Uncontrolled When Printed
Document comes into force 06/12/2014
Supersedes Form RT3180 06-14 on 06/12/2014
Signaller’s­Line­Blockage­Form
RT3180­
December 2014 (Side 1 of 2)
Section
1
General­arrangements
WON/GZAC­No.
(if applicable)
Circle­role­requesting
IWA COSS PC
line­blockage
Requested­by
Name­of­signaller
Phone­number
Signal­box
Employer
Time­needed­for­the
activity
DP
SWL
Stn Train
Staff Crew
Panel/workstation
hrs
mins
Will­the­work­affect­the­safety­of­the­line?­­­­­­­­
Yes/No
Circle­the­type­of­additional
protection
Section
2
T-COD
Token
Signalling
disconnection
EPR
Detonator
protection
Not­required
Blocking­the­line­
Line­to­be­blocked
Between­(signal/points)
and­(signal/points)
Protecting­signal(s)
Go­to­page­2­and­complete­-­
Appendix­
A
if­the­line­blockage­includes­any­level
crossings­
Appendix
B
if­additional­protection­is
required
Appendix
E
if­there­is­a­change­of­signaller
Tick­the­box­when­agreed­that­details­are­correct
Section
3
Granting­authority
Is­the­line­to­be­blocked­clear­of­trains?
Blockage
number
1­­
2
3
4
5
6
7
8
9
1­­0
Authority­number
Yes/No
If­‘No’­check­that­the­train­has­passed­the­site­of­work­before­granting­line­blockage
Blockage­taken­at­
Time
Date
Call­back­time
Blockage­given­up­at
Time
Date
Uncontrolled When Printed
Document comes into force 06/12/2014
Supersedes Form RT3180 06-14 on 06/12/2014
Signaller’s­Line­Blockage­Form­(Appendices)
RT3180­
December 2014 (Side 2 of 2)
Appendix
A
Level­crossing­arrangements
Level­crossing
Supervising­signal­box
Method
Level­crossing
Supervising­signal­box
Method
A
Q
E
N
A
Q
E
N
A
Q
E
N
A
Q
E
N
A
Q
E
N
A
Q
E
N
A
Q
E
N
A
Q
E
N
In­the­method­column,­circle­-
A
if­an­attendant­is­required
throughout­the­blockage­(at­AHBC,
CCTV,­OD­or­RC­crossings)
Appendix
B
Q
if­an­attendant­is­required­some­
of­the­time­(at­AHBC,­CCTV,­OD
or­RC­crossings)
E
if­the­signals/sirens/bells­are
switched­off­(at­ABCL­or­AOCL
crossings)
N
if­there­is­normal­working­at­the­
­crossing
Additional­protection
Signalling­Disconnection
Name­of­signalling
technician
Disconnected
signalling­equipment
Detonator­Protection
Detonators­placed­at­
signal­or­beyond­points­
Token
T-COD­
Time­token
issued
These­track­
circuits
are­occupied­
by­T-CODs
Time­token
returned
EPR
EPR applied­to­the
following­sections
Appendix
C
Appendix
D
Appendix
E
Not­used­
Not­used
Change­of­signaller
Name­of­new­signaller
Time
Date
Name­of­new­signaller
Time
Date

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