Date of occurrence Location name Aninoasa Local time 06:00 Latitude 44:58:12 North

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1 -4980 Occurrence Summary What Location Date of occurrence Location name Aninoasa Local time 06:00 Latitude 44:58:12 North Event type Rolling stock events Fire in RS Longitude 25:26:16 East Description Direct Cause descrip the diesel multiple unit Desiro Siemens no. 2114, that ompose the train no caught fire Direct cause The fire happened because the over-heating of the power supply cables from the double radial fan, part of the unit without adjuster from the air conditioning equipment of the wagon no. 2 of the diesel multiple unit Desiro 2114, it leading to the ignition of their ínsulation and thermic affecting of the very close components. Contributing factors? failure (blocking of the rotor) of one of the double radial fans from the composition of the unit without adjuster of the air conditioning equipment of the wagon no.2 of the diesel multiple unit Desiro 2114;? keeping in operation of the diesel multiple unit Desiro 2114, after achieving the time limit for the performance of the planned repairs. Final Report Other Attachments Nam Desc Type Size Last Orga Repo Nam Desc Type Size Last Orga Repo Micro PDF /2 soft File 916 7/20 Word 16 - RI 7:56: incen 35 diu AM Anin oasa CR trans mis.p df 0 ERAIL-REP PUBLIC 1 Monday, March 11, 2019

2 -4980 What Title Fire in RS, , Aninoasa (Romania) Occurrence type Rolling stock events Fire in RS Occurrence Class Accident Date of occurrence Local time 06:00 Events Rolling stock events - Fire in RS Descriptions Language English Translation provider Information providers own translation Description the diesel multiple unit Desiro Siemens no. 2114, that ompose the train no caught fire Location name Aninoasa Railway System type Railway Country Romania Location type Station Border Country Line type Single track Line number Allowed line speed Km number Latitude 44:58:12 North Longitude 25:26:16 East Location description Aninoasa railway station Additional location in on Bucharest railway county in the center of Romanian railway network Location type details Plain track Fixed installations Occurrence details Railway vehicles Movement type Passenger train Train number 9438 RU Romania Wagons overturned No National Company for Passenger Railway Transport "CFR-Calatori" S.A. Train speed at mom Passengers onboard Yes Vehicle description Desiro Siemens diesel multiple unit Other objects involved in the occurrence Other objects ERAIL-REP PUBLIC 2 Monday, March 11, 2019

3 -4980 Parties involved IM Involved Romania - National Railway Company "CFR" S.A. RU Romania - National Company for Passenger Railway Transport "CFR-Calatori" S.A. Passengers Staff Level crossing users Unauthorised persons Others Total Fatalities Serious injuries Minor injuries Material consequences Material Damage Rolling stock Estimated total mate < Damage description air conditioning installation burned Images Name Description Type Size Last modified Organization Repository 0 Causation Causes Language English Translation provider Information providers own translation Direct Cause description Direct cause The fire happened because the over-heating of the power supply cables from the double radial fan, part of the unit without adjuster from the air conditioning equipment of the wagon no. 2 of the diesel multiple unit Desiro 2114, it leading to the ignition of their ínsulation and thermic affecting of the very close components. Contributing factors? failure (blocking of the rotor) of one of the double radial fans from the composition of the unit without adjuster of the air conditioning equipment of the wagon no.2 of the diesel multiple unit Desiro 2114;? keeping in operation of the diesel multiple unit Desiro 2114, after achieving the time limit for the performance of the planned repairs. Underlying and root causes description ERAIL-REP PUBLIC 3 Monday, March 11, 2019

4 -4980 Underlying causes One did not comply with the provisions of Chapter 3 Norms for the performance of the inspections and planned repairs of the railway vehicles and their periodicity (cycle) of the Railway Norm :2011 Railway vehicles. Types of inspections and planned repairs. Norms of time or norms of run km for the performance of inspections and planned repairs", approved by Order of Minister of Transports and Infrastructure no.315/2011, amended by Order of Minister of Transports and Infrastructure no.1359/2012, as follows: -subparagraph 3.1, that is the diesel multiple unit Desiro 2114 was not withdrawn from running at the achievement of the norm of time stipulated for the performance of the planned repairs; -table 3.1, letter A, position no.10, that is one did not meet with the cycle of planned repairs for the diesel multiple unit Desiro Root causes None. Language Romanian Translation provider Original version Direct Cause description Cauza directa Incendiul s-a produs ca urmare a supraîncalzirii cablurilor de alimentare ale ventilatorului dublu radial, din compunerea unita?ii fara regulator a instala?iei de climatizare a vagonului nr.2 a automotorului Desiro 2114, fapt ce a condus la aprinderea izola?iei acestora?i afectarea termica a componentelor din imediata vecinatate. Factori care au contribuit? defectarea (blocarea rotorului) unuia din ventilatoarele dublu radiale din compunerea unita?ii fara regulator a instala?iei de climatizare a vagonului nr.2 al automotorului Desiro 2114;? men?inerea în exploatare a automotorului Desiro 2114, dupa realizarea normei de timp pentru efectuarea repara?iilor planificate. Underlying and root causes description ERAIL-REP PUBLIC 4 Monday, March 11, 2019

5 -4980 Cauze subiacente Nu au fost respectate prevederile Capitolului 3 Norme pentru efectuarea reviziilor?i repara?iilor planificate ale vehiculelor feroviare?i periodicitatea acestora (ciclul) din Normativul Feroviar :2011 Vehicule de cale ferata. Tipuri de revizii?i repara?ii planificate. Normele de timp sau normele de kilometri parcur?i pentru efectuarea reviziilor?i repara?iilor planificate", aprobat prin Ordinul Ministrului Transporturilor?i Infrastructurii nr.315/2011 modificat?i completat prin Ordinul MTI nr.1359/2012, astfel: -subpunctul 3.1, în sensul ca automotorul Desiro 2114 nu a fost retras din circula?ie la realizarea normei de timp prevazuta pentru efectuarea repara?iilor planificate; -tabelul 3.1, lit. A, pozi?ia nr.10, în sensul ca nu a fost respectat ciclul de repara?ii planificate pentru automotorul Desiro Cauze primare În cursul investiga?iei nu au fost identificate cauze primare. Causation classification Rolling stock events - Fire in RS 1 - Maintenance Recommendations Causation links Rolling stock events - Fire in RS Causal factors - Maintenance Investigation details Legal Basis Other reason descrip National rules imposed by implementing of the Safety Directive 2004/49/EC - in light of Article 19, 2 of SD - (a) the seriousness of the accident or incident National investigatio 188 Occurrence creation :46:15 Investigator in charge Decision to investigate Declaration date Date of IM/RU notific Report Type Final report Workflow Status Validated Report Version 2 Investigation Status Closed Other Attachments Name Descriptio Type Size Last Organizati Repositor 0 ERAIL-REP PUBLIC 5 Monday, March 11, 2019

6 -4980 Final Report Name Descriptio Type Size Last Organizati Repositor Microsoft PDF File /27/201 Word - RI 6 7:56:35 incendiu AM Aninoasa CR transmis.p df ERAIL-REP PUBLIC 6 Monday, March 11, 2019