Rail transportation safety investigation R16T0111

Update: The TSB has completed this investigation. The report was published on 27 June 2018.

Table of contents

Uncontrolled movement of railway equipment

Canadian National Railway Company
Remote control locomotive system
2100 west industrial yard assignment
Mile 23.9, York Subdivision
MacMillan Yard
Vaughan, Ontario

View final report

The occurrence

On , at about 2335 Eastern Daylight Time, the Canadian National Railway Company (CN) remote control locomotive system 2100 west industrial yard assignment was performing switching operations at the south end of CN's MacMillan Yard, which is in the Concord industrial district of Vaughan, Ontario. The assignment was pulling 72 loaded cars and 2 empty cars southward from the yard onto the York 3 main track in order to clear the switch at the south end of the Halton outbound track to gain access to the west industrial lead track (W100) switch. The assignment helper attempted to stop the assignment to prepare to reverse into track W100, in order to continue switching for customers. However, the assignment continued to move. It rolled uncontrolled for about 3 miles and reached speeds of up to 30 mph before stopping on its own at about Mile 21.1 of the York Subdivision. There were no injuries. There was no release of dangerous goods and no derailment.

Safety Communications

Recommendations

2018-06-27

TSB Recommendation R18-02: The Department of Transport update the Railway Employee Qualification Standards Regulations to address the existing gaps for railway employees in safety-critical positions related to training, qualification and re-qualification standards, and regulatory oversight.

Media materials

News release

2018-06-27

TSB calls for update to railway employee qualification standards following an uncontrolled train incident north of Toronto in June 2016
Read the news release

Speeches

2018-06-27

TSB Rail investigation report R16T0111 (MacMillan Yard) - Opening remarks
Faye Ackermans, Board member, TSB
and
Rob Johnston, Manager, Railway Investigations, Central Region & Headquarters

Backgrounders

2018-06-27

Findings of TSB investigation (R16T0111) into an uncontrolled movement of rolling stock at MacMillan Yard near Toronto, Ontario, June 2016
Read the backgrounder

2018-06-27

Safety communications related to TSB investigation (R16T0111) into the June 2016 uncontrolled movement of rolling stock at MacMillan Yard, Vaughan, Ontario
Read the backgrounder

2018-06-27

Uncontrolled movement of rolling stock related to TSB investigation report (R16T0111)
Read the backgrounder

Deployment notice

2016-06-28

TSB launches an investigation into an uncontrolled train movement from the MacMillan Yard in Toronto, Ontario

The Transportation Safety Board of Canada (TSB) is launching an investigation into an uncontrolled train movement which ran, from Canadian National Railway’s (CN) MacMillan Yard in Toronto, Ontario, for 3.2 miles on the CN York Subdivision main track on 17 June 2016. There were no conflicting train movements and no injuries were reported.


Investigation information

Map showing the location of the occurrence


Investigator-in-charge

Photo of Robert Bruder

Robert Bruder joined the Transportation Safety Board of Canada (TSB) in September of 2013 as Regional Senior Investigator Rail/Pipeline at the TSB’s Toronto office. Mr. Bruder has an extensive background in railway operations and risk management garnered over a 36-year career with CN Rail. He managed CN’s Risk Management Department for Eastern Canada from 2004 to 2013, and was extensively involved in development and implementation of CN’s safety management system, accident/injury investigation, analysis and cause-finding processes, as well as derailment emergency response and mitigation.


  Download high-resolution photos from the TSB Flickr page.

Class of investigation

This is a class 2 investigation. These investigations are particularly complex and involve several safety issues requiring in-depth analysis. Class 2 investigations, which frequently result in recommendations, are generally completed within 600 days. For more information, see the Policy on Occurrence Classification.

TSB investigation process

There are 3 phases to a TSB investigation

  1. Field phase: a team of investigators examines the occurrence site and wreckage, interviews witnesses and collects pertinent information.
  2. Examination and analysis phase: the TSB reviews pertinent records, tests components of the wreckage in the lab, determines the sequence of events and identifies safety deficiencies. When safety deficiencies are suspected or confirmed, the TSB advises the appropriate authority without waiting until publication of the final report.
  3. Report phase: a confidential draft report is approved by the Board and sent to persons and corporations who are directly concerned by the report. They then have the opportunity to dispute or correct information they believe to be incorrect. The Board considers all representations before approving the final report, which is subsequently released to the public.

For more information, see our Investigation process page.

The TSB is an independent agency that investigates air, marine, pipeline, and rail transportation occurrences. Its sole aim is the advancement of transportation safety. It is not the function of the Board to assign fault or determine civil or criminal liability.

Date modified: