TRI Employee: REDACTED Operations Accident! incident Report Badge Number: REDACTEDACID Number: 5% it} 9 7 Violations Fit for [acid 3 Accident Damage Clwimcss Duty Typfin injury! Illness Auto in ROW Portland Streetcar sop Ye? 3 Security ROW Trespasscr Fit for Duty CI Defect Certification Trip CI Abandonment Docs: Operator [1 Ru|? El Rule El slip, Trip, Fall Violation Incidct Date Day Time Train Run of Pass. Vehicle it Courtesy- -is 10:13:11 Thursday 11:53 911152 14 2 417A Cards PM Name 'Badge No. lIon1ePl1one Position 1-E REDACTED REDACTED REDACTED Op 1; era or ,9 Sex Age Years of Service Start of Shift D1-iver's Lic Date Supervisor 49 3:45 EEIAM -REDACTED [j 3 PM Lead :4 Home Address. City, State, Zip Qthel. REDACTED Briefly describe damage to the TM vehicle Damage Over Front End Damage to Fiberglass 5400? Yes |:lNo Were you injured? No EYes fill our Report 1:g'Occupan'onal Investigated By: 1 was El INB ours at Expo Center at <10 MPH. The other vehicle was traveling at MPH. given was CI Horn Bell None. Warning by other vehicle was El Horn police Shefifi :11 one. :4 . Traffic 2' Tram Control was Pro-empt Wayside Signal (E Working Not Working) Other "1 Aspect of signal Amber Crossing Gate Up Down} Mme El Traffic lights (El Working l:I Not Working) CI Flagging None Photos Taken Yes No Weather Light Rail Road Running Running Cab CI Clear Conditions Condition Surface Lights Lights Lljaflgg 2 Cloudy Daylight Dry Dry Our Vehicle Other Yes El Raining Dawn El Wet Wet Marker Vehicle Mushmom El Snowing Dark Muddy Lit Lit Up Bypass Fog Dusk Snow Unlit Unlit Cl Down Glare Ij show [3 Other eadlight No other Lit Reverser position Y5 Utllit Forward Driver's Namc l)rivcr's License Numberfstateffixpiration Date Sci: D. D. Insurance Company Policy Number Work Phone .5 . 3 I -- '5 Address, City, state, ZIP Home Phone . 2 Plate Number State Make Model 1 Type Year Color 9 73 ea we 9. Describe dmnagc Over $400 Pass. Yes No 5 Registered x" work phone iW. 51313. 35!} Home Phone 1 AFC Employee: 8 Badge Number: Operations Accident! Incident Report REDACTED ACID Number: Essenger Action Essenger Location %cident Type Other Passenger Factors Floor! Step Intending On Train Fall on board Wearing glasses Condition i:i Boarding At Door on board Carrying objects Hit by door CI Able Wet Departmg Carfi Fall I Stairweil Debris I Litter '5 3 Ci Standing ali away from Using cane Snow! Ice 3 Niotring Door# El Crutches Walker Unknown Front ., El Irnpainnent (describe) 1? Mobility Aid 3 Middle -- 5 El Other El Rear o" Wheelchair Motorized wheelchair 33 Other l:I Scooter Movement! Action Direction Headed Further Descri tion 4.. . . 5 Walking 1n street I ROW Ij North At Intersection Not at Intersection El Running in street a' ROW Booth In crosswalk El Crossing diegongiyg 3 3; CI Standing in street! ROW East Not in from of train 4: CI Ascending I Descending Stairs West Crossing from behind Vehicle Riding Bicycle Unl<11ovn1__ M. Against signal Getting infout of other vehicle -5 5 Working in streetf ROW I I )the'r No signal I: From between perked vehicles Er} 7' El Playing in street Other I: a. Cl Passenger in Name Address. City, State, Zip Vehicle Pedestrian A Describe Infilry Sex I). 0. B. Work Phone Home Phone in Name Address, City, State, Zip Pedestrian [3 cm, Describe Injury Sex u. 0 Work Phone Home Phone 3, in Name Address. City, 8 II: El Pedestrian Othgf Describe imuzry Sex D. O. B. Work Phone Home Phone '3 CI CI El Passenger in Name Address, City, State. Zip :3 Vehicle Ci Pedestrian 1 I S: other Msex D. 0. B. Work Phone Home Phone in /I;/Nfirvne Address, City, State, Zip 6 1.0 Pedestrian other Describe D. 0. Work Phone Home Phone TL-e.n..r. '1 12' Operations Accident! Incident Report Employee: REDACTED Badge Number: REDACTED ACID Number: (94; a7 171 CI Ffassenger in Name Vclucle Pedestrian 1 0111.3; C1131 51315. ZIP Home Phone Work Phone in Name Addres Vehicle I3 Pedestrian . El Other C1Iy,St3tt=,Zlp Home Work phone El Passenger in Name Vehicle El Pedestrian 1_ 5| om, Lily. State, Zip ..I Home Phone Work Phone Passenger in Name I I Adana,-35 Vehicle at I-'edmtrian gamer Sfatfi, ZIP Home Phone Work Phone Passenger In Name Address VehicleState. ZIP Home Phone Work Phone Name Drivcr's License Date Sex I). 0. 13. Insurance Lbmpan}; Policy Number Work Phone -3 :13 -. . . Address, Cay, State, Hum', phone 13 5- Plate Number State Make Model I Type Yea; comdamage Over $400 Pass. Yes No 5 Registered work Slatfl, Hume Phone Other Property Damage {Describe} gin on Center track at Expo Platform '-in! I Operations Accident! Incident Report REDACTED . - Employee: Badge Number: ACID NumberName of Suspect(s) (If Known) Age Height Weight Hair Color Hair Length Color Clothing or other characteristics Suspect Description Weapons Type of Theft Vanda Individual None Operator's Property cats ,5 Group (Count) Handgun Passenger PW, Windows 3 Male Shotgun I Rifle Other I CI Doors at El Female Assault Weapon CI Train interior 5. El Adult Knife Train exterior Youth Hands I Feet El Operatm. Platform 3 W'h1te Club I Baton passage, Other Black El other CI Hispanic :3 El Asian Action taken against I3 Arrested Cl Other El Cited Ejected Unknown None Other Describe what happened. (Include details of any special circumstances or conditions, such as curves, grades, obstruction to view, and what you did) I lefl Delta park platform on an amber signal. I proceeded posted speed northbound. I slowed to twenty five MPH at the sign, and slowed to ten MPH before the switches. I proceeded through the switches to the center track at Expo center. I looked toward the cab of the consist on the eastern track to wave at the operator after I passed the crosswalk and insured there were no hazards on the piatfonn. I did not see anyone in the cab. I was slowing down, I looked forward then down at the speedometer. I do not recall what happened then. As the train moved the next hundred feet was startled when the train made contact with the backstop. A passerby came from the parking lot and asked if I was ok, I said] was. I called control to report the incident and lowered the pantagraphs. Trimet maintenance people came running from inside the brealcroom. I got a passenger emergency call and answered it i asked ifthey were OK, he said he was. I told him I would let him exit as soon as possible. I could not open all the doors because the forward door was platfom-1. Control told ,3 me to cut out the first door and then open them, but the maintenance people had a crew key and let the two passengers (one in each car) of? the train. I remained in the tub. I heard the maintenance people ask the passengers if they were OK, they said they were fine and left the premises. *5 2 HI