ATSB releases preliminary report from Westwood locomotive collision

Accident site

Key points:

  • Locomotive collided with the rear of a stationary coal train on entering a loop;
  • Locomotive was operating long end leading during route tuition for two drivers;
  • Preliminary report outlines factual information, investigation is ongoing.

Long end leading operations - where the drivers' cab is to the rear of the locomotive relative to the direction of travel - is one of a number of areas of focus of the Australian Transport Safety Bureau's on-going investigation into the fatal collision of a locomotive with the rear of a stationary coal train at Westwood, Queensland, on 18 June 2021.

The ATSB has released a preliminary report into the accident, which details factual information from the investigation's early evidence collection phase but does not contain analysis or findings. The report notes that the single Queensland Rail (QR) 2470 class locomotive (operating as a 'light engine' as no rolling stock was attached) had left Rockhampton for Bluff, operating long end leading.

Three drivers were on board the locomotive: one tutor driver and two qualified drivers undergoing route tuition (to learn the signalling, speeds and track dynamics of the route) before being qualified to operate trains between Rockhampton and Bluff. One of the drivers undergoing route tuition was performing the role of driver, the other was performing the role of co-driver, assisting the driver by observing, announcing and confirming signal aspects as they were sighted.

While the route between Rockhampton and Bluff is dual track, maintenance on the Down line to the west of Westwood meant all rail traffic in that area had to use the Up line, and the common loop at Westwood was being used to facilitate passing traffic.

As the locomotive approached Westwood on the Down line, an empty Aurizon coal train was waiting in the crossing loop, and the Network Control Officer (NCO) set the signal interlocking system to show a yellow (caution) aspect at the approach signal and a red (stop) aspect at the signal before the points to enter the Westwood common loop.

The NCO then set the points as planned from the Down line into the loop.

Analysis of the locomotive's data logger showed a partial application of the independent brake was initiated as the locomotive entered a downhill gradient into the Westwood yard. It entered the 50 km/h turnout from the Down line to the loop at approximately 72 km/h.

In response to a SPAD (signal passed at danger) alarm the NCO made an emergency radio broadcast. There was no response from the locomotive crew.

A full independent braking application was made approximately four seconds after the locomotive entered the turnout, when it was travelling at 60 km/h. The locomotive collided with the rear of the coal train, just past the start of the crossing loop, at a speed of approximately 44 km/h.

The locomotive and the last nine wagons of the coal train sustained significant damage in the collision. The driver was fatally injured, the co-driver sustained serious injuries, and the tutor driver received minor injuries.

"When operating long end leading, the structure of the locomotive and the configuration of the cabin limits vision for the train crew, and as our investigation progresses, the ATSB will review and examine the functionality and cabin ergonomics of the 2470 class locomotive for long end leading operations," ATSB Chief Commissioner Angus Mitchell said.

"We will also review the nature and extent of the use of long end leading for main line operations, other factors that might have influenced the crew's performance, and the risk controls in place relating to collisions and authority exceedances, such as SPADs, during long end leading operations."

The investigation will also review change management and risk management processes applicable to the use of long end leading for route tuition and post incident procedures for managing emergencies on the network.

Since the accident, QR has suspended all mainline long end leading operations, with permitted operations for long end leading limited to shunting, turning of a locomotive, setting back and propelling movements.

Separately, the Office of the National Rail Safety Regulator issued a safety alert on 25 June 2021 that required all infrastructure managers and rolling stock operators to review the risks associated with long end leading operations by the end of July.

The ATSB will release a final report at the conclusion of the investigation.

"However, should a critical safety issue be identified during the course of the investigation, the ATSB will immediately notify relevant parties so appropriate and timely safety action can be taken," Mr Mitchell said.

You can find here the preliminary report: RO-2021-007: Collision between light engine LET0 and empty coal train EE16, Westwood, Queensland, on 18 June 2021

Last update 10 September 2021

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