively. (See fig. 5.) According to 
FRA, the increase in the human factor accident rate in 2004 can be 
attributed to increases in accidents caused by employees not following 
railroad operating rules. (These rules specify various operating 
procedures, such as the proper positioning of track switches, to ensure 
safe operations.) However, according to FRA, these types of human 
factor accidents decreased by 21 percent from the first half of 2005 to 
the first half of 2006. Officials attribute this decrease largely to 
actions the agency has taken to focus railroads' attention on this 
problem,[Footnote 8] including issuing a safety advisory and an 
emergency order in 2005 to address the problem of employees leaving 
hand-operated main track switches in nonsignaled territory in the wrong 
position, the cause of an increasing number of accidents, including the 
Graniteville accident.[Footnote 9] 

Figure 5: Human Factor and Track Accident Rates, 1980 through 2005: 

[See PDF for image] 

Source: FRA. 

[End of figure] 

While the individual railroads have primary responsibility for their 
safe operation, FRA conducts various activities to oversee safety. FRA 
develops and enforces regulations for the industry that include 
requirements related to safety. For example, these regulations include 
requirements governing track, signal and train control systems, grade 
crossing warning device systems, mechanical equipment--such as 
locomotives and tank cars--and railroad operating practices. FRA also 
enforces hazardous materials regulations issued by PHMSA as they relate 
to the safe transportation of such materials by rail. Many of FRA's 
regulations have detailed, prescriptive minimum requirements for track 
and equipment, such as wheel safety requirements and formulas that 
determine maximum allowable speeds on curved track. However, some 
regulations are not prescriptive and allow railroads greater 
flexibility in determining how to comply. For example, if a railroad 
chooses to implement a processor-based train control system or 
product,[Footnote 10] it must develop and receive FRA's approval for a 
railroad safety program plan. The plan should include a description of 
risk assessment procedures and the safety assessment process, and 
railroads have flexibility to adjust their programs to accommodate the 
specific system or product change. In addition, some regulations 
require railroads to develop and implement safety programs, such as 
accident and incident reporting programs and roadway worker protection 
programs. 

In 1996, FRA adopted a more participatory approach to rulemaking 
through the creation of the Railroad Safety Advisory Committee. This 
committee is designed to include all segments of the rail community in 
developing solutions to safety regulatory issues. Currently, the 
committee consists of 39 member organizations, including 
representatives from railroads, railroad associations, labor, states, 
and agencies with railroad regulatory responsibility in Canada and 
Mexico. 

FRA conducts inspections to determine railroads' compliance with its 
regulations. Typically, inspectors conduct inspections at specific 
sites of railroad operations. For example, inspectors examine track, 
equipment, devices, employee actions, or procedures and may review 
records maintained by the railroad in order to determine the railroad's 
compliance with FRA regulations. Inspectors generally specialize in one 
of five areas, called inspection disciplines: (1) operating practices, 
(2) track, (3) hazardous materials, (4) signal and train control, and 
(5) motive power and equipment. (See table 1.) FRA's policy is to cite 
defects for most instances of noncompliance and to encourage the 
railroad to comply voluntarily. 

Table 1: FRA's Inspection Disciplines: 

Inspection Discipline: Operating practices; 
Examples of what inspections cover (not all inclusive): Railroad 
operations related to human factors, including employee compliance with 
railroad operating rules, railroads' monitoring of this compliance, 
drug and alcohol testing of employees, employees' hours of service, 
radio communications, locomotive engineer qualification, and accident 
and incident reporting. 

Inspection Discipline: Track and structures[A]; 
Examples of what inspections cover (not all inclusive): Condition of 
track and structures, including track components and geometry, railroad 
track inspections, and programs to maintain continuous welded rail 
track and protect roadway workers. 

Inspection Discipline: Hazardous materials; 
Examples of what inspections cover (not all inclusive): Rail 
transportation of hazardous materials, including the integrity, 
markings, maintenance, and placement of tank cars; the training of 
train crews; security; and emergency preparedness. 

Inspection Discipline: Signal and train control; 
Examples of what inspections cover (not all inclusive): Signal 
switching systems, locomotive signal devices, locks and brake 
application, including related recordkeeping, testing, modifications, 
and repairs. 

Inspection Discipline: Motive power and equipment; 
Examples of what inspections cover (not all inclusive): Design and 
operation of railroad rolling equipment, including railroad freight and 
passenger car safety, locomotive safety and maintenance, safety 
devices, brake system safety, and emergency preparedness procedures. 

Source: GAO analysis of FRA information. 

Notes: FRA has recently established a new inspection discipline, 
industrial hygiene, which covers the protection of railroad employees 
on the job, including enforcement of FRA standards for occupational 
safety and health. The discipline is also responsible for the operation 
of FRA's internal occupational safety and health program for ensuring 
FRA employee safety and health. The resources devoted to this 
inspection discipline are relatively small--FRA plans to have a total 
of 5 industrial hygienist inspectors. In comparison, the other 
inspection disciplines each have between 50 and 90 inspectors, 
approximately. 

[A] In addition to its manual inspections, FRA has an automated track 
inspection program that uses data produced by vehicles that precisely 
measure track geometry. 

[End of table] 

When railroads do not comply voluntarily or identified defects are 
serious, FRA may cite violations and assess civil penalties either 
against railroads or individuals or take other enforcement actions to 
promote compliance with its regulations. FRA developed the concept of 
focused enforcement in the mid-1990s to ensure that inspectors know 
which violations pose the greatest hazards and make enforcement 
decisions accordingly. The purpose of this approach is to concentrate 
FRA's enforcement efforts on the areas with the greatest potential 
safety benefits. FRA's enforcement policy, as stated in its 
regulations, specifies that before recommending penalties, inspectors 
should consider the seriousness of the condition or act, the potential 
safety hazards, and the current level of compliance of the individual 
or railroad, among other things. FRA is authorized to negotiate civil 
penalties with railroads and exercises this authority. For example, it 
settles claims annually with each Class I railroad. FRA uses civil 
penalties as its primary enforcement tool. However, it also has other 
available enforcement tools. These include compliance agreements and 
compliance orders, special notices for repair, emergency orders, 
criminal penalties, disqualification orders and injunctions. (See app. 
II for further discussion.) 

FRA conducts additional oversight of Class I railroads through the 
Railroad System Oversight program, established in October 2005, which 
addresses safety issues not subject to regulation, such as aspects of 
worker fatigue, as well as safety compliance issues. Under this 
program, the agency assigns an FRA manager for each Class I railroad to 
cooperate with it on identifying and resolving safety issues. These 
managers act as liaisons with the railroads and labor officials, 
analyze accident and inspection data for their assigned railroad, and 
support FRA's inspection and enforcement efforts. Finally, under this 
program, FRA has begun annual meetings with the leadership of each 
Class I railroad to discuss its safety performance. 

The Railroad System Oversight program replaced FRA's Safety Assurance 
and Compliance Program, which had emphasized using teams--consisting of 
FRA inspectors and other FRA officials, railroad officials, and union 
representatives--to identify and resolve safety issues, as a complement 
to FRA's regular inspection activity. The agency envisioned this 
program as a comprehensive approach to safety through which these 
representatives would work together to identify and correct the root 
causes of problems across an entire railroad. According to FRA, the 
program had a number of accomplishments, such as improving 
collaboration among management, labor and FRA, and encouraging 
railroads' voluntary cooperation in taking corrective action on safety 
issues not covered under FRA's safety regulations. However, FRA ended 
this program in response to concerns that it had lost its 
effectiveness, inhibited enforcement actions, and shifted regional 
resources away from conducting site-specific inspections, the mainstay 
of FRA's safety program. 

In addition to these activities, FRA conducts other types of safety 
oversight aimed at reducing train accidents, such as monitoring of 
railroad safety data, accident investigations and reviews and 
investigations of complaints, and education efforts aimed at small 
railroads.[Footnote 11] Furthermore, FRA funds research and development 
that supports its safety oversight, by, for example, assisting in the 
development of new regulations and the revision of existing 
regulations. 

FRA is a small agency, especially in relation to the industry it 
regulates. As of July 2006, FRA had 657 full-time and part-time safety 
staff, including about 400 inspectors in the field (in its regional, 
district, and local offices). In addition, 30 state oversight agencies 
participate in a partnership program with FRA to conduct safety 
oversight activities at railroads' operating sites. Currently, about 
160 state inspectors work with FRA to conduct inspections and other 
investigative and surveillance activities as needed. In contrast, the 
railroad industry has about 235,000 employees,[Footnote 12] 219,000 
miles of track in operation, 158,000 signals and switches, and over 1.6 
million locomotives and cars. 

FRA Has Made Progress in Targeting Its Oversight Efforts on the Basis 
of Risk: 

In planning its safety oversight, FRA focuses its efforts on the 
highest priority risks related to train accidents through a number of 
initiatives aimed at addressing the main causes of these accidents as 
well as through improvements in its inspection planning approach. The 
agency's overall strategy for targeting its oversight at the greatest 
risks--the National Rail Safety Action Plan--provides a reasonable 
framework for guiding the agency's efforts. FRA's various initiatives 
to address the two main causes of train accidents--human factors and 
defective track--are promising. However, most of these initiatives are 
not yet fully implemented and their overall impact on safety will 
probably not be apparent for a number of years. FRA has also recently 
implemented new approaches for planning its inspection activity--based 
on analyses of accident, inspection, and other data--that allow it to 
better target the greatest safety risks and more effectively use its 
inspectors. 

National Rail Safety Action Plan Provides Strategy for Addressing 
Highest Priority Risks, but Impact of Safety Initiatives Is Not Yet 
Clear: 

FRA's May 2005 National Rail Safety Action Plan provides an overarching 
framework for the agency's efforts to target its oversight at the 
highest priority risks. The agency developed the plan in response to a 
leveling off of the train accident rate in recent years and the 
occurrence of serious train accidents in 2004 and early 2005. The plan 
outlines a number of initiatives aimed at reducing the main types of 
train accidents, those caused by human factors and track 
defects.[Footnote 13] These efforts include some innovative approaches 
for the railroad industry, such as a pilot project for reporting close 
calls, that are designed to prevent accidents by addressing safety 
problems that may cause them.[Footnote 14] Other efforts include new 
regulations, several research endeavors, and new track inspection 
vehicles. We have not reviewed these individual initiatives in depth, 
but believe that the plan provides a reasonable strategy for guiding 
and prioritizing FRA's efforts to reduce the rates of accidents 
attributable to human factors and track defects. 

Some of the efforts outlined in the action plan are underway, and some 
are planned for the near future. FRA issued a progress report to the 
Secretary of Transportation on the action plan in June 2006 and intends 
to continue to report on the plan's implementation. Since issuing the 
plan, the agency has pursued additional initiatives to target risks 
posed by human factors and track defects, including issuing new track 
regulations in response to a congressional mandate and encouraging a 
new braking technology. (See table 2.) The combined initiatives hold 
promise for reducing the risks associated with human factors and track 
defects. However, these efforts are in varying stages of development or 
implementation and their overall impact on safety will probably not be 
apparent for a number of years. Some individual initiatives, such as 
the close call reporting project, may start showing results in the next 
year or two. 

Table 2: Key FRA Initiatives Aimed at Addressing Main Causes of Train 
Accidents: 

Cause of train accidents: Human factors; 
Initiative: Rail Safety Action Plan initiatives: Regulations on 
employee compliance with railroad operating rules; 
FRA action and time frame: Issued proposed regulation in October 2006. 
Plans to issue final regulation by the end of 2007. 

Cause of train accidents: Human factors; 
Initiative: Rail Safety Action Plan initiatives: Pilot project to 
establish voluntary reporting system to learn from close call 
incidents; 
FRA action and time frame: Plans to initiate this 5-year project in 
January 2007 at one Class I railroad site. FRA is seeking the 
participation of other railroads. 

Cause of train accidents: Human factors; 
Initiative: Rail Safety Action Plan initiatives: Research on worker 
fatigue to develop a model that could be used to improve crew 
scheduling; 
FRA action and time frame: Discussed results of the research with key 
stakeholders and released a report on the results in November 2006. 

Cause of train accidents: Human factors; 
Initiative: Other initiatives: Pilot project to establish voluntary 
risk management programs at railroad worksites; 
FRA action and time frame: Is considering establishing a pilot project 
in fiscal year 2008. 

Cause of train accidents: Human factors; 
Initiative: Other initiatives: Encouraging new braking technology that 
can prevent or reduce human error; 
FRA action and time frame: Released a study on new brake system 
technology in August 2006 and plans to issue proposed regulations in 
May 2007 to facilitate its use. 

Cause of train accidents: Track defects; 
Initiative: Rail Safety Action Plan initiatives: New track inspection 
vehicles; 
FRA action and time frame: Plans to deploy two new vehicles in early 
2007. 

Cause of train accidents: Track defects; 
Initiative: Rail Safety Action Plan initiatives: Research and 
development on new inspection technologies; 
FRA action and time frame: Demonstrated a prototype system in October 
2005. Enhanced the system in 2006 and is planning further enhancements 
in 2007. 

Cause of train accidents: Track defects; 
Initiative: Other initiatives: Additional regulations on continuous 
welded rail track; 
FRA action and time frame: Issued a final rule on rail joint inspection 
in October 2006. Plans to develop additional regulations for improving 
management of this type of track, but has not yet developed time frames 
for this effort. 

Source: GAO analysis of FRA data. 

[End of table] 

The National Rail Safety Action Plan also outlines the agency's 
development of a new approach for planning its inspections, based on 
greater use of its accident and inspection data. Since issuing the 
plan, FRA has made other efforts to improve its approach for planning 
its inspections.[Footnote 15] Starting in fiscal year 2006, FRA's new 
inspection planning approach has allowed the agency to better target 
its inspections on the basis of risk and to better coordinate 
inspection planning among its headquarters and regional offices. 

FRA Is Making a Number of Efforts to Reduce Accidents Caused by Human 
Factors: 

Human factor accidents result from unsafe acts of individuals, such as 
employee errors, and can occur for a number of reasons, such as 
employee fatigue or inadequate supervision, training, or 
staffing.[Footnote 16] FRA has recently issued proposed regulations 
aimed at reducing the most common causes of such human factor train 
accidents: improper positioning of track switches or derails,[Footnote 
17] shoving rail cars without properly monitoring for safe conditions 
or controlling the movement, and leaving rail cars in a position that 
obstructs adjacent track. Procedures for employees to follow to avoid 
these types of accidents are contained in railroads' operating 
rules.[Footnote 18] Currently, FRA regulations contain general 
requirements that railroads train employees on their operating rules 
and periodically test their compliance with these rules, but do not 
specifically require that employees follow the rules that can prevent 
these types of accidents.[Footnote 19] As a result, according to FRA 
officials, the agency has had a limited ability to cite noncompliance 
and take enforcement actions in this area. The proposed regulations 
mirror established railroad operating rules that require employees to 
follow procedures, such as procedures related to the positioning of 
track switches, that if followed, could prevent these types of 
accidents. In addition, they include further requirements for railroads 
to train employees on these rules and monitor their compliance with 
these rules. According to FRA, these new requirements and its ability 
to enforce them will make railroad employees more accountable for 
following operating rules and railroad management more accountable for 
ensuring that employees do so. 

FRA is also sponsoring a 5-year Confidential Close Call Reporting 
System pilot project, through which employees of participating 
railroads can provide confidential information on close calls. A 
neutral party, the Bureau of Transportation Statistics, will maintain 
the close call data and a team of representatives from the 
participating railroad, labor organizations, FRA, and the bureau will 
review these data to identify safety problems. Railroads will be 
expected to correct identified problems in order to prevent accidents. 
The purpose of this project is to determine the effectiveness of such a 
voluntary reporting system for the railroad industry. FRA has developed 
plans to monitor and evaluate the performance of the project over time; 
these plans include short-term and long-term performance measures. The 
agency anticipates that it will have early indications of how the 
program is affecting safety in the next year or two. To date, one Class 
I railroad has committed to participate in this project, at one yard on 
its system, and, according to FRA, two others have expressed strong 
interest. Such systems have contributed to significant reductions in 
accidents in some other industries, such as aviation. 

FRA and the National Transportation Safety Board (NTSB) have identified 
employee fatigue as a significant factor in many train accidents. 
Railroad employees often work long hours and have unpredictable and 
fluctuating work schedules. Under current law, these employees could 
potentially work a maximum of 11 hours and 59 minutes, followed by 8 
hours off duty, and then another 11 hours and 59 minutes on duty, 
continually.[Footnote 20] In addition, time spent waiting for 
transportation at the end of a tour of duty and being transported to a 
release point, called limbo time, does not count as either duty or off- 
duty time and can be significant. FRA has sponsored a study to develop 
a fatigue model that could be used to improve train crew scheduling 
practices, has discussed the draft results with railroads and labor 
organizations, and released the final report on the study in November 
2006. The agency is also taking some other actions to encourage 
railroads to improve their management of employee fatigue, such as 
providing funding for a new program, in use at a Class I railroad, that 
tracks and analyzes crew scheduling to remedy practices that could 
contribute to fatigue. 

Through a recent investigation of a 2004 train accident in which three 
people died, NTSB found that the engineer and conductor were likely 
asleep at the controls and recommended that FRA require railroads to 
use scientifically based principles when assigning work schedules for 
train crew members and to limit crew member limbo time.[Footnote 21] In 
recent testimony, the FRA Administrator noted that, several times in 
the 1990s, the Department of Transportation proposed legislation to 
repeal or reform the hours-of-service law or to require railroads to 
develop fatigue management plans, but that these bills encountered 
opposition and were not passed. However, since that time, FRA has not 
submitted such legislation. The agency has not yet responded to NTSB's 
recommendations, but has told us that it intends to tell the board, as 
it has in the past, that the agency lacks jurisdiction to issue 
regulations addressing hours of service.[Footnote 22] 

While we were conducting our work, FRA was considering establishing a 
pilot project that would use risk management to help reduce human 
factor accidents at selected railroad worksites. Risk management can be 
described as a systematic approach for identifying, analyzing, and 
controlling risks.[Footnote 23] The agency envisioned that, under such 
a project, each worksite would collect and analyze data on precursors 
to human factor accidents--such as close call incidents, employee 
errors, or organizational characteristics--to better identify and 
correct individual and organizational factors that contribute to such 
accidents and therefore reduce the risks of such accidents occurring. 
The agency proposed that funding for this project be included in its 
fiscal year 2008 budget request and this proposal was approved by the 
department. In January 2007, as we were finalizing our report, FRA told 
us that it had decided to expand the scope of this project to include 
efforts to use risk management to reduce all types of accidents, not 
only human factor accidents. 

FRA has examined possible approaches to use for this project. According 
to agency officials, one possible approach is represented by a new 
program that a Class I railroad has implemented at two locations on its 
system. In this program--which has received funding from FRA--a 
committee of employees documents employee behaviors that could lead to 
unsafe conditions, without recording names, and provides feedback to 
the responsible employees to help them eliminate these behaviors. FRA 
has also considered the approach used by the Occupational Safety and 
Health Administration's Voluntary Protection Program. This program 
recognizes individual worksites with exemplary safety records and 
practices, including the identification, analysis, prevention, and 
control of workplace hazards that could lead to employee injuries and 
illnesses.[Footnote 24] 

As envisioned by FRA officials, this project will focus on establishing 
risk management programs at three separate railroad worksites and will 
include close monitoring and evaluation of these programs to determine 
their impact in reducing accidents over a 5-year period. If the pilot 
is successful, FRA anticipates establishing a voluntary risk management 
program for the railroad industry, which would encourage railroads to 
implement this type of approach on a systemwide basis in order to 
reduce human factor accidents, as well as other types of accidents. 

Finally, FRA has recently issued a study on a new braking technology, 
electronically controlled pneumatic brakes, which improves train- 
handling and decreases stopping distances by 40 to 60 percent. These 
brakes use an electronic line to uniformly command brake applications 
and releases throughout the train. FRA has decided that it will develop 
new regulations to facilitate the use of this technology over the next 
decade. According to FRA officials, improving railroads' braking 
systems can have a significant safety benefit by improving the ability 
of locomotive engineers to control their trains and, therefore, avoid 
or reduce the severity of some types of human factor-caused 
accidents.[Footnote 25] 

The above initiatives use a variety of approaches, some quite 
innovative, for addressing the causes of human factor accidents. These 
initiatives, which are in varying stages of development or 
implementation, have the potential to eventually reduce these types of 
accidents. However, while some may start showing results in the next 
year or two, their overall impact will likely not be apparent for a 
number of years. Furthermore, all of these initiatives, except for the 
proposed regulations on operating rules, depend on voluntary actions by 
railroads, and, in some cases, labor as well, for their success. For 
example, the impact of FRA's effort to develop a model to address the 
problem of worker fatigue depends on the extent to which railroads 
eventually use this model to improve train crew scheduling practices. 
FRA has worked with railroads and labor on some of these initiatives, 
but it is too early to predict their outcomes. 

FRA Is Pursuing Several Initiatives to Improve the Detection and 
Management of Track Defects: 

Railroads operate trains on about 219,000 miles of track across the 
United States. This track consists of traditional jointed rail as well 
as newer rails that are smooth bands of welded steel, called continuous 
welded rail. Derailments can occur when rails are uneven or too wide 
apart or when rails or joint bars are cracked or broken. FRA inspects 
track conditions through manual inspections conducted on-foot or in on- 
track equipment, and with automated track inspection vehicles that 
precisely measure track and can identify problems that are difficult to 
detect through other types of inspections. The agency operates one 
automated track inspection vehicle that it uses in inspecting track and 
plans to add two more for this purpose in early 2007.[Footnote 26] 
According to FRA, these additional vehicles will allow the agency to 
triple the miles of track that it is able to inspect per year, to 
nearly 100,000 miles.[Footnote 27] 

FRA is also developing an automated inspection system for improving the 
detection of cracks in joint bars. Such cracks can lead to a derailment-
causing break but can be difficult to detect through simple visual 
inspections. Specifically, FRA has designed and is refining a high-
resolution video inspection system that can be used in on-track 
inspection equipment and will improve detection of these 
defects.[Footnote 28] According to FRA, the technology is ready for 
use, was demonstrated and refined in the field in 2006, and will 
undergo further enhancements in 2007. The agency expects that railroads 
will make use of the technology and is reviewing how to use it in its 
own inspections. According to FRA, one Class I railroad is starting to 
make use of this technology and others have shown strong interest in 
it. 

Finally, in response to a congressional mandate and NTSB 
recommendations, FRA has recently finalized regulations that require 
track owners to conduct detailed and periodic inspections of rail 
joints in continuous welded rail track. Although FRA issued regulations 
in 1998 requiring railroads to develop and implement procedures for the 
inspection and maintenance of continuous welded rail track, a number of 
train accidents occurred since that time in which the failure of a rail 
joint on this type of track was a factor.[Footnote 29] FRA officials 
told us that the railroads' overall management of the condition of 
continuous welded rail track is a major concern for the agency because 
about 20 accidents involving problems with this type of track occur per 
year and these accidents are usually serious. FRA has estimated that 
continuous welded rail track represents between 99,000 and 120,000 
miles of the 219,000 miles of track in operation in the United States. 
The agency is working with the Railroad Safety Advisory Committee to 
develop additional regulations to improve railroads' management of this 
type of track. 

These initiatives have the potential to reduce accidents caused by 
track defects. FRA's deployment of two new track inspection vehicles in 
early 2007 will enable the agency to significantly expand its ability 
to monitor the condition of the nation's track. The agency's 
development of an automated inspection system has the potential to help 
prevent derailments, provided that railroads make use of this 
technology. Finally, FRA's issuance of new regulations related to 
continuous welded rail track and development of further regulations in 
this area should eventually improve railroads' management of this type 
of track, although time frames for the development of new regulations 
are not yet clear. 

FRA Has Made Progress in Targeting Its Inspections on the Basis of 
Risk: 

Like other modal safety administrations within the Department of 
Transportation, FRA has few resources for overseeing railroads compared 
with the scope of its responsibility. According to agency officials, it 
inspects 0.2 percent of railroad operations per year. FRA has developed 
a new approach--the National Inspection Plan--for using available data 
to target its inspections at the greatest safety risks. The agency 
began using the new approach for three of its inspection disciplines 
(operating practices, track, and motive power and equipment) in October 
2005 and expanded it to the remaining two disciplines (hazardous 
materials and signal and train control) by March 2006. The purpose of 
the plan is to optimize FRA's ability to reduce the rates of various 
types of train accidents as well as releases of hazardous materials. 
The plan provides guidance to each regional office on how its 
inspectors, who each specialize in one of the five inspection 
disciplines, should divide up their work by railroad. 

Developing the plan involves two steps. In the first step, FRA 
headquarters produces an initial plan for each of the agency's eight 
regions. This plan specifies, by inspection discipline, numeric goals 
for the level of inspection activity to allocate to each railroad, by 
state. These numeric goals are derived from models--based on trend 
analyses of accident, inspection, and other data--that predict, by 
inspection discipline, locations where train accidents and incidents 
are likely to occur within each region and provide the optimal 
allocation of inspection resources to prevent accidents.[Footnote 30] 
FRA has developed separate models for each inspection discipline based 
on how well individual data elements, such as historical information on 
inspection results, tend to predict accidents. According to FRA 
officials, they expect to refine this new planning process to reflect 
lessons learned during the first year of its implementation. 

In the second step, the regional administrators are allowed to adjust 
the goals for their region on the basis of local knowledge and emerging 
issues, such as recent accidents. However, according to FRA officials, 
there were only a few such adjustments for fiscal year 2006. Throughout 
the year, FRA monitors how the regions are meeting their goals. 
Starting in fiscal year 2007, regional administrators will have a 
second opportunity to adjust their inspection plans at midyear to 
respond to safety issues that emerged during the first 6 months of the 
year. 

Previously, FRA had a less structured, less consistent, and less data- 
driven approach for planning inspections. According to agency 
officials, each region prepared its own inspection plan, based on 
judgments about appropriate priorities and analysis of available data. 
However, the use of data was not consistent from region to region. 
Inspectors had greater discretion about where to inspect and based 
decisions about priorities on their knowledge of their inspection 
territories. 

The National Inspection Plan covers federal inspectors, but not state 
inspectors. Other than funding training and computer equipment, FRA 
does not provide funding for state inspection activities.[Footnote 31] 
Therefore, each state makes its own decisions about how to use its 
inspectors. FRA officials told us that the agency has not included 
states in the National Inspection Plan because it does not have 
authority to tell the states what inspections to conduct. The 30 states 
that participate in FRA's state program have varying numbers of 
inspectors and most conduct inspections in some, but not all, of FRA's 
five inspection disciplines. According to FRA, its regional offices 
coordinate with the states in their region to avoid duplication of 
effort. The regional administrators may make adjustments to their 
National Inspection Plan goals based on the work of state inspectors 
within their region. 

The National Inspection Plan also does not establish priorities across 
regions and inspection disciplines, but rather, for given staffing 
levels for each discipline within each region, assigns inspection 
levels to railroads and states. However, FRA eventually plans to use 
its results to help decide how to optimally allocate additional 
inspectors, as vacancies occur or new positions are funded. According 
to headquarters officials, the National Inspection Plan model played a 
role in a decision to allocate additional inspection staff to the 
operating practices discipline in the regions.[Footnote 32] However, 
officials told us that they will need more time to determine how well 
the plan is working before using it to reallocate resources among the 
regional offices. 

The fiscal year 2006 plan resulted in various reallocations of 
inspection activity within FRA's regional offices. These reallocations 
have allowed FRA to better target its inspections on the basis of risk. 
For example, in the track area, in some cases regions are focusing more 
attention on certain railroads that have higher accident rates and 
worse track conditions than others. Conversely, in the area of 
operating practices, some regional offices have decreased their focus 
on certain railroads that have shown good or improving performance in 
this area compared with other railroads. 

In fiscal year 2006, in addition to implementing the National 
Inspection Plan, the agency implemented a new coordinated approach for 
planning nonroutine inspection activity, by inspection discipline. 
Examples of these types of inspections include in-depth inspections by 
a regional office of a railroad's compliance with track standards; 
interregional inspections of compliance with certain regulations, such 
as those related to bridge safety, of a Class I railroad that operates 
in multiple regions; and headquarters-led inspections of Class I 
railroads' drug and alcohol testing programs. Some of these planned 
inspections are based on analyses of data on accidents by railroad, 
accident causes, and inspection results in order to define, beyond the 
National Inspection Plan goals, what railroad locations and specific 
regulatory requirements warrant increased attention by inspectors. 
Others, such as inspections of some required railroad safety programs, 
are performed periodically. According to FRA officials, the regional 
offices and headquarters previously planned such inspections separately 
and made less use of data in their planning. Under this new planning 
approach, FRA headquarters and regional offices coordinate in 
developing plans for inspections they will conduct, by inspection 
discipline. These plans are compiled into an agencywide plan, and then 
FRA tracks the completion of these inspections. 

FRA's new approaches for planning its inspection activity allow it to 
better target the greatest safety risks and coordinate inspection 
planning among its eight regional offices and headquarters offices. 
Therefore, they allow FRA to make more effective use of its inspectors. 
However, it is not yet clear whether these new planning approaches will 
lead to a prioritization of inspection levels across regions and 
inspection disciplines or improved safety. 

FRA Relies Primarily on Direct Inspections to Identify Safety Problems 
and Does Not Oversee Railroads' Management of Safety Risks: 

In carrying out its safety oversight, FRA identifies safety problems on 
railroad systems mainly through routine inspections to determine 
whether operations, track, and equipment, such as signals and 
locomotives, are in compliance with safety standards. Through this 
approach, FRA inspectors identify a range of safety problems at various 
sites on railroads' systems, through citing defects and violations. FRA 
also identifies some broad-scale compliance problems that affect 
multiple sites, mainly through analyses of accident and inspection 
data, internal discussions, and some nonroutine inspections. 

FRA's inspections focus on compliance with minimum standards within 
five separate inspection disciplines and do not attempt to determine 
how well railroads are managing safety risks on their systems. APTA, 
PHMSA, and Transport Canada have implemented approaches to oversee the 
management of safety risks by U.S. commuter railroads, U.S. pipelines, 
and Canadian railroads, respectively. These oversight approaches 
complement, rather than replace, traditional compliance inspections and 
therefore provide additional assurance of safety. However, we are not 
recommending that FRA adopt such an oversight approach, since the 
agency is currently pursuing various initiatives to reduce train 
accident rates. In our view, these initiatives need time to mature to 
demonstrate their effects and, subsequently, an informed assessment 
would need to be made about whether additional actions are warranted. 

FRA's Oversight Identifies a Range of Site-Specific and Broad-Scale 
Problems on Railroad Systems: 

Overseeing the safety of the railroad industry is a huge task. FRA's 
400 inspectors, along with about 160 state inspectors, oversee 686 
railroads, with about 235,000 employees, 219,000 miles of track, 24,000 
locomotives, 1.6 million cars, 158,000 signals and switches, and 
240,000 highway-rail grade crossings.[Footnote 33] As noted previously, 
according to FRA officials, the agency's inspectors are able to 
directly observe only about 0.2 percent of the railroad industry's 
operations per year. FRA carries out this oversight responsibility 
primarily through inspections of railroads' compliance with its safety 
standards at various locations on railroads' systems and through 
cooperation and enforcement aimed at resolving identified problems. 
During inspections, which are generally conducted separately within the 
five inspection disciplines, inspectors examine railroads' compliance 
with a broad range of federal standards. Inspectors discuss identified 
compliance problems (called defects) with railroads to achieve 
voluntary compliance, and cite violations--recommending that the agency 
take enforcement action against a railroad--when they determine that 
the problems are serious or when a railroad does not voluntarily 
comply. (See app. II for a description of FRA's use of cooperation and 
enforcement to resolve safety problems and improve safety.) In 
addition, FRA's Railroad System Oversight managers work with Class I 
railroads and labor to identify and resolve some safety problems that 
are not directly related to compliance with the agency's regulations. 
For example, one manager worked with a railroad and labor organization 
to improve the railroad's program for communicating with roadway 
workers to ensure that they are aware of and implement key safety 
procedures. 

FRA primarily monitors railroads' compliance through routine 
inspections by individual inspectors at specific sites on railroads' 
systems.[Footnote 34] As discussed previously, FRA inspects locations 
likely to have safety problems, which it identifies using accident and 
previous inspection data as well as other information. Inspectors 
typically cover a range of standards within their discipline during 
these inspections. This inspection approach focuses on direct 
observations of specific components of the train, related equipment, 
and railroad property--including the track and signal systems--as well 
as operating practices to determine whether they meet FRA's standards. 
(See figs. 6 and 7.) Inspectors also examine railroads' inspection and 
maintenance records. The railroads have their own inspectors who are 
responsible for ensuring that railroad equipment, track, and operations 
meet federal rail safety standards. For example, FRA requires that 
railroads inspect brake systems, signal systems, passenger equipment, 
track conditions, and train crews' adherence to operating rules, among 
other things. According to FRA officials, the agency's inspectors often 
review the railroads' records of inspection to determine whether the 
records accurately represent the types of problems FRA inspectors are 
finding during their own inspection activities. 

Figure 6: FRA Inspector Measuring Track Gauge: 

[See PDF for image] 

Source: FRA. 

[End of figure] 

Figure 7: FRA Inspector Inspecting Train Cars: 

[See PDF for image] 

Source: FRA. 

[End of figure] 

FRA also conducts more in-depth inspection efforts that generally focus 
on railroads' compliance in a particular area, such as their 
inspections of employees' adherence to operating rules. These efforts 
often involve a team conducting separate inspections at multiple sites, 
generally within one of FRA's eight regions.[Footnote 35] FRA focuses 
these in-depth inspection efforts on emerging issues, identified 
through previous routine inspections or analyses of accident data. FRA 
also periodically conducts in-depth inspections of some systemwide 
programs that the railroad is required to implement, such as employee 
drug and alcohol testing programs and accident and incident reporting 
programs. In some cases, FRA may conduct a systemwide in-depth set of 
inspections on a railroad to determine its overall compliance within a 
single inspection discipline or in several disciplines. For example, in 
early 2006, in response to a Class I railroad's high accident rates, 
FRA conducted an in-depth set of inspections of the railroad's 
compliance with operating practices, track, signal and train control, 
motive power and equipment, and hazardous materials regulations across 
its system. However, according to an FRA headquarters official, the 
agency does not frequently perform systemwide or multidisciplinary 
inspections. 

In 2005, federal and state inspectors conducted a total of about 63,000 
inspections.[Footnote 36] According to FRA, routine inspections 
constituted about 75 percent of the inspections of railroads and in- 
depth inspections accounted for about 11 percent. The remainder of 
these inspections (14 percent) consisted of other types of activities, 
such as investigations of accidents and complaints. Inspectors in the 
track discipline performed the most inspections, followed by those in 
the motive power and equipment, operating practices, hazardous 
materials, and signal and train control disciplines.[Footnote 37] This 
approach to oversight enables FRA inspectors and managers to identify a 
wide range of safety problems. Inspectors identify specific compliance 
problems--conditions that do not meet FRA's standards--at sites they 
visit by citing defects. Inspectors cite violations for those defects 
that they believe warrant enforcement action. They consider a number of 
factors in making this decision, including the railroad's history of 
compliance at that location and the seriousness of the noncompliance 
(such as whether it is likely to cause accidents, injuries, or releases 
of hazardous materials). Inspectors in some disciplines cite more 
defects and violations than others. (See fig. 8.) Overall, FRA and 
state inspectors cited about 293,000 defects and about 9,500 violations 
during the 63,000 inspections conducted in 2005. 

Figure 8: Inspections Conducted and Defects and Violations Cited, by 
Inspection Discipline, in 2005: 

[See PDF for image] 

Source: GAO analysis of FRA data. 

Note: These figures include inspections carried out by both federal and 
state inspectors. Inspectors are instructed to cite defects for most 
instances of noncompliance found, but have discretion in determining 
which instances to cite as violations warranting enforcement action. 

[End of figure] 

The motive power and equipment discipline cites almost half of all 
defects and over a third of all violations. FRA officials told us that 
the standards in this inspection discipline are the most prescriptive, 
making defects and violations easier to find. However, these types of 
defects cause a much smaller proportion of accidents than human factors 
and track defects.[Footnote 38] (See fig. 4.) The most frequently cited 
violations include those for noncompliance with standards regarding 
locomotives and freight cars, track conditions, recordkeeping on the 
inspection and repair of equipment and track, and the condition of 
hazardous materials tank cars. 

While individual defects and violations are generally for compliance 
problems identified at specific locations on railroads' systems, FRA 
also identifies broad-scale compliance problems, by inspection 
discipline, that affect multiple locations on a railroads' system. It 
does so mainly through analyses of accident data and data on defects 
and violations found during inspections, communications among managers 
at headquarters and in its eight regional offices on the results of 
analyses and inspections, and further inspections to obtain more 
information about identified problems. Agency officials told us that 
they hold frequent internal discussions about emerging issues to 
determine where problems are occurring and plan actions that the agency 
should take to address them. The agency's Railroad System Oversight 
managers support this effort by analyzing systemwide accident and 
inspection data, by inspection discipline, for the Class I railroads to 
identify trends and emerging issues. FRA may plan and conduct in-depth 
inspections to determine the scope of such issues. For example, if the 
rate of human factor accidents has increased at various locations on a 
railroad's system, FRA may conduct inspections of operating practices 
at these locations. 

Examples of broad-scale problems FRA has identified at railroads 
include weak implementation within a particular state of a program for 
monitoring employees' adherence to operating rules, poor inspections by 
a railroad of its track in a particular region, systemic problems in 
reporting accidents and incidents, and defective equipment across a 
railroad's system. In some cases, FRA inspectors identify some higher- 
level management issues, such as a lack of supervision or inadequate 
training of railroad personnel, which could have led to the compliance 
problems. According to FRA officials, they discuss broad-scale 
compliance problems with railroad officials to try to get these 
problems resolved. For example, after an in-depth inspection, 
inspectors meet with railroad managers to discuss overall problems 
found and, according to headquarters officials, usually provide a 
written summary of those problems. Efforts to cooperate with the 
railroad to resolve broad-scale problems may be combined with 
enforcement actions, usually civil penalties, for specific violations 
identified at individual sites. According to FRA officials, the agency 
always conducts follow-up on serious problems it has identified to 
ensure that they are resolved.[Footnote 39] 

While FRA does track and maintain data on various types of train 
accidents and incidents as well as defects and violations cited by 
inspectors and enforcement actions taken, the agency does not centrally 
track the broad-scale compliance problems it has identified.[Footnote 
40] These problems are described in some agency documents, such as 
inspectors' summary reports on findings of in-depth inspection efforts; 
various reports prepared by the Railroad System Oversight managers on 
the Class I railroads;[Footnote 41] and the agency's overall plan, by 
region and inspection discipline, for its nonroutine inspection 
activity. As explained in the next section, this lack of centralized 
tracking can impede the ability of the agency to measure the 
effectiveness of its efforts to resolve identified broad-scale 
problems. 

FRA's five Railroad System Oversight managers also identify some broad 
safety problems at Class I railroads that are not related to 
compliance. They identify these problems mainly through contacts with 
labor and railroad officials and FRA regional officials and try to 
address them through cooperation with the railroad. For example, these 
managers have worked with railroads in addressing labor's concerns 
about practices for transporting train crews at the end of their shifts 
that may worsen fatigue and programs for training employees on the 
railroads' operating rules. In some cases, these problems were first 
identified under the Safety Assurance and Compliance Program. 

Several Other Organizations Have Implemented Comprehensive Approaches 
for Overseeing the Management of Safety Risks in Transportation 
Industries: 

FRA officials have noted that their approach of directly inspecting 
safety conditions and targeting locations that are most likely to have 
compliance problems provides a safety net and holds railroad management 
accountable. However, because the number of FRA and state inspectors is 
small relative to the size of railroad operations, FRA inspections can 
cover only a very small proportion of railroad operations (0.2 
percent). Also, FRA targets inspections at locations on railroads' 
systems where accidents have occurred, among other factors, rather than 
overseeing whether railroads systematically identify and address safety 
risks that could lead to accidents. 

Rail transportation poses a variety of potential safety hazards, 
including collision or derailment; injury to workers, passengers, or 
nearby residents; and damage to property or the environment. Risk 
management is a systematic approach for dealing with the risks posed by 
such safety hazards and has been used in the private and public sectors 
for decades. It can be described as a continuous process of managing-- 
through the systematic identification, analysis, and control of risks 
associated with hazards (or threats)--the likelihood of their 
occurrence and their negative impact.[Footnote 42] A framework for risk 
management based on industry best practices and other criteria that we 
have developed divides risk management into five major phases: (1) 
setting strategic goals and objectives, and determining constraints; 
(2) assessing risks; (3) evaluating alternatives for addressing these 
risks; (4) selecting the appropriate alternatives; and (5) implementing 
the alternatives and monitoring the progress made and results 
achieved.[Footnote 43] Risk management can help to improve systemwide 
safety by systematically identifying and assessing risks associated 
with various safety hazards and prioritizing them so that resources may 
be allocated to address the highest risks first. It also can help in 
ensuring that the most appropriate alternatives to prevent or mitigate 
the effects of hazards are designed and implemented. 

Other transportation oversight organizations have developed and 
implemented approaches for overseeing industries' overall management of 
safety risks. In particular, during the last 10 years, APTA, PHMSA, and 
Transport Canada have developed and implemented such oversight 
approaches for U.S. commuter railroads, U.S. pipelines, and Canadian 
railroads, respectively. These approaches complement, rather than 
replace, traditional compliance inspections. APTA established a U.S. 
commuter railroad oversight program in 1996, in partnership with FRA 
and the commuter rail industry, that supplements FRA's inspections of 
these railroads.[Footnote 44] Under this program, APTA provides 
guidelines to these railroads on managing the safety of their systems-
-including safety risks--and audits their plans for and implementation 
of this management approach. Beginning in 2000, PHMSA issued a series 
of requirements for pipeline operators to develop "integrity 
management" programs to manage risk in areas--such as those that are 
densely populated--where leaks or ruptures could have the greatest 
impact on public safety.[Footnote 45] The agency's integrity management 
regulations supplement its minimum safety regulations, and it inspects 
operators' compliance with both types of standards. In Canada, the 
department responsible for overseeing railroad safety, Transport 
Canada, in 2001 began requiring that railroads establish safety 
management systems that include risk management.[Footnote 46] Transport 
Canada assesses these systems as well as railroads' compliance with its 
traditional safety standards.[Footnote 47] (For further information on 
GAO's risk management framework and these oversight approaches, see 
app. III.) 

These oversight approaches are intended to provide additional assurance 
of safety beyond that provided by inspections of compliance with 
minimum safety standards. They supplement uniform, minimum standards by 
encouraging or requiring companies to identify and address their unique 
safety risks. APTA, PHMSA, and Transport Canada have emphasized that 
risk management provides a higher standard of performance than 
traditional safety regulation based on compliance alone. According to 
APTA officials, their approach helps companies to prioritize their 
actions for addressing risk and therefore optimize safety within 
constraints of their resources. According to PHMSA officials, pipeline 
companies' compliance with the agency's traditional regulations ensures 
minimum safety performance, but its integrity management approach has 
improved the ability of these companies to systematically address the 
full range of safety threats to their pipelines. According to Transport 
Canada officials, by encouraging systemwide improvements in companies' 
safety performance in order to address systemic causes of specific 
problems, its new approach helps the agency to leverage its resources. 
Transport Canada has emphasized that risk management ensures that risks 
are being adequately addressed and should point railroads to areas 
where they could undertake initiatives beyond their current practices 
that could improve their overall safety performance. Transport Canada 
officials also told us that a primary objective of their new approach 
is for railroads to assume more responsibility for the safety of their 
operations. Similarly, APTA officials told us that their oversight 
approach is proactive because it encourages companies to identify and 
address potential hazards before accidents occur. 

We have reviewed PHMSA's gas transmission pipeline integrity management 
oversight approach and have recently concluded that it enhances public 
safety.[Footnote 48] We also found that representatives from the 
pipeline industry, safety advocacy groups, and state agencies generally 
agree that this approach improves public safety. Operators told us that 
the primary benefit of the program is the comprehensive knowledge they 
acquire about the condition of their pipelines. APTA and Transport 
Canada officials have told us that their oversight approaches have not 
been formally evaluated to determine their effectiveness. However, 
according to FRA officials, APTA's system safety oversight approach has 
strengthened safety program management in the commuter rail sector. 
Finally, Transport Canada is expanding its safety management system 
approach to its oversight of civil aviation. 

While FRA does not oversee railroads' overall approach for managing 
safety risks on their systems, it has taken some steps in a limited 
number of areas to oversee and encourage risk management in the 
railroad industry. For example, the agency has several regulations in 
place that require railroads to use a risk-based approach for managing 
safety in specific areas: the operation of high-speed passenger trains, 
the fire safety of new passenger cars and locomotives, and the adoption 
of new processor-based signal and train control technologies. In 
addition, PHMSA, in consultation with FRA and the Transportation 
Security Administration, has recently proposed a regulation that could 
lead to greater FRA oversight of railroads' management of hazardous 
materials risks.[Footnote 49] FRA has also issued guidance for 
passenger railroads on assessing collision hazards and risks and 
developing strategies for addressing them.[Footnote 50] In addition, 
FRA is currently working with APTA and some commuter railroads to 
improve these railroads' abilities to conduct collision hazard 
analyses. Finally, as discussed earlier, FRA is considering 
establishing a pilot project to examine how a risk management approach 
could be used in the railroad industry, on a voluntary basis, to reduce 
human factor accidents as well as other types of accidents. 

Although FRA is taking some steps to encourage increased use of risk 
management in the railroad industry, oversight of railroads' overall 
approach for managing safety risks on their systems, in addition to 
FRA's existing discipline-specific compliance-based oversight, has the 
potential to provide additional assurance of safety. Such an approach 
could help to ensure that railroads systematically identify and address 
the full range of risks on their systems and could also encourage 
railroads to take on more responsibility for safety. According to 
agency officials, FRA is concerned that railroads too often wait for 
inspectors to show up before addressing problem areas, while FRA would 
prefer that they find and fix problems on their own. However, 
developing and implementing such a new oversight approach would be a 
major undertaking for the agency and would also require the support and 
participation of the railroad industry. 

While we believe that adopting a comprehensive approach for overseeing 
railroads' management of safety risks, similar to the approaches 
discussed in this section, can lead to improved safety, we are not 
making a recommendation aimed at encouraging FRA to adopt such an 
oversight approach. As discussed in the previous section, FRA is 
pursuing several initiatives aimed at reducing train accident rates. In 
our view, these initiatives need time to mature to demonstrate their 
effects and, at the appropriate time, the department may wish to 
conduct an informed assessment to determine whether additional actions 
are warranted. 

FRA Measures Its Progress in Achieving a Variety of Safety Goals, but 
Has Limited Information on the Direct Results of Its Oversight: 

FRA has a broad range of goals and measures that it uses to provide 
direction to and track the performance of its safety oversight 
activities. However, its ability to make informed decisions about its 
inspection and enforcement programs is limited because it lacks 
measures of the intermediate outcomes, or direct results, of these 
programs that would show how they are contributing toward the end 
outcomes, or ultimate safety improvements, that the agency seeks to 
achieve. Furthermore, while FRA has made some changes in its oversight 
approach in response to external and internal evaluations, it has not 
evaluated the effectiveness of its enforcement approach. Evaluations 
can provide a broader range of information on program performance and 
how to improve it than performance measures alone. Both performance 
measures and evaluations can provide valuable information on program 
results that helps hold agencies accountable for their programs' 
performance. 

FRA Has Established a Range of Safety Goals and Uses Cooperation and 
Enforcement to Achieve These Goals: 

To its credit, FRA has adopted a range of useful safety performance 
goals.[Footnote 51] These safety goals are useful because they help the 
agency target its oversight efforts to help achieve the department's 
goals of reducing (1) the rate of rail-related accidents and incidents 
and (2) the number of serious hazardous materials releases. For fiscal 
year 2007, FRA established six new agencywide safety goals that are 
aligned with its five inspection disciplines and its grade crossing 
efforts. These goals are to reduce the rates of (1) accidents caused by 
human factors; (2) accidents caused by track defects; (3) accidents 
caused by equipment failure; (4) accidents attributable to other 
causes, including signal defects; (5) hazardous materials releases; and 
(6) grade-crossing incidents. These departmental and agency goals 
represent the key end outcomes, or ultimate results, FRA seeks to 
achieve through its oversight efforts. The agency has also recently 
established regional office goals that are generally aligned with the 
new agencywide goals. These regional office goals help FRA to link the 
oversight activities of its eight regional offices with its overall 
goals. 

FRA officials told us that their inspection and enforcement programs 
contribute to meeting these safety goals, or end outcomes, by resulting 
in the correction of safety problems and compliance.[Footnote 52] These 
desired direct results can be called the intermediate outcomes of the 
inspection and enforcement programs, although FRA has not identified 
them as such. FRA officials told us that they use a combination of 
cooperation with railroads and enforcement actions to achieve the 
correction of safety problems and compliance. The linkages between such 
program outputs and desired intermediate and end outcomes can be 
demonstrated in a "logic model" that helps to show how program 
activities contribute to the ultimate results the agency seeks to 
achieve.[Footnote 53] (See fig. 9.) 

Figure 9: How FRA's Inspection and Enforcement Programs Contribute to 
Rail Safety: 

[See PDF for image] 

Source: GAO analysis of FRA information. 

Note: The program outputs and intermediate outcomes identified in this 
figure are examples of the outputs and intended direct results of FRA's 
inspection and enforcement and resulted from discussions with FRA 
officials. FRA has not identified these as outputs or intermediate 
outcomes. In addition to the agency's inspection and enforcement 
efforts, its Railroad System Oversight managers work cooperatively with 
the Class I railroads to achieve safety improvements not related to 
compliance. 

[End of figure] 

FRA uses cooperation with railroads and enforcement actions in various 
ways to resolve safety problems and achieve compliance. As explained 
previously, problems identified in inspections can be site-specific 
compliance problems or broader problems affecting multiple sites. 
Inspectors try to resolve site-specific compliance problems found 
during routine inspections by discussing defects with railroad 
officials in order to achieve voluntary compliance. The agency's policy 
of focused enforcement requires that inspectors cite violations and 
recommend enforcement actions, most frequently civil penalties, for 
those compliance problems that pose the greatest safety hazards. 
Enforcement actions can require railroads to correct identified 
compliance problems as well as deter future noncompliance. After in- 
depth inspection efforts at multiple sites, inspectors meet with 
railroad managers to discuss overall findings of safety problems that 
need to be corrected to achieve compliance. FRA sometimes encourages or 
requires railroads to make broad-scale improvements, such as in the 
training of railroads' track inspectors, which could help a railroad to 
comply with the agency's standards. (See app. II for more information 
on how FRA uses cooperation and enforcement to improve safety.) 

Performance Measures Support FRA's Oversight, but Information on Direct 
Results Is Limited: 

Consistent with the Government Performance and Results Act of 1993, 
which calls on federal agencies to develop performance measures to help 
determine the extent to which intended outcomes are achieved, FRA has 
developed a range of performance measures that it uses to track the 
progress of--and provide direction to--its safety oversight 
programs.[Footnote 54] (See table 3.) A number of these measures 
provide useful information about the extent to which various desired 
end outcomes, or ultimate results, are being achieved. In particular, 
FRA has developed a number of measures, based on agency and regional 
goals, that capture important components of its progress in achieving 
the department's overall safety goals. Since these new measures are 
linked to inspection and enforcement activities of its inspection 
disciplines and regional offices, they can provide some useful 
information on progress in achieving the desired end outcomes. For 
example, the agency expects that inspection and enforcement efforts in 
the operating practices discipline will reduce accidents caused by 
human factors, and it tracks the extent to which these accidents are 
reduced, both at the national and the regional level. 

Table 3: FRA's Safety Performance Measures: 

Type of measure: End outcomes: Departmental safety goals; 
Description: Rate of rail- related accidents and incidents[A] and 
number of serious hazardous materials releases. 

Type of measure: End outcomes: Agency safety goals; 
Description: Rates of train accidents caused by human factors, track 
defects, equipment defects, or other (signal and miscellaneous) causes; 
rate of nonaccident rail- related hazardous materials releases; and 
rate of highway-rail grade crossing incidents. 

Type of measure: End outcomes: Regional office safety goals; 
Description: By region, numbers of train accidents caused by human 
factors, track, equipment, and other causes and numbers of highway-rail 
grade crossing incidents. 

Type of measure: End outcomes: Class I railroad safety performance 
trends; 
Description: Trends in rates of accidents of various types for each 
Class I railroad. 

Type of measure: Program outputs and management: Agency efficiency 
goal; 
Description: Ratio of safety budget expenditures on safety-related 
activities, such as inspections, versus administrative activities. 

Type of measure: Program outputs and management: Management of 
inspection and enforcement activities; 
Description: 
* Various measures used in targeting inspections and determining 
enforcement actions, including trends in various types of accidents and 
employee injuries and cited defects and violations, by inspection 
discipline, region, state, and railroad; 
* Inspections conducted and costs by region and inspection discipline; 
* Extent to which regions are meeting planned targets for inspections; 
* Timeliness of reports received from railroads on actions taken to 
remedy violations[B]; 
* Measures related to enforcement, including civil penalties assessed 
and collected and processing times. 

Source: GAO analysis of FRA information. 

[A] Includes train accidents as well as grade-crossing, trespassing, 
and other accidents. 

[B] For those violations requiring corrective action, railroads are 
required, within 30 days after the end of the month in which the 
violation occurred, to notify FRA of the actions they have taken. 

[End of table] 

The agency has adjusted its oversight approach in response to trends in 
end outcome measures. For example, it developed the National Rail 
Safety Action Plan in response to a flat trend in the overall train 
accident rate and an increasing rate of accidents caused by human 
factors. In addition, FRA has developed measures to track the 
performance of Class I railroads, and it reviews these measures 
quarterly to assist in making decisions about oversight of these 
railroads. 

FRA also uses various measures of program outputs, such as numbers of 
inspections and enforcement actions, as well as some other types of 
measures to manage its oversight efforts. While the agency does not 
track its cooperative efforts to achieve compliance, it does track 
inspection and enforcement activities. In fiscal year 2007, the agency 
will start using an efficiency measure to track its progress in using 
its resources on safety-related activities, such as inspections, rather 
than on administrative activities. FRA headquarters and inspection 
staff use data on defects and violations cited in inspections, together 
with data on accidents and incidents, in planning inspection activities 
and making enforcement decisions. Finally, FRA tracks whether railroads 
report on actions taken to correct violations within the required time. 

While FRA has developed a range of measures of end outcomes and program 
outputs, it lacks measures of the desired intermediate outcomes, or 
direct results, of its inspection and enforcement efforts--that is, the 
correction of identified safety problems and compliance. We have found 
that it is a useful practice for agencies to establish measures of 
intermediate outcomes to help show programs' contributions to desired 
end outcomes.[Footnote 55] According to FRA officials, inspectors 
review reports on corrective actions provided by railroads and may ask 
a railroad to resubmit a report if they believe that it does not 
adequately address the violation.[Footnote 56] FRA officials also told 
us that inspectors always follow up on serious problems identified-- 
both site-specific and broader scale problems--to ensure that they are 
corrected, and may cite additional violations if they find continuing 
problems.[Footnote 57] However, the agency does not measure the extent 
to which identified safety problems have been corrected. Without such a 
measure, FRA cannot determine the extent to which its inspection and 
enforcement efforts are achieving the desired direct results. 

Measuring whether safety problems have been corrected is particularly 
important when serious compliance problems are broad-scale, affecting 
multiple sites, whether the problems are local, regional, or 
systemwide. These problems are sometimes identified in reports of in- 
depth inspections. For example, one set of track inspections of a Class 
I railroad at various sites within a region in early 2006 led to 
overall findings that these locations had deteriorating track 
conditions, that no repair work was scheduled, and that the railroad's 
track inspections were not adequate.[Footnote 58] According to FRA 
officials, headquarters managers and managers of the agency's eight 
regional offices frequently discuss serious safety problems, indicated 
by the results of field inspections and data analyses, to determine the 
scope of the problems and decide on actions the agency should take to 
ensure that railroads resolve them. However, while FRA tracks a variety 
of safety related data, it does not centrally track these broad-scale 
compliance problems or their status and therefore lacks overall 
information on the effectiveness of its efforts to ensure that they are 
resolved.[Footnote 59] 

FRA also lacks overall measures of railroads' compliance. FRA officials 
told us that, while defect rates (the ratio of defects found per units 
inspected) measure noncompliance found by inspectors, they cannot be 
used to produce statistically valid measures of railroads' overall 
level of compliance because inspections are focused on problem areas 
and FRA is not able to conduct enough inspections of railroads to 
ensure that it is getting a good measure of compliance.[Footnote 60] 
Officials have emphasized that the agency relies on inspectors' day-to- 
day oversight of and interaction with railroads to track compliance. 
Also, as noted previously, FRA officials, both at the headquarters and 
regional levels, analyze defect data in each inspection discipline to 
identify emerging issues and plan inspection activity. Finally, 
officials noted that the agency is planning to use its automated track 
inspection vehicles to survey most of the national track system and to 
monitor improvements in the condition of track over time. 

We recognize that developing measures of intermediate outcomes would be 
difficult and that it is challenging for regulatory agencies to develop 
such measures.[Footnote 61] Nevertheless, some other regulatory 
agencies in the Department of Transportation have developed such 
measures. For example, the Federal Motor Carrier Safety Administration 
measures the percentage of truck companies that improve their 
performance in a follow-up inspection and PHMSA measures the extent of 
improvement in pipeline operators' integrity management programs, as 
indicated by successive inspections of operators' programs. FRA 
officials have told us that the fact that the agency has not integrated 
its existing safety-related databases has impeded its ability to 
develop measures of intermediate outcomes. The agency has an initiative 
underway to better integrate these databases, including its database on 
accidents and incidents and its inspection and enforcement databases, 
in order to better manage its information resources.[Footnote 62] 

Performance measures should provide agency managers with information 
that helps them make decisions that improve program performance, 
including decisions to adjust policies and priorities. As noted, FRA 
has used its existing performance measures to make decisions about its 
oversight approach in a variety of ways. However, not having measures 
of the intermediate outcomes of its inspection and enforcement 
approaches limits FRA's ability to make informed decisions about these 
approaches and adjust them to improve performance. Intermediate outcome 
measures can provide more timely information on program performance 
than end outcome measures, because it may take longer for program 
efforts to affect end outcomes. 

Measures of program results can also help hold agencies accountable for 
the performance of their programs. Congress needs information on 
program results to support its oversight of agencies and their budgets. 
FRA's new discipline-specific and region-specific outcome measures do 
help ensure accountability for results. However, without measures of 
intermediate outcomes, the extent to which FRA's inspection and 
enforcement programs are achieving direct results and contributing to 
desired end outcomes is not clear. FRA officials have noted that they 
cannot attribute any drops in accident rates solely to FRA's efforts 
because other factors, such as railroads' investments in their systems, 
also play an important role. 

FRA can also use measures of intermediate outcomes to increase 
railroads' accountability for correcting safety problems. In spring 
2006, the agency instituted annual meetings with the heads of the Class 
I railroads to discuss their overall safety performance, using trends 
in various accident rates. These meetings are a good step forward for 
the agency because they represent an opportunity for FRA to put 
pressure on top railroad executives to adequately address major 
problems the agency has identified. However, without measures of the 
extent to which individual railroads have addressed such problems, FRA 
cannot take full advantage of this opportunity. In addition, without 
central tracking of these problems and their status, FRA's ability to 
identify continuing or recurring problems as well as interrelated 
problems and make appropriate enforcement decisions may be impaired, 
especially since much of this work is performed in eight separate FRA 
regional offices and in five separate inspection disciplines.[Footnote 
63] According to FRA, annual meetings with the major railroads to 
negotiate civil penalties focus on individual violations but also 
address systemic issues that have been identified through analysis of 
individual violations. However, regional officials told us that these 
meetings do not generally deal with systemic issues. Readily available 
information on the status of broader problems would help put a 
railroad's individual violations into perspective and could help ensure 
that FRA negotiates appropriate final amounts with railroads. 

FRA Has Made Changes in Response to Evaluations but Has Not Evaluated 
Its Enforcement Approach: 

Besides requiring performance measurement, the Government Performance 
and Results Act of 1993 calls for agencies to evaluate the 
effectiveness of their programs in achieving intended outcomes. We have 
found that, since it can be challenging for regulatory agencies to 
measure the direct results of their programs, program evaluations are 
particularly helpful in determining these results.[Footnote 64] Program 
evaluations are objective, systematic studies that answer questions 
about program performance and results. By examining a broader range of 
information than is feasible to monitor on an ongoing basis through 
performance measures, evaluation studies can explore the benefits of a 
program as well as ways to improve program performance. They can also 
be used to develop or improve agencies' measures of program performance 
and help ensure agencies' accountability for program results.[Footnote 
65] 

FRA's safety oversight activities have recently undergone several 
external evaluations by the department's Inspector General, as well as 
an internal review, and FRA has made some changes as a result. For 
example, on the basis of several reviews since 1998, the department's 
Inspector General in 2004 recommended that FRA develop a plan to make 
meaningful use of available data to focus its inspection and 
enforcement activity.[Footnote 66] FRA developed its National 
Inspection Plan in response. Also, in 2004, FRA established a committee 
to conduct an internal review of its Safety Assurance and Compliance 
Program. This committee solicited the views of various FRA managers on 
the strengths and weaknesses of the program. Based on its findings, FRA 
terminated this program and replaced it with its Railroad System 
Oversight program. 

In addition, the Office of Management and Budget assessed FRA's overall 
safety program in 2003.[Footnote 67] Although the office found this 
overall program to be moderately effective, it also found that FRA had 
not arranged for independent evaluations of its design and 
effectiveness. In response, FRA arranged for a review of its Railroad 
Safety Board process and has stated that it will continue to have 
regular independent reviews of various aspects of its safety 
program.[Footnote 68] The agency is planning to have an independent 
evaluation of its Railroad System Oversight program conducted in the 
third quarter of fiscal year 2007. FRA also made some other 
improvements in response to recommendations of the Office of Management 
and Budget assessment, including developing its new efficiency measure 
and procuring new vehicles for conducting track inspections. 

Although FRA has modified various aspects of its safety oversight in 
response to evaluations, it has not evaluated the extent to which its 
enforcement is achieving desired results. In addition to providing 
information on program performance and how it could be improved, an 
evaluation of FRA's enforcement approach could help to identify data 
needed to develop useful performance measures. For example, the Federal 
Motor Carrier Safety Administration examined the rate of violations by 
trucking companies before and after implementing a policy of assessing 
maximum penalties for such violations and, based on initial analyses, 
has improved its data system to be better able to analyze this trend. 

Under FRA's focused enforcement policy, developed in the mid-1990s, 
inspectors cite a small percentage of identified defects (about 3 
percent in 2005) as violations that they recommend for enforcement 
action, generally civil penalties. While this policy relies, to a great 
extent, on cooperation with railroads to achieve compliance and is 
intended to focus FRA's enforcement efforts on those instances of 
noncompliance that pose the greatest safety hazards, it is not clear 
whether the number of civil penalties issued, or their amounts, are 
having the desired effect of improving compliance. FRA officials have 
told us that they have not evaluated the effectiveness of civil 
penalties in ensuring compliance, noting that this would be difficult 
because penalty payments usually occur after the agency's yearly 
settlement process. However, without an evaluation of its enforcement 
program, FRA is missing an opportunity to obtain valuable information 
on the performance of this program and on any need for adjustments to 
improve this performance. 

Conclusions: 

The various initiatives that FRA has begun in the past year and a half 
to better target its oversight--by addressing the main causes of train 
accidents and better focusing inspections on problem areas--hold 
promise for bringing down the train accident rate, reducing injuries, 
and saving lives. Some initiatives, such as reporting of close call 
incidents, encourage the railroad industry to address safety problems 
before they result in accidents. However, the success of many of these 
initiatives will depend on voluntary actions by the railroads and their 
overall safety impact will likely not be apparent for a number of 
years. While FRA is pursuing these initiatives, it has not changed its 
approach for conducting inspections, which relies primarily on direct 
observations of operations, equipment, and track. An additional 
approach that has provided additional assurance of safety in the U.S. 
commuter railroad, U.S. pipeline, and Canadian railroad industries is 
oversight of companies' overall management of safety risks. Although we 
believe that a similar approach could help improve rail safety, we are 
not recommending that FRA adopt such an approach because its current 
initiatives to bring down the train accident rate need time to 
demonstrate their effects. 

Without measures of the direct results of its inspection and 
enforcement programs, FRA cannot demonstrate how these programs are 
contributing to rail safety and lacks key information that could help 
it improve performance. This information could also help FRA hold 
railroads accountable for addressing safety problems it identifies. 
While these measures are not always easy to develop, at least one other 
modal administration within the department has done so at our 
recommendation. Coupled with better measures of FRA's direct results is 
the need to assess the effectiveness of its enforcement program, 
especially its use of civil penalties, to understand the degree to 
which they contribute to improved safety outcomes and to determine 
whether it should adjust its approach to improve performance. 

Recommendations for Executive Action: 

To enhance FRA's ability to determine the extent to which its 
inspection and enforcement programs are contributing to rail safety and 
whether changes in these programs are needed, we recommend that the 
Secretary of Transportation direct the Administrator of FRA to take the 
following two actions: 

* develop and implement measures of the direct results of its 
inspection and enforcement programs; and: 

* evaluate the agency's enforcement program to provide further 
information on its results, the need for additional data to measure and 
assess these results, and the need for any changes in this program to 
improve performance. 

Agency Comments: 

We provided a draft of this report to the Department of Transportation 
for its review and comment. The department did not offer overall 
comments on the draft report or its recommendations. It did offer 
several technical comments, which we incorporated where appropriate. 

We are sending copies of this report to congressional committees and 
subcommittees with responsibility for transportation safety issues; the 
Secretary of Transportation; the Administrator, Federal Railroad 
Administration; and the Director, Office of Management and Budget. We 
will also make copies available to others upon request. This report 
will be available at no charge on the GAO Web site at [Hyperlink, 
http://www.gao.gov]. 

If you have any questions about this report, please contact me at (202) 
512-2834 or siggerudk@gao.gov. Contact points for our Offices of 
Congressional Relations and Public Affairs may be found on the last 
page of this report. Staff who made key contributions to this report 
are listed in appendix IV. 

Signed by: 

Katherine A. Siggerud: 
Director, Physical Infrastructure Issues: 

[End of section] 

Appendix I: Scope and Methodology: 

To determine how the Federal Railroad Administration (FRA) focuses its 
efforts on the highest priority risks related to train accidents in 
planning its safety oversight, we reviewed FRA's National Rail Safety 
Action Plan, plans for developing new regulations, documents related to 
its initiatives for reducing human factor and track-caused accidents, 
and inspection planning documents. We also discussed the agency's 
inspection planning approach and key initiatives with headquarters and 
regional officials responsible for these areas. In addition, we 
obtained information on FRA's initiatives through attending 
congressional hearings on FRA's oversight and meetings of the Railroad 
Safety Advisory Committee. 

To determine how FRA identifies safety problems on railroad systems in 
carrying out its oversight, we determined how FRA uses its inspections, 
the Railroad System Oversight program, and other oversight activities 
to oversee safety and identify problems. In order to do this, we 
reviewed FRA's regulations, policies, procedures, and guidance for 
conducting inspections and identifying safety problems as well as 
reports on inspection results. We also reviewed the agency's statutory 
authority under the Federal Railroad Safety Act and reviewed Railroad 
Safety Oversight program documents. We discussed FRA's oversight 
activities with FRA headquarters managers and inspection discipline 
specialists and Railroad Safety Oversight managers to gain a greater 
understanding of how FRA identifies safety problems on railroad 
systems. We also contacted three (Chicago, Forth Worth, and Atlanta) of 
the eight FRA regional offices reporting the highest numbers of 
accidents in their jurisdictions during 2005. We discussed this topic 
with administrators and track and human factor discipline specialists 
from each of these regional offices. We conducted these interviews on- 
site at the offices located in Fort Worth, Texas, and Chicago, 
Illinois. We also discussed this topic with officials from the three 
state regulatory associations employing the greatest number of railroad 
safety inspectors in order to discuss how state inspectors coordinate 
their activities with FRA inspectors. (See the end of this appendix for 
a list of organizations that we contacted.) We also examined our 
published work on risk management and safety oversight approaches used 
by other modal administrations within the Department of Transportation 
as well as some other organizations responsible for overseeing rail 
safety. 

We reviewed FRA data on its inspection activities for the period from 
1996 through 2005. To assess the reliability of the inspection data, we 
(1) performed electronic testing of required data elements, (2) 
reviewed existing information about the data and the system that 
produced them, and (3) interviewed agency officials knowledgeable about 
the data. We discussed our preliminary results with FRA to ensure that 
we were capturing the correct information and consulted with these 
officials to resolve questions on the data collection process. We 
determined that the data were sufficiently reliable for the purposes of 
this report. 

To determine how FRA assesses the impact of its oversight efforts in 
improving safety, we examined the methods FRA uses to assess the 
results of its oversight programs and FRA's use of this information to 
make decisions about its oversight strategy. As part of this effort, we 
reviewed FRA documents on its safety performance measures and 
evaluations of its oversight and enforcement activities. We also 
discussed this issue with managers at headquarters and in the regional 
offices responsible for developing and using performance information. 
In addition, we reviewed our recommendations on performance 
measurement, the use of performance information, and program evaluation 
and determined the extent to which FRA's practices are consistent with 
these recommendations. 

We focused our work on FRA's oversight activities aimed at reducing 
train accidents-such as train collisions and derailments-rather than 
those aimed at reducing highway-rail crossing and trespassing 
accidents. FRA's oversight of highway-rail grade crossing safety has 
been the subject of two recent Department of Transportation Inspector 
General audits. In addition, both these types of accidents and 
trespassing accidents involve issues not related to railroad safety 
performance, such as driver awareness of grade crossing safety and 
individuals' willingness to abide by railroads' warning signs on their 
property. We also focused on FRA's oversight of railroads rather than 
its oversight of non-railroad companies (such as shippers of hazardous 
materials by rail) because the agency 's oversight efforts focus 
primarily on railroads. In addition, according to FRA, most recent 
serious train accidents involving the release of hazardous materials 
have resulted from problems with railroad operations. 

Other Aspects of Our Work: 

We also examined how FRA uses enforcement and other methods for 
ensuring that safety problems on railroad systems are resolved. In 
order to do this, we reviewed FRA's policies, procedures, and guidance 
for conducting enforcement; major enforcement actions such as 
compliance agreements; Railroad Safety Oversight program documents; and 
other agency documents. We also discussed FRA's approaches to resolving 
safety problems, through enforcement and other means, with officials 
from FRA headquarters, Railroad System Oversight managers, and 
administrators and inspection discipline specialists in three regional 
offices. Regarding FRA's enforcement approach, we reviewed how FRA 
employs enforcement to improve safety on railroads' systems. However, 
we could not determine the extent to which railroads address systemic 
safety problems as a result of enforcement because FRA does not track 
the broad-scale safety problems it identifies or the extent to which 
these problems are resolved. We focused on FRA's use of enforcement as 
part of its overall oversight strategy and did not examine the agency's 
individual enforcement actions. 

We also obtained FRA data on civil penalties from FRA's enforcement 
database, which includes data on assessed and collected amounts from 
1996 through 2005. We assessed the reliability of the enforcement data 
by the same means that we employed to assess the reliability of FRA's 
inspection data. We determined that the enforcement data used in this 
report were sufficiently reliable for the purposes of this report. 

Finally, we met with or contacted the following organizations or 
persons in order to obtain a fuller understanding of railroad safety 
issues and obtain their perspectives on FRA's oversight approach. 

Other federal agencies: 

National Transportation Safety Board: 

Freight railroads (Class I): 

BNSF Railway Company: 
CSX Transportation, Inc. 
Norfolk Southern Railway Company: 
Union Pacific Railroad Company: 

Passenger railroads: 

National Railroad Passenger Corporation, or Amtrak: 
Northeast Illinois Regional Commuter Rail Corporation, or Metra: 
New Jersey Transit Rail Operations: 

Regional and short line railroad management companies: 

Cedar American Rail Holdings, Inc. 
RailAmerica: 

Industry associations: 

American Chemistry Council: 
Association of American Railroads: 
American Public Transportation Association: 
American Short Line and Regional Railroad Association: 

Labor unions: 

AFL-CIO Brotherhood of Maintenance of Way Employees: 
Brotherhood of Locomotive Engineers and Trainmen: 
United Transportation Union: 

State oversight organizations: 

Association of State Rail Safety Managers: 
California Public Utilities Commission: 
Ohio Public Utilities Commission: 
Texas Department of Transportation: 

Canadian oversight organization: 

Transport Canada: 

Academic expert: 

Dr. Ian Savage, Department of Economics, Northwestern University: 

[End of section] 

Appendix II: FRA Addresses Safety Problems through Cooperation and 
Enforcement: 

FRA uses cooperation with railroads and enforcement actions in various 
ways to resolve identified safety problems and achieve compliance. When 
inspectors find problems during inspections, FRA's policy is to cite 
defects for most instances of noncompliance and to encourage the 
railroad to comply voluntarily. For example, issues may be addressed on 
site with railroad officials during inspections. According to FRA 
officials, railroads often correct identified problems immediately and 
if so, these problems would not require additional action. When 
railroads do not comply voluntarily or the identified defects are 
serious, FRA may cite violations and recommend civil penalties or take 
other enforcement actions--either against railroads or individuals--to 
promote compliance with safety regulations.[Footnote 69] According to 
FRA officials, inspectors follow up on violations or high numbers of 
defects within 60 days to ensure that they are corrected.[Footnote 70] 

FRA most commonly uses civil penalties against companies as its 
enforcement tool for site-specific violations.[Footnote 71] From 
January 2005 through July 2006, FRA assessed about 8,600 violations for 
civil penalties. FRA has other enforcement tools. These include 
compliance agreements and compliance orders, civil penalties against 
individuals, special notices for repair, emergency orders, criminal 
penalties, disqualification orders, and injunctions. (See table 4.) FRA 
uses these tools much less frequently than it does civil penalties. For 
example, FRA issued 288 special notices for repair, 118 warning letters 
and fewer than a dozen of all other enforcement actions during this 
period.[Footnote 72] 

Table 4: Description of FRA Enforcement Actions and Frequency of Use, 
January 2005 through July 2006: 

Enforcement action: Civil penalty against a railroad or other entity 
except for an individual; 
Number of times used: 8,606; 
Description: Imposes a monetary penalty on a railroad or other entity, 
such as a company that ships hazardous materials by rail, that violates 
a rail safety or hazardous materials statute, regulation, or order. 
Each day that the violation continues is a separate violation. 

Enforcement action: Special notice for repair; 
Number of times used: 288; 
Description: Orders a locomotive, freight car, or passenger car out of 
service and may require a reduction of the maximum operating speed over 
defective track segments. 

Enforcement action: Warning letter to an individual; 
Number of times used: 118; 
Description: Informs an individual that FRA believes that the 
individual has committed a rail safety or hazardous materials violation 
and that any future violation by the individual will result in 
enforcement action. 

Enforcement action: Civil penalty against an individual; 
Number of times used: 6; 
Description: Imposes a monetary penalty on any individual who willfully 
violates or willfully causes the violation of a rail safety statute, 
regulation, or order. 

Enforcement action: Compliance agreement; 
Number of times used: 2; 
Description: States a railroad's agreement to take a specified action 
to promote compliance. The railroad agrees that if, in FRA's judgment, 
the required action is not performed, the railroad will not contest 
FRA's sanction-typically a compliance order. See below. 

Enforcement action: Criminal penalty; 
Number of times used: 1; 
Description: Imposes (1) either a monetary penalty or imprisonment for 
up to 2 years, or both, on an individual for knowingly and willfully 
violating certain reporting, recordkeeping, or other regulations or (2) 
a monetary penalty or imprisonment for up to 5 years, or both, for 
knowingly violating the hazardous materials statute or an implementing 
regulation or order. 

Enforcement action: Disqualification order; 
Number of times used: 1; 
Description: Prohibits an individual from performing safety- sensitive 
functions in the rail industry for a specified period if the 
individual's violation of a rail safety statute or regulation 
demonstrates unfitness to perform such functions. 

Enforcement action: Emergency order; 
Number of times used: 1; 
Description: Orders corrective action where an unsafe condition or 
practice causes an emergency situation involving a hazard of death or 
personal injury. 

Enforcement action: Compliance order; 
Number of times used: 0; 
Description: Directs compliance following repeated failure to comply 
with rail safety or hazardous material statute or regulation. 

Enforcement action: Injunction; 
Number of times used: 0; 
Description: Restrains a violation of, or enforces, a rail safety or 
hazardous materials regulation or order. 

Source: FRA. 

[End of table] 

FRA inspectors cite many defects, but cite comparatively few of these 
defects as violations warranting enforcement action. Since 1996, FRA 
inspectors have cited an average of about 4 violations for every 100 
defects cited annually. According to FRA officials, inspectors cite 
relatively few defects as violations warranting enforcement action 
because FRA's focused enforcement policy guides inspectors to cite 
violations only for problems that pose safety risks. In addition, 
inspectors have discretion in citing a defect or a violation for a 
given instance of noncompliance--FRA directs inspectors to first seek 
and obtain the railroads' voluntary compliance with the rail safety 
regulations. 

According to FRA officials, inspectors usually choose to provide the 
railroad with information about defects they found during their 
inspection, discuss these instances of noncompliance, and attempt to 
obtain the railroad's commitment to improve compliance. If the 
railroad's response is inadequate or the inspector finds that the 
problem warranting the defect is serious, the inspector may exercise 
the agency's enforcement discretion by citing a violation, recommending 
that FRA take enforcement action, generally a civil penalty. The agency 
makes an initial penalty assessment against the railroad based on the 
type of violation that occurred.[Footnote 73] FRA meets with the major 
railroads in an annual settlement meeting to negotiate a final amount 
for all civil penalties cited in the past year. This amount is based on 
the railroad's compliance history and efforts to correct the problem, 
among other factors.[Footnote 74] The total value of civil penalties 
assessed and collected each year was higher from 2001 through 2005 than 
from 1996 to 2000. (See fig. 10.) According to FRA officials, the 
higher civil penalty assessments after 2000 reflect the agency's 
efforts to focus its inspection activity on areas that present the 
greatest risk. FRA officials also told us that when the agency 
initiated the Safety Assurance and Compliance Program--which emphasized 
a partnership approach with railroads to improve safety--in 1995, 
inspectors initially cited fewer violations. They noted that in 2001 
FRA's management pushed for inspectors to be more aggressive in citing 
violations. Since 2001, the amounts collected have been about 63 
percent of the amounts initially assessed. Consistent with the purpose 
of the federal railroad safety laws and with federal court decisions 
interpreting the purpose of such laws, the agency's goals are to 
promote safety and to gain compliance rather than to maximize amounts 
collected. For example, FRA may agree to a reduced penalty amount if 
the railroad immediately remedies the safety problem or implements a 
new program to prevent a problem from recurring.[Footnote 75] This is 
consistent with federal law. In other cases, FRA will agree to a 
reduced penalty amount if its documentation on the violation is not 
substantial enough. 

Figure 10: FRA's Civil Penalties, 1996 through 2005, in 2005 Dollars: 

[See PDF for image] 

Source: GAO analysis of FRA data. 

Notes: Individual penalties resulting from violations are consolidated 
into one or more case(s) for each railroad and are negotiated annually 
with FRA and the railroad during settlement conferences. 

Each year's amounts are for cases initiated in that year. Some 
penalties may be initially assessed in one year, with the final 
assessment in another year. FRA, in commenting on a draft of our 
report, provided 2006 civil penalty figures. However, we did not use 
this information because there was not enough time to assess its 
reliability before the report was issued. 

Penalties against individuals are not included. From 1996 through 2005, 
FRA issued an average of 1 civil penalty per year against individuals. 

[End of figure] 

FRA seeks to resolve broad-scale compliance problems it has identified 
by first discussing them with railroad officials and elevating them, as 
necessary, to obtain an appropriate response. After in-depth inspection 
efforts at multiple sites, inspectors meet with railroad managers 
responsible for those sites to discuss overall findings or problems. 
For very serious or systemic problems, FRA may ask railroads to submit 
corrective action plans and may review these plans for adequacy. FRA 
sometimes discusses broad problems with railroad headquarters officials 
to try to obtain corrective actions. For example, one regional 
administrator told us that his region arranged a multiregion meeting 
with the senior management of a Class I railroad to discuss systemic 
problems with the railroad's equipment. FRA asked the railroad to 
submit a corrective action plan to address the equipment problems. 
According to FRA officials, the railroad has been meeting the 
milestones in the corrective action plan and has been making progress 
in addressing its equipment problems. Also, FRA's Railroad System 
Oversight managers, who act as liaisons with the Class I railroads, 
help to maintain frequent communication with these railroads about 
major problems that have been identified and associated corrective 
actions. These efforts to cooperate with railroads to resolve problems 
may be combined with civil penalties for violations found at specific 
locations. According to FRA officials, when in-depth inspections result 
in findings of serious problems, inspectors always follow up to 
determine whether these problems are adequately resolved. However, FRA 
has no central repository for data on the status of these broader 
problems its inspectors have identified at railroads. 

FRA officials told us that they hold frequent internal discussions 
among headquarters and regional management about these broad-scale 
compliance problems that have been identified--whether local, regional, 
or systemwide--and actions that the agency should take to attempt to 
resolve them. According to FRA officials, the agency sometimes uses 
compliance agreements, which require railroads to take significant 
actions beyond those specifically required by regulations to improve 
their ability to comply, when broad-scale compliance problems are 
egregious and have not been resolved through other methods. Compliance 
agreements allow FRA to apply more leverage in trying to obtain 
compliance because FRA uses the agreements as an alternative to the 
railroad involved undergoing an FRA proceeding for a compliance order. 
For example, under recent compliance agreements, railroads have agreed 
to reinstruct managers on how to test employees' adherence to operating 
rules and to develop and implement track maintenance plans to eliminate 
systemic track defects. FRA monitors railroads' performance under these 
agreements. In some instances, FRA has also used compliance orders to 
address significant railroad compliance problems. However, these 
enforcement tools are seldom used. FRA has entered into 13 compliance 
agreements altogether and one compliance order since 1996, or an 
average of about 1 per year. In comparison, since 1996, FRA has 
assessed in the neighborhood of almost 40,000 violations for civil 
penalties. 

This approach to resolving broad-scale safety problems has had some 
success. For example, the three railroads that have entered into 
compliance agreements in the past 2 years have generally made progress 
in improving compliance, according to the results of FRA's follow- 
up.[Footnote 76] In addition, FRA officials have cited a number of 
other successes, including improved compliance by several railroads 
with signal inspection and testing requirements,[Footnote 77] and 
another railroad's implementation of an electronic system to record 
locomotive defects and repairs following FRA's finding that inadequate 
recordkeeping had resulted in the operation of locomotives with 
multiple defects. FRA's Railroad System Oversight managers have also 
worked with railroads to make some systemic safety improvements not 
related to compliance. For example, these managers have encouraged 
railroads to make improvements related to roadway worker communication, 
signal maintenance, and mentoring of new employees. 

[End of section] 

Appendix III: Oversight of Risk Management in the U.S. Commuter 
Railroad, U.S. Pipeline, and Canadian Railroad Industries: 

Risk management is a systematic process for assessing risks and taking 
appropriate steps to deal with them. It is founded on several 
inspection disciplines, including financial economics, decision 
science, organizational theory, and strategic management. The National 
Academy of Sciences, a presidential commission, private organizations, 
and others have addressed the subject and have recognized its 
applicability in both the private and the public sectors. We have 
developed a framework for risk management based on industry best 
practices.[Footnote 78] This framework divides risk management into 
five major phases. (See table 5.) 

Table 5: Risk Management Framework: 

Phase: Strategic goals, objectives, and constraints; 
Description: Establish an organization's strategic goals and the steps 
needed to attain those results, including performance measures to 
assess progress. Constraints that affect outcomes can also be 
identified during this phase. 

Phase: Risk assessment; 
Description: Assess the threats to and vulnerabilities of assets so 
that countermeasures may be instituted to prevent or mitigate risks. 
Risks can be assessed by various methods, depending on the specific 
application and knowledge available. 

Phase: Alternatives evaluation; 
Description: Evaluate risk reduction methods by considering the 
countermeasures and the costs and benefits associated with each. 
Countermeasures can be considered and prioritized according to a number 
of factors, such as the degree of risk reduction they afford and the 
cost and difficulty to implement them. 

Phase: Management selection; 
Description: Choose among alternative actions. Management's active 
participation is important at this phase because risk assessment tools 
contain various assumptions about preferences that may require value 
judgments and review at the management level. 

Phase: Implementation and monitoring; 
Description: Move from planning to implementing the selected 
countermeasures. Following implementation, monitoring is essential to 
help ensure that the entire risk management process remains current and 
relevant. 

Source: GAO. 

[End of table] 

During the last 10 years, the American Public Transportation 
Association (APTA), Pipeline and Hazardous Materials Safety 
Administration (PHMSA), and Transport Canada have developed and 
implemented new approaches for overseeing safety in the U.S. commuter 
railroad, U.S. pipeline, and Canadian railroad industries, 
respectively. These approaches promote the use of risk management and 
incorporate various elements of risk management noted above. They also 
complement traditional compliance inspections. 

In 1996, following two serious commuter rail accidents, APTA, with FRA 
support, started a program to help its 16-member commuter railroad 
properties develop and implement plans for managing the safety of their 
systems. APTA had previously developed a similar program for the rapid 
transit industry. Risk management is a key aspect of these plans, which 
must include, among other things, goals and objectives, the 
identification of hazards, an assessment of their associated risks, the 
analysis and implementation of actions to reduce these risks, and 
internal assessments of the effectiveness of safety management. 
Commuter railroads are given the latitude to develop individual plans 
that conform to APTA's guidelines but that are based on their unique 
circumstances. APTA audits its member railroads' system safety 
management plans on a 3-year cycle. During the first year, APTA 
conducts an initial assessment of the plan; during the second year, 
APTA evaluates how well the railroad implements its plan; and during 
the third year, APTA follows up with the railroad to see what actions 
it has taken in response to APTA's audit findings. 

In 2000, to better focus on safety risks that are unique to individual 
pipelines, PHMSA, then operating as the Office of Pipeline Safety, 
issued the first in a series of integrity management regulations that 
now apply to more than 1,000 hazardous liquid and gas transmission 
pipelines operating in densely populated and environmentally sensitive 
areas. Under this approach, operators are required to develop programs 
to systematically assess and mitigate safety threats, such as 
corrosion, to pipelines located in such high-risk areas. For example, 
these programs must integrate all available information about pipeline 
integrity and the consequences of a leak or rupture, repair identified 
defects within defined time limits based on their severity, and 
evaluate the need for additional preventive and mitigating actions. In 
addition, operators are required to report program performance measures 
to PHMSA semi-annually. PHMSA inspects these written programs as well 
as their implementation in periodic comprehensive inspections. 

During the 1990s, a series of derailments raised concerns over the 
level of safety in the Canadian rail industry. In 2001, following a 
review of its oversight approach, Transport Canada determined that a 
more comprehensive safety management assessment was necessary to 
minimize safety risks, and adopted new safety management regulations 
under Canada's Railway Safety Act. The new regulations require that 
Canadian railway companies develop their own safety management systems, 
subject to Transport Canada's review. These systems must include, among 
other things, annual safety performance targets; the identification of 
safety issues through a variety of methods (such as analyses of safety 
data and input from employees); an assessment of the risks associated 
with these issues to determine their significance; the development, 
approval, and implementation of strategies for controlling these risks; 
and systems for monitoring these strategies and other management- 
approved corrective actions. Transport Canada audits the railroads' 
documentation and implementation of their safety management systems. 
The level of such monitoring varies depending on the safety performance 
of the railroad. 

[End of section] 

Appendix IV: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Katherine Siggerud (202) 512-2834 or siggerudk@gao.gov: 

Staff Acknowledgments: 

In addition to the contact named above, James Ratzenberger, Assistant 
Director; Ashley Alley; Marianne Anderson; Timothy Bober; Elizabeth 
Eisenstadt; Judy Guilliams-Tapia; Brandon Haller; Bonnie Pignatiello 
Leer; Masha P. Pastuhov-Purdie; and Minette Richardson made key 
contributions to this report. 

FOOTNOTES 

[1] See U.S. Department of Transportation, Office of the Inspector 
General, Audit of Oversight of Highway-Rail Grade Crossing Accident 
Reporting, Investigations and Safety Regulations, MH-2006-016 
(Washington, D.C., Nov. 28, 2005); and Report on the Audit of the 
Highway-Rail Grade Crossing Safety Program, MH-2004-065 (Washington, 
D.C., June 16, 2004). 

[2] Generally, human factors are behaviors that affect job performance, 
such as incorrectly setting switches. According to FRA, the term human 
factors refers broadly to the role of human participation in any system 
and to the ways in which human beings positively or negatively 
contribute towards system performance. 

[3] This figure is an FRA estimate, based on an estimation of the 
amount of activity, such as train movements, on each railroad in the 
United States. 

[4] Risk is the combination of the likelihood and the consequence of a 
specified hazard being realized. 

[5] A train mile is the movement of a train a distance of 1 mile. 

[6] For 2005, the Surface Transportation Board has defined Class I 
railroads as railroads earning adjusted annual operating revenues of 
$319.3 million or more. Class II railroads are those earning between 
$25.5 million and $319.3 million, and Class III railroads are those 
earning less than $25.5 million. 

[7] FRA defines a train accident as any collision, derailment, fire, 
explosion, act of God, or other event involving operation of railroad 
on-track equipment (standing or moving) that results in reportable 
damages greater than the current reporting threshold to railroad on- 
track equipment, signals, track, track structures, and roadbed. The 
threshold for 2006 was $7,700. 

[8] In addition, according to FRA, train accident rates for 2006 will 
probably appear slightly more favorable than those for 2005 because of 
a single, large increase in the dollar level reporting threshold for 
the year 2006. Specifically, starting in 2006, railroads are required 
to report accidents resulting in railroad property damage exceeding 
$7,700, up from the previous threshold of $6,700. 

[9] Nonsignaled territory refers to sections of track where no signal 
or other system is in service that indicates that a main track switch 
may be in other than its normal position. 

[10] A processor-based train control system or product is one that is 
dependent for its proper functioning on a digital processor, such as an 
onboard signal or switch control. 

[11] For example, FRA conducts twice yearly training seminars for short 
line railroads on how to comply with its regulations and operate 
safely. 

[12] This number does not include contractor employees hired by the 
railroads. 

[13] The National Rail Safety Action Plan also includes initiatives to 
improve hazardous materials safety and emergency response capability. 
Most of the serious accidents involving the release of hazardous 
material that have occurred in the last several years have been caused 
by human factors or track defects. 

[14] According to FRA, a close call is an opportunity to improve safety 
practices in a situation or incident that has a potential for more 
serious consequences. It represents a situation in which an ongoing 
sequence of events was stopped from developing further, preventing the 
occurrence of potentially serious safety-related consequences. 

[15] Other key agency plans that focus efforts on the highest priority 
risks related to train accidents include the department's rulemaking 
agenda, strategic plan and annual performance plan, and FRA's 
performance budget. The rail safety goals and measures contained in the 
performance plan and performance budget are discussed later in this 
report. 

[16] Management decisions at the organizational level, such as 
decisions regarding the allocation of resources or crew scheduling, can 
have consequences in the workplace that can contribute to human factor 
accidents. 

[17] Derails are devices used to prevent the obstruction of track by 
unauthorized movements of trains or unattended rolling stock. 

[18] Most Class I railroads use one of two sets of standard rules: the 
Northeast Operating Rules Advisory Committee rulebook and the General 
Code of Operating Rules. Railroads must file their operating rules with 
FRA. 

[19] In a few cases, FRA's regulations do require some practices, such 
as securing a sufficient number of handbrakes, that are in railroad 
operating rules. Also, the Switching Operations Fatality Analysis 
working group--made up of representatives of FRA, unions, railroads, 
and the Department of Transportation's Volpe National Transportation 
Systems Center--studies fatalities that occur to workers engaged in 
switching operations and recommends ways that such events can be 
prevented. 

[20] The law also specifies that train employees are required to have 
10 consecutive hours off duty following 12 continuous hours on duty. 

[21] NTSB, Collision of Union Pacific Railroad Train MHOTU-23 With BNSF 
Railway Company Train MEAP-TUL-126-D With Subsequent Derailment and 
Hazardous Materials Release, Macdona, Texas, June 28, 2004, Railroad 
Accident Report NTSB/RAR-06/03 (Washington, D.C., 2006). 

[22] According to FRA, it is the only safety regulatory agency in the 
Department of Transportation that lacks regulatory authority over 
worker duty hours. 

[23] Risk is the combination of the likelihood and the consequence of a 
specified hazard (or threat) being realized. We have developed a 
framework for risk management based on industry best practices. See 
app. III for a discussion of this framework as well as comprehensive 
risk management approaches in use by several other transportation 
agencies for overseeing the U.S. commuter railroad, U.S. pipeline, and 
Canadian railroad industries. 

[24] In reviewing the Voluntary Protection Program of the Occupational 
Safety and Health Administration, along with several other voluntary 
compliance programs, we found that benefits reported by participating 
worksites included reduced injury and illness rates, an improved safety 
culture, and improved employee-management relations. See GAO, Workplace 
Safety and Health: OSHA's Voluntary Compliance Strategies Show 
Promising Results, but Should Be Fully Evaluated before They Are 
Expanded, GAO-04-378 (Washington, D.C.: Mar. 19, 2004). 

[25] FRA has also recently issued standards for processor-based 
positive train control systems. These systems are an advanced train 
control technology that can prevent train collisions through automatic 
brake applications. They also can provide enhanced protection for 
maintenance-of-way workers. 

[26] FRA also has two additional automated track inspection vehicles 
that are primarily used for research activities but occasionally are 
used for inspections. 

[27] However, FRA may inspect some sections of track more than once a 
year. 

[28] FRA also has a number of other ongoing efforts to improve track 
inspection capabilities. For example, since 2002 it has sponsored a 
Rail Integrity Task Force--composed of experts in the railroad 
industry, FRA, and the Department of Transportation's Volpe National 
Transportation Systems Center--to identify best practices for rail 
inspection, maintenance, and replacement. 

[29] In continuous welded rail track, rails are welded together to form 
one continuous rail that may be several miles long. There may be joints 
in this rail for several reasons, including the need for insulated 
joints that electrically separate track segments for signaling purposes 
and the need to replace a section of defective rail. 

[30] We did not evaluate these models or the data on which they are 
based. FRA defines train incidents as events involving the movement of 
railroad equipment that results in a casualty but does not cause damage 
above the reporting threshold established for train accidents, which 
was $7,700 in 2006. 

[31] FRA provides training for state inspectors and certifies them as 
qualified to perform inspections and cite violations. 

[32] Overall, the motive power and equipment discipline currently has 
the highest number of inspectors (86), followed by the operating 
practices discipline (76), the track and structures discipline (73), 
the signal and train control discipline (61), and the hazardous 
materials discipline (55). However, to help reduce human factor 
accidents, which account for the highest percentage of train accidents, 
inspectors in the motive power and equipment discipline conduct some 
inspections of operating practices. 

[33] These figures do not include railroad contractor employees or 
track that is not in use. 

[34] Inspectors also sometimes travel along part of a railroad's system 
in conducting inspections. According to FRA, from 2002 to 2005, 
inspectors traveled between two locations in 17 percent of the routine 
inspections of railroads. 

[35] However, in some cases, FRA conducts nationwide inspections of 
railroads' compliance with specific requirements. For example, in mid- 
2006, it began a set of nationwide inspections of various railroads' 
compliance with requirements for notifying train crews of the types of 
hazardous materials being transported on their trains, after 
identifying noncompliance in this area as a problem. 

[36] This number includes inspections of railroads as well as of 
nonrailroads (companies that ship hazardous materials by rail, tank car 
manufacturers, and tank car repairers). In 2005, inspections of 
nonrailroads represented 7 percent of all inspections. 

[37] To help reduce accidents caused by human factors, which are the 
leading cause of train accidents, FRA's motive power and equipment 
inspectors conduct some inspections to look for operating practices 
problems that can lead to these types of accidents. 

[38] FRA officials have explained that operating practices inspectors 
have had a limited ability to cite defects and violations because of 
the way regulations in this area are written. For example, as noted 
previously, the regulations contain general requirements about 
railroads' programs for inspecting employees' adherence to operating 
rules and do not specifically require that employees follow these 
rules. The agency expects that its proposed regulations on operating 
rules will improve its ability to enforce in this area, because the 
requirements will be more stringent than existing regulations. 

[39] App. II contains a description of FRA's efforts to resolve such 
problems through discussions with railroad officials as well as 
enforcement actions. According to FRA officials, the agency uses 
compliance agreements, which require railroads to take significant 
actions to improve their ability to comply, when broad-scale compliance 
problems are egregious and have not been resolved through other 
methods. FRA has issued eight such agreements since 2000. These 
agreements have mainly focused on compliance problems in the operating 
practices and track disciplines. 

[40] According to FRA officials, its ability to track broad-scale 
compliance problems is limited because its existing databases related 
to safety are not integrated. The agency has an effort underway to 
better integrate its existing data. The next section contains a 
description of this effort. 

[41] The Railroad System Oversight managers track the status of 
nonregulatory problems, as well as some regulatory problems, that they 
are working on and, in response to our request, created papers for us 
describing systemwide and regional issues for each of the Class I 
railroads. In addition, these managers produce quarterly and annual 
reports showing safety trends--based mainly on accident data--for each 
of the Class I railroads. 

[42] Risk is the combination of the likelihood and the consequence of a 
specified hazard being realized. In risk management, the term "threat" 
is sometimes used in place of hazard. 

[43] GAO, Risk Management: Further Refinements Needed to Assess Risks 
and Prioritize Protective Measures at Ports and Other Critical 
Infrastructure, GAO-06-91 (Washington, D.C.: Dec. 15, 2005); Homeland 
Security: Summary of Challenges Faced in Targeting Oceangoing Cargo 
Containers for Inspection, GAO-04-557T (Washington, D.C.: Mar. 31, 
2004); and Rail Security: Some Actions Taken to Enhance Passenger and 
Freight Rail Security, but Significant Challenges Remain, GAO-04-598T 
(Washington, D.C.: Mar. 23, 2004). 

[44] APTA is a nonprofit organization representing the transit 
industry, including U.S. commuter rail systems. APTA offered to develop 
this program after FRA directed passenger railroads to develop system 
safety plans for addressing hazards associated with passengers 
occupying the lead units of a train. The APTA program is more extensive 
and is intended to cover all aspects of system safety. FRA issued this 
directive in 1996, in an emergency order, after two passenger train 
accidents caused 14 deaths. 

[45] PHMSA administers the national regulatory program to ensure the 
safe transportation of hazardous liquids and natural gas by pipeline. 
PHMSA and FRA are similar in several respects. For example, both 
oversee large industries with relatively few inspectors. Both also 
oversee industries that have relatively few deaths, injuries, and 
accidents (as compared to transportation as a whole), making additional 
safety gains more difficult. 

[46] Transport Canada oversees the safety and security of Canada's 
rail, marine, highway, and aviation operations. 

[47] In addition, the European Commission has funded an effort to 
develop proposed guidelines for a safety management system for rail 
companies of its member nations. These proposed guidelines recommend 
that European railways incorporate some basic risk management elements-
-including safety performance targets, risk assessment and control, and 
an internal audit process--in their safety management systems. See E.M. 
El Koursi, L. Tordai and J. Rodriguez. European Commission Fifth 
Framework Programme, SAMNET Thematic Network, SAMNET Synthesis Report, 
Safety Management and Interoperability (SAMNET, February 2006). 

[48] GAO, Natural Gas Pipeline Safety: Integrity Management Benefits 
Public Safety, but Consistency of Performance Measures Should Be 
Improved, GAO-06-946 (Washington, D.C.: Sept. 8, 2006). 

[49] As noted previously, FRA enforces PHMSA's hazardous material 
regulations as they relate to the transportation of such materials by 
rail. Specifically, under this proposed regulation, which was issued in 
December 2006, railroads would be required to compile annual data on 
certain shipments of hazardous materials that are particularly 
hazardous, use the data to analyze safety and security risks along the 
rail transportation routes where those materials are transported, 
assess alternative routing options, and base routing decisions on those 
assessments. 

[50] FRA has also worked with Amtrak, which does not participate in 
APTA's program, to assist it in developing a system safety plan that is 
consistent with APTA's guidelines. 

[51] We have reported that agencies should create a set of performance 
goals that address important and various aspects of program 
performance. See, for example, GAO, Results-Oriented Government: GPRA 
Has Established a Solid Foundation for Achieving Greater Results, GAO-
04-38 (Washington, D.C.: Mar. 10, 2004); Managing for Results: 
Strengthening Regulatory Agencies' Performance Management Practices, 
GAO/GGD-00-10 (Washington, D.C.: Oct. 28, 1999); and Agency Performance 
Plans: Examples of Practices That Can Improve Usefulness to 
Decisionmakers, GAO/GGD/AIMD-99-69 (Washington, D.C.: Feb. 26, 1999). 

[52] A number of other agency efforts--including the Railroad Safety 
Oversight program, the development of new safety standards, rail- 
related research and development, and initiatives to improve highway- 
rail grade crossing safety--also contribute toward these end outcomes. 

[53] We have suggested that regulatory programs develop logic models to 
develop a better understanding of how their programs deliver results, 
in order to select appropriate performance goals and measures. See GAO-
04-38 and GAO/GGD-00-10. 

[54] This act is the centerpiece of a statutory framework that Congress 
put in place during the 1990s to help resolve the long-standing 
management problems that have undermined the federal government's 
efficiency and effectiveness and to provide greater accountability for 
results. See GAO-04-38. 

[55] See GAO/GGD/AIMD-99-69 and GAO/GGD-00-10. 

[56] For violations determined by the inspector to require corrective 
action, railroads are required to provide FRA with a report within 30 
days of the end of that month on the corrective actions they have 
taken. These reports also include the type of action taken, such as 
repair or replacement of equipment and disciplinary action or training 
of employees. FRA tracks whether these reports are received on time as 
well as the types of actions taken. 

[57] FRA's inspection reports contain a field for recording the receipt 
of railroads' reports on corrective actions but do not contain a field 
for recording whether inspectors have determined, in following up on 
violations, that the corrective actions are adequate. Furthermore, some 
regional staff told us that inspectors do not consistently record 
follow-up inspections as such. 

[58] In contrast, defects and violations tend to be much more specific. 
In this case, inspectors also found numerous defects concerning 
specific instances of track not meeting federal standards and two 
violations concerning defects that had gone for more than 30 days 
without corrective action. 

[59] In fiscal year 2006, FRA compiled information for the first time 
on all in-depth inspection activity by its headquarters and regional 
offices into one report and began producing quarterly updates on the 
status of these inspections. These updates contain some information on 
findings of broad-scale problems, in narrative form, but do not provide 
overall assessments of progress being made by each railroad as a whole 
in addressing these problems. 

[60] However, FRA does include in its quarterly review of Class I 
railroads' performance trends certain operating practices and track 
defect rates that it has found to be related to accident rates. 

[61] We have reported on such challenges and how agencies have overcome 
them. See, in particular, GAO-04-38; GAO/GGD-00-10; Managing for 
Results: Measuring Program Results That Are Under Limited Federal 
Control, GAO/GGD-99-16 (Washington, D.C.: Dec. 11, 1998); and Managing 
for Results: Regulatory Agencies Identified Significant Barriers to 
Focusing on Results, GAO/GGD-97-83 (Washington, D.C.: June 24, 1997). 

[62] FRA has tasked a contractor with developing a plan for a data 
warehousing strategy for the agency that will integrate its data from 
various sources. According to agency officials, this initiative will 
allow FRA to better monitor its performance, through, for example, 
providing scorecards and graphical tools to depict performance. 

[63] A major concern with the previous Safety Assurance and Compliance 
Program, which ended in 2005, was that systemwide safety problems 
handled under this program took too long to resolve. 

[64] Such evaluations can also help determine the extent to which a 
program is having an impact on these outcomes versus other variables 
that affect outcomes. See GAO-04-38. 

[65] See GAO, Program Evaluation: An Evaluation Culture and 
Collaborative Partnerships Help Build Agency Capacity, GAO-03-454 
(Washington, D.C.: May 2, 2003); and Program Evaluation: Studies Helped 
Agencies Measure or Explain Program Performance, GAO/GGD-00-204 
(Washington, D.C.: Sept. 29, 2000). 

[66] U.S. Department of Transportation-Office of the Inspector General, 
Review of Allegations that FRA Deputy Administrator Attempted to Relax 
Safety Enforcement Against Union Pacific (Washington, D.C., Dec. 10, 
2004); and Audit of Oversight of Highway-Rail Grade Crossing Accident 
Reporting, Investigations, and Safety Regulations, MH-2006-016 
(Washington, D.C., Nov. 28, 2005). 

[67] The Office of Management and Budget performed this assessment 
using its Program Assessment Rating Tool. This tool examines factors 
that affect and reflect program performance, including program purpose 
and design, performance measurement and evaluations, and aspects of 
program management. 

[68] The Railroad Safety Board approves or denies requests for waivers 
or special approval submitted by railroads and other parties subject to 
FRA regulations. 

[69] While we reviewed how FRA employs enforcement to improve safety on 
railroads' systems, we could not determine the extent to which 
railroads address systemic safety problems as a result of enforcement. 
This is because FRA does not track the broad-scale safety problems it 
identifies or the extent to which these problems are resolved. We 
focused on FRA's use of enforcement as part of its overall oversight 
strategy and did not examine the agency's individual enforcement 
actions. 

[70] Often, an inspector will conduct follow-up re-inspections during 
other routine inspections. However, an inspector may make a special 
visit to conduct follow-up if warranted. 

[71] FRA's Statement of Enforcement Policy specifies that before citing 
violations and recommending penalties, inspectors consider the 
seriousness of the condition or act, the potential safety hazard posed 
by the condition or act, and the current level of compliance of the 
offending person (e.g., a railroad or individual), among other things. 

[72] FRA could not supply data covering a longer period on the 
frequency of use of all of its enforcement actions without substantial 
effort. 

[73] In December 2006, FRA published in the Federal Register proposed 
amendments to its schedules of civil penalties for each type of 
violation to ensure that penalty amounts more fully reflect the risk 
associated with a railroad's violation of the rail safety regulations. 

[74] Given the volume of civil penalty cases, FRA usually negotiates 
civil penalties with smaller railroads and shippers through the mail 
and telephone conferences. FRA is authorized to negotiate civil 
penalties with railroads and exercises this authority by annually 
settling civil penalty amounts with each railroad. The criteria for 
compromising with railroads on civil penalty amounts are set in 
statute. In determining the amount of a compromise, the Secretary shall 
consider (1) the nature, circumstances, extent, and gravity of the 
violation; (2) with respect to the violator, the degree of culpability, 
any history of violations, the ability to pay, and any effect on the 
ability to continue to do business; and (3) other matters that justice 
requires. 

[75] The Federal Motor Carrier Safety Administration follows a similar 
policy. See GAO, Large Truck Safety: Federal Enforcement Efforts Have 
Been Stronger Since 2000, but Oversight of State Grants Needs 
Improvement, GAO-06-156 (Washington, D.C.: Dec. 15, 2005). 

[76] FRA's compliance agreements with three different divisions of one 
Class I railroad have resulted in improved compliance. FRA had to 
extend the compliance agreement with the third division because 
noncompliance continued but has since terminated the compliance 
agreement because of improved safety performance. While FRA does not 
have overall measures of compliance, it sometimes, in summary reports 
on follow-up inspections at a railroad, records trends in certain types 
of defects found. 

[77] FRA has noted instances of significant noncompliance with signal 
inspection and testing requirements on the part of two major commuter 
railroads and at least one Class I railroad. 

[78] To develop the framework, we reviewed risk management literature, 
our reports and testimonies on this topic, and other government 
guidance. In addition, we consulted with experts on risk management, 
risk modeling, and terrorism. We reviewed numerous frameworks from 
industry, government and academic sources. We field-tested the 
framework, and it was reviewed by academic experts in risk management. 
See GAO-06-91. 

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