皇冠体育app

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Summary

At about 01:40 hrs on Friday 8 June 2018, a road-rail vehicle (RRV) ran away while being on-tracked at a road-rail access point south of Bradford Interchange station. 皇冠体育app RRV ran downhill for approximately 340 metres, before coming to a stop as the track levelled out in the station. 皇冠体育app RRV鈥檚 machine operator and machine controller were able to run along with it and warned a member of track maintenance staff, who was able to move clear in time.

皇冠体育app RRV ran away because its rail wheels were, incorrectly, partially deployed and because the rail wheel braking system had not been correctly maintained.

Partial deployment of the rail wheels was a result of the machine operator not following the standard industry procedure for on- and off-tracking. He had routinely been on- and off-tracking in this manner and this had not been detected by his employer, Readypower.

皇冠体育app braking system on the rail wheels had not been correctly maintained because fitters were not following the original equipment manufacturer鈥檚 instructions and Readypower had not detected this.

An underlying factor was that the industry鈥檚 competence management system for machine operators focuses on the renewal of qualifications, rather than demonstrating ongoing competence.

Recommendations

皇冠体育app RAIB has made three recommendations. 皇冠体育app first one seeks to improve the industry鈥檚 competence management system for all machine operators who work on Network Rail鈥檚 infrastructure. 皇冠体育app second, addressed to Readypower, is intended to improve the management of competence of its staff. 皇冠体育app last recommendation aims to improve the quality of the maintenance instructions and training provided to Readypower鈥檚 fitters.

Simon French, Chief Inspector of Rail Accidents said:

鈥淕etting road-rail plant safely on and off the track ought to be a straightforward business. Unfortunately, over the years RAIB has had to investigate too many incidents in which this operation has gone wrong, and the machine involved has run away downhill, often for quite long distances. Too often the people in charge have not known what to do to stop the runaway. In this case, the machine operator鈥檚 actions were not in line with what he had been trained to do, and no-one had checked on him. Of greater concern, however, is that the machine鈥檚 brakes did not hold it stationary on the 1 in 46 gradient. This was because they were badly maintained, a state of affairs that can be traced back to poor instructions and inadequate supervision of the plant hire company鈥檚 maintenance staff.

鈥溁使谔逵齛pp management of safety in the rail plant industry is something that RAIB has expressed concern about before. In the past, one of the important issues has been the competence of machine operators and maintainers. In this case, the problems were not only at the plant hire company. 皇冠体育app project to convert many road-rail vehicles to direct rail wheel braking also lacked important elements of safety assurance, such as provision for proper information about the machines being converted, and adequate arrangements for training the people who would have to maintain the new braking systems.

鈥淭his incident provides an opportunity for the industry to learn major lessons from a relatively minor event. Our recommendations are directed to Network Rail and one other company, but I hope that people in all areas of the rail plant sector will take note of the learning points in this report, and make sure that their company safety management systems are comprehensive and fully implemented.鈥�

Notes to editors

1. 皇冠体育app sole purpose of RAIB investigations is to prevent future accidents and incidents and improve railway safety. RAIB does not establish blame, liability or carry out prosecutions.
2. RAIB operates, as far as possible, in an open and transparent manner. While our investigations are completely independent of the railway industry, we do maintain close liaison with railway companies and if we discover matters that may affect the safety of the railway, we make sure that information about them is circulated to the right people as soon as possible, and certainly long before publication of our final report.
3. For media enquiries, please call 01932 440015.

Newsdate: 14 March 2019