December 2015 VIA Rail derailment emphasizes the need for additional physical defences as highlighted by TSB Watchlist
Dorval, Quebec, 27 February 2017 – In the release of its investigation report (R15D0118) today into the December 2015 derailment of a VIA Rail passenger train in Montréal, Quebec, the Transportation Safety Board of Canada (TSB) again highlights the risk of serious train collisions or derailments if railway signals are not consistently recognized and followed.
On 11 December 2015, at approximately 0910 Eastern Standard Time, VIA Rail passenger train No. 605 (the train) left Central Station in Montréal, Quebec, with 14 passengers on board. The train was travelling west on the north track when, at Turcot-Ouest (Mile 6.26), it derailed after negotiating a crossover at 55 mph, where the authorized speed was 15 mph. One of the locomotives and the track sustained minor damage and a VIA Rail on-board service employee suffered minor injuries.
The investigation determined that the train passed a signal at Turcot-Ouest that called for a speed of 15 mph, but no action was taken to slow down the train. At the time, the train was operating under a foreman's instructions. When trains travel through a protected work area on the track, train crews must communicate with foremen to obtain instructions. The foreman must specify the tracks that can be used and the restrictions, if any. In this case, the foreman's instructions were limited to the south and north tracks and did not include the adjacent freight track. The instructions, as well as the train's regular routing, led the train crew to think they would remain on the north track beyond Turcot-Ouest. If track foremen's instructions do not include all required information, train crews could misunderstand and misinterpret the instructions, increasing the risk of accidents.
The lead locomotive was equipped with a forward-facing camera and a prototype in-cab locomotive voice recorder. The recording of the in-cab conversations synchronized with the forward-facing camera assisted greatly in the investigation by making it possible to confirm the actions of the train crew and the dynamics of the derailment. This investigation reinforces the importance of TSB recommendations (R03-02 and R13-02) and the Watchlist item relating to on-board voice and video recorders.
A number of TSB investigations have cited train signal misinterpretation or misperception as a cause or contributing factor in the accident, and that is why this issue is on our Watchlist. If other physical defence methods for controlling trains in signalled territory are not in place, the risks of collision and derailment are increased when signal indications are not correctly recognized or followed. The Board has previously issued two recommendations for additional physical defenses (R00-04 and R13-01) to protect against missed railway signals.
Following the occurrence, VIA Rail issued a bulletin with special instructions requiring a radio broadcast to state the signal indication displayed. For its part, CN implemented several mitigating measures to ensure that employees are in full compliance with Planned Protection.
See the investigation page for more information.
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.
For more information, contact:
Transportation Safety Board of Canada
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