Reference number
RR201700012
Date reported
Published date
Mode
Affected operation/industry
Concern subject type
Concern summary

The concern related to the operator’s management of the incremental train control system.

Reporter's deidentified concern

The reporter expressed a safety concern related to the management of the incremental train control system (ITCS) failure on [date].

The reporter advised that initially the trains were being controlled by hand written proceed authorities but on [date], the system changed to electronic train orders (ETO) through the screens in the cab with no advanced warning. Train controllers and drivers had completed the ITCS training course in late 2013 to early 2014, mainly being trained on the positive train control side of the equipment. There has been no refresher training on the use of ETOs.

Although ETO working is the desired and safest default method of operation from the degrading of ITCS, up until this event all previous ITCS failures had been degraded to hand written proceed orders. The result was a poor understanding of the safe working system (ETOs) by both train control and drivers.

Named party's response

[Operator] is investigating this concern in the same way that it addresses all incidents and hazards raised by employees and contractors. This involves identifying the cause and putting in place corrective actions to ensure the incident or hazard is controlled.

[Operator] takes any safety concerns very seriously and we can confirm that controls were implemented to mitigate the degraded state of the ITCS system on [date]. [Operator] reverted to operating within our approved mixed mode operation. This included providing refresher information to train drivers and train controllers on operation of the ETO system. In addition, [operator] has conducted an engineering root cause analysis to determine ways to prevent this kind of ITCS degradation from happening again in the future.

Regulator's response

The ONRSR is aware that the ITCS system utilised by the operator became inoperable.

The [operator] has in place a secondary safe-working system - ETO.

The ONRSR notes the concerns raised in respect to the understanding of the ETO system. The ONRSR intends to monitor the findings of [operator’s] investigation and conduct its own regulatory activities to ensure the maintenance of rail safety worker competence with respect to the use of the system.