For those interested, the
RAIB▸ have today published their report on the East Somerset Juc derailment on
their website. As
TSM▸ originally said, human error but not by the train crew...
11 The immediate cause of the accident was that the signaller did not operate a set of points (943 points) to the correct position for the safe movement of train 7A91 (Figure 2).
12 Causal factors were:
a. the failure of the signalling equipment on the Merehead branch;
b. the lack of a method over and above use of route-setting cards for helping the signaller to ensure that he had taken the correct actions in manually setting the route for train 7A91 at the time that pilot working was introduced; and
c. the signaller did not refer to his route-setting cards when setting a route for train 7A91 between two signals (signal W275 and signal W77; see Figures 2 and 3);
13 It is probable that the signaller^s actions were affected by fatigue because of the number of hours and the nature of the shifts that he had worked in the period leading up to the accident. If this were the case, fatigue was a causal factor.
TLM
