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WCIA INCIDENT REPORT <br /> MEMBER CITY/ORGANIZATION: City of Anacortes Date: December 18, 2008 <br /> This report shall be completed by the person who was present at the time the incident occurred or was <br /> discovered. Information is to be recorded immediately and the form forwarded to the Member's <br /> Claims Contact Person who will then forward a copy to Washington Cities Insurance Authority. <br /> Name(s) of Member Personnel Department Phone <br /> Involved <br /> Steven Lange Engineering Department 360.293.1920 <br /> Name(s) of OTHERS Involved Address Phone <br /> Mike McAdams WSDOT Signal Department 360.848.7259 (Office) or 206.255.3881 (Cell) <br /> Dave Polda WSDOT Signal Department 360.848.7259 (Office) <br /> Date of Incident: Reported to Member Personnel on 12-18-08 Time: 10:50 am <br /> Location (be Specific): Southwest corner of 17th Street and Q Avenue <br /> Describe all acts and resulting conditions in detail: <br /> It was reported to me by Mike and Dave at the time specified that the City's signal cabinet needs to be <br /> replaced. They were in town working, after a very recent power outage, resetting the signals along <br /> Commercial Avenue and also 17th Street. <br /> Puget Sound Energy was in town working on their system because of the power outage. It was stated <br /> by Mike and Dave that there was a power surcharge in the system that damaged the 17t`' Street and <br /> Q Avenue signal circuitry, cabinet and related appurtenances. <br /> What active measures, or assistance (if any) did Member Employees take? <br /> 1. /informed Eric Shjarback, Assistant City Engineer of the situation, as well as what I was doing. <br /> 2. I then contacted Teresa Loop at PSE to inform her of what WSDOT found. Teresa sent an <br /> email to Jan Thorton, of PSE, letting her know that Steven Lange is requesting a claims form. <br /> A copy of this email was sent to me at the same time. <br /> 3. I then contacted Sandi Andersen, Operations Manager, letting her know about the situation <br /> and that she may need to have her crews set up temporary stop signs at the intersection. She <br /> stated to keep her informed. It turns out that Mike and Dave moved the temporary stop signs <br /> from 17th and Commercial to 17th and Q Avenue. <br /> 4. Within 15-minutes of being informed of the situation, I met both Mike and Dave on-site to take <br /> photos of the cabinet and wiring. Once the lower cabinet was opened up, there was a strong <br /> smell of burnt wires. Photos were taken. <br /> 5. I requested that the cabinet and appurtenances get replaced as soon as possible. I was <br /> informed by both Mike and Dave that they would not be able to replace the cabinet until after <br /> the first of the year because of scheduled vacations in their Department. <br /> 6. Mike and Dave were able to get the stop flashers working, with the exception of the <br /> southbound. They will return tomorrow(12-19-08) to see if they can wire the southbound <br /> flasher. Until then, the temporary stop signs will remain in place. <br /> Q:Carol/Incident Report Form for WCIA <br />