Formal Inquiries

Earlswood report and recommendations

Rail Safety and Standards Board has issued its formal inquiry report into the circumstances of the derailment of a train travelling from Gatwick to London Victoria on 30 June 2003.

The formal inquiry was convened under independent chairmanship and included representatives on the panel from the involved parties. As with all such inquiries the panel's task was to establish the immediate and underlying causes of the accident and make recommendations to prevent or reduce the risk of recurrence.

Sequence of events

At 0526hrs on 30 June 2003, the 0520hrs Gatwick Airport to London Victoria travelling at approximately 72mph (116km/h) was derailed between Earlswood and Quarry Tunnel. The derailment was due to the presence of a short sharp reverse curve immediately before the derailment site giving a track alignment unfit for that speed. The track leading up to the derailment site had been tamped during a possession between 0008hrs and 0507hrs on that morning. This was the first train to pass over the Up Quarry line after the possession.

Conclusions

The formal inquiry panel concluded that the immediate cause of this accident was that the track alignment, after track maintenance was not fit for line speed. The track quality supervisor did not check the alignment of the track at the north end of the tamping site before handing back the track as safe to run.

The panel also concluded that the tamping machine was not moved clear of the end of the work and therefore the short sharp reversal was not easily apparent to the track quality supervisor or operators. The (WIN ALC) equipment was not used for lining purposes.

Recommendations

The report makes recommendations for improvements in a number of key areas and these are summarised as follows.

• The definition of the role of the Track Quality Supervisor needs to be madecommon throughout the industry.
• Mandate that, when suitable software is fitted to tampers, it is always used on all running line tamping work, so that a post work record is immediately available to the track quality supervisor on completion and that records are archived for future reference.
• Organisations managing tamping operations shall review their tamping suppliers' competence management systems to ensure that competence assessment (including management surveillance) processes adequately control risks (such as the cessation of the good practice of moving clear of the end of tamping) and training/competence assessment adequately covers any software in use.

Rail Safety and Standards Board has issued a full copy of the report to each member of the Railway Group and the other organisations involved in the accident. All recipients of the report need to review the findings and recommendations and take actions where appropriate to address identified deficiencies within their own systems. Rail Safety and Standards Board will track the industry's response to this report.