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Author Topic: Waterloo station - collision and derailment, 15 Aug 2017  (Read 21349 times)
IndustryInsider
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« Reply #60 on: December 20, 2017, 11:48:40 »

Along with the incident at Cardiff, these are gentle reminders to NR» (Network Rail - home page) and it’s contractors that although the recent safety record is incredibly good, a major incident could still easily happen if safety procedures are allowed to slip.
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SandTEngineer
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« Reply #61 on: December 20, 2017, 12:59:15 »

Primarily points 1524A and 1524B should have been clipped in their normal position (as per plan) but were not.

Secondarily, a test wire was left connected which shorted out the electrical detectors to 1524A&B and fooled the signalling system into believing the point blades were correctly set and locked normal.

If only one of the above had happened the accident would not have occurred - it required the combination of the two. Holes in the cheese.

Had unclipped point blades moved without the testing wire being present, detection would have been lost and the starting signal would not have cleared.

10 out of 10 for that summary.  As a practicing signal engineer for nearly 50 years now, I am bitterly disappointed to have to read that the lessons learnt from the Clapham accident have not been followed through.  I know that the pressure to complete things to time is greater than ever, but when safety of the travelling public is concerned, we need to remember not to be frightend and to stand up when required and say NO.
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paul7575
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« Reply #62 on: December 20, 2017, 13:50:25 »

With points 1524A and 1524B (and 1524C) all clipped normal, how would they achieve a route into P13/14?

Am I missing something obvious here?   Or did I misread something earlier that implied that 1524 and 1525 operated together?

Paul
« Last Edit: December 20, 2017, 14:27:24 by paul7755 » Logged
Oxonhutch
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« Reply #63 on: December 20, 2017, 14:10:48 »

With points 1524A and 1524B (and 1524C) all clipped normal, how would they achieve a route into P13/14?

Through Points 1525A which were free to move independently of points 1524A or B.  Points 1525B were also free to move but were located on a locked-out route.
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SandTEngineer
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« Reply #64 on: December 20, 2017, 14:11:15 »

With points 1524A and 1524B (and 1524C) all clipped normal, how would they achieve a route into P13/14?

Am I missing something obvious here?

Paul
Paul,  if you look at Figure 2 in the report you will see that it is 1525AB points that direct trains into/out of Platforms 12/13/14/15.  1524ABC points are only required normal for those movements.
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paul7575
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« Reply #65 on: December 20, 2017, 14:29:29 »

With points 1524A and 1524B (and 1524C) all clipped normal, how would they achieve a route into P13/14?

Am I missing something obvious here?

Paul
Paul,  if you look at Figure 2 in the report you will see that it is 1525AB points that direct trains into/out of Platforms 12/13/14/15.  1524ABC points are only required normal for those movements.

Ok ta.   Goes back to that '4 state' truth table we discussed earlier doesn't it.

Paul
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SandTEngineer
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« Reply #66 on: December 20, 2017, 14:44:50 »

With points 1524A and 1524B (and 1524C) all clipped normal, how would they achieve a route into P13/14?

Am I missing something obvious here?

Paul
Paul,  if you look at Figure 2 in the report you will see that it is 1525AB points that direct trains into/out of Platforms 12/13/14/15.  1524ABC points are only required normal for those movements.

Ok ta.   Goes back to that '4 state' truth table we discussed earlier doesn't it.

Paul
Correct.
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SandTEngineer
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« Reply #67 on: December 20, 2017, 15:15:22 »

One of the basic principles of signalling testing is that all Test Straps are individually numbered.  When you fit them you ‘count them all out and then count them all back in again’ to make sure one doesn’t get accidentally left in place.  If a ‘strap’ is required to be left into place after commissioning then it should be made permanent and designed/checked/approved within well documented procedures and standards.

Lets wait and see what the continuing RAIB (Rail Accident Investigation Branch) investigation throws up.......
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Oxonhutch
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« Reply #68 on: December 20, 2017, 19:56:48 »

Yup. The number of wires landed on each terminal is in the plan.

Part of our [on my heritage railway] S+T sign-off, is confirming that each terminal has the correct wire count. Sounded anal to me the first time I had to do it, but this accident reinforces why it is so necessary.
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« Reply #69 on: December 21, 2017, 18:26:08 »

One of the basic principles of signalling testing is that all Test Straps are individually numbered.  When you fit them you ‘count them all out and then count them all back in again’ to make sure one doesn’t get accidentally left in place.  If a ‘strap’ is required to be left into place after commissioning then it should be made permanent and designed/checked/approved within well documented procedures and standards.

Lets wait and see what the continuing RAIB (Rail Accident Investigation Branch) investigation throws up.......

Like SandTEngineer I am surprised that a test strap and points were left unclipped; whilst there is much ribbing of S & T by E & P one thing I do know from experience of working with S & T  testing teams is their attention to detail, being methodical and not being concerned if they tell the powers that be "we ain't finish testing yet"
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« Reply #70 on: January 29, 2018, 16:13:33 »


Lets wait and see what the continuing RAIB (Rail Accident Investigation Branch) investigation throws up.......

Appears RAIB have produced their  Interim Report.

https://assets.publishing.service.gov.uk/media/5a3bc2b8ed915d61889d9b4e/IR022017_171220_Waterloo.pdf

Roger Ford has a summary in Febs Modern Railway.

Appears a Test Strap was left in place and the relevant points not clipped. He says similar to Cardiff incident in 2106 when a decommissioned set of points was not clipped.

Very worrying.

« Last Edit: January 29, 2018, 16:19:09 by eightf48544 » Logged
Adelante_CCT
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« Reply #71 on: January 29, 2018, 18:40:41 »

I agree, very worrying that they know an incident will occur in Cardiff in 88 years time.
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johnneyw
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« Reply #72 on: January 29, 2018, 19:32:19 »

I agree, very worrying that they know an incident will occur in Cardiff in 88 years time.

I see low ticket sales for the service on that day. On the upside, a good one to short form!
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SandTEngineer
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« Reply #73 on: January 29, 2018, 20:47:35 »


Lets wait and see what the continuing RAIB (Rail Accident Investigation Branch) investigation throws up.......

Appears RAIB have produced their  Interim Report.

https://assets.publishing.service.gov.uk/media/5a3bc2b8ed915d61889d9b4e/IR022017_171220_Waterloo.pdf

Roger Ford has a summary in Febs Modern Railway.

Appears a Test Strap was left in place and the relevant points not clipped. He says similar to Cardiff incident in 2106 when a decommissioned set of points was not clipped.

Very worrying.



...err.  We discussed the interim report in this thread from post #58 onwards..... Roll Eyes Wink
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SandTEngineer
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« Reply #74 on: November 19, 2018, 18:01:04 »

Second report just published https://www.gov.uk/raib-reports/report-19-2018-collision-at-london-waterloo

If anybody here struggles to understand any of it then please ask away and I'll try to answer/clarify.

Quite damming of NRs» (Network Rail - home page) competence management processes (after all the recent cases on the preserved railway network).

In particular I was really concerned about this statement:

Quote
The RAIB (Rail Accident Investigation Branch) has observed that there are certain similarities between the factors that caused the Waterloo accident and those which led to the serious accident at Clapham Junction in 1988. The RAIB has therefore expressed the concern that some of the lessons identified by the public inquiry, chaired by Anthony Hidden QC following Clapham, may be fading from the railway industry’s collective memory.

My involvement in Clapham was reasonably close and I always related this tale to anybody new that worked for me. At the time I was Project Engineer for the Waterloo Area Resignalling (WARS) at ML Engineering (Plymouth) Ltd. We had the contract for the Resignalling.  We were in the middle of installation in Clapham Relay Room (the new one for WARS located in Victoria Signalling Centre, yes, I know). New lineside cables had been installed terminating on racks, and the link terminals fitted with RED DOME NUTS (those in the S&T (Signalling and Telegraph) industry will know what they do). BR (British Rail(ways)) had stagework wiring installed on the Righthand side of the terminations whilst we were installing the new interlocking wiring on the Lefthand side, with the connecting link obviously not fitted. BR then used the new cables to connect the new trackside equipment being installed in stages to the old Clapham signalbox interlocking. So, one fateful morning, siting in my office having my day starting cup of tea, the telephone rang and the person at the other end said "Hey, have you heard there's been a big accident at Clapham Junction, three trains involved and lots of people killed and injured?". You obviously can guess that my heart certainly sank to the floor and thoughts started flashing through my mind, crikey hope our staff haven't done anything. Started looking at the news reports on the TV and you can then imagine how my feelings progressed during the day.

Well, I suppose my point is, it becomes one of those defining moments in your career that you NEVER FORGET. I just hope we don't end up having a repeat of all that to make people understand and learn it all over again.
« Last Edit: November 19, 2018, 20:43:14 by SandTEngineer » Logged
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