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Driver 'may have deliberately exceeded the speed limit' in defective loco says RAIB report

The Rail Accident Investigation Branch (RAIB) has released its report into a signal passed at danger at Stafford, 26 April 2012.

A full copy of the report is available here

At about 13:35 hrs on 26 April 2012, a locomotive operated by DCR passed signal SD4-81 at Stafford, which was displaying a red aspect, by about 94 metres. As the locomotive approached the area where the incident occurred, it had been running at speeds of up to 103 mph: the railway rule book requires that locomotives running on their own are restricted to a maximum speed of 75 mph.

The RAIB investigation identified that the locomotive had been travelling at excessive speed on the approach to the signal, and that the driver did not make a full brake application as soon as he received the first indication that signal SD4-81 was displaying a red aspect. In addition:

  • the driver may have deliberately exceeded the speed permitted for locomotives running on their own, and had limited experience of the effect of high-speed operation on the braking performance of such locomotives;
  • DCR had not assessed the competence of the driver on the route over which he was travelling;
  • the driver may have been partially misled by a defective speedometer on the locomotive (this was probably indicating 90 mph at the locomotive’s maximum speed of 103 mph);
  • both the driver involved in the incident and his manager were part-time consultants with DCR who were also driving trains for the company on a ‘zero hours’ basis; and
  • the Office of Rail Regulation (ORR) had not inspected the implementation of Devon & Cornwall Railways’ safety management system, despite an internal recommendation that this should be done before DCR started operating trains.

As a result of this incident the ORR has carried out four site inspections of DCR’s operation and the owner of DCR has brought in a new management team, audited DCR’s compliance with its safety management system and has reported taking steps to ensure the competence of DCR’s train drivers.


As a consequence of this incident, the RAIB has made five recommendations:

  • two recommendations have been made to DCR, regarding the management of competence of all its safety-critical staff and confirmation that locomotives are fit to run before they are released from maintenance for operational use;
  • two recommendations have been made to the ORR, regarding:
    1. management review of its assessment of safety certificate applications and the resolution of outstanding issues through supervision; and
    2. supervision of DCR’s revised safety management system, to verify that it has established adequate controls regarding both the competence of safety-critical staff and traction & rolling stock maintenance;
  • one recommendation has been made to RSSB (Rail Safety & Standards Board), regarding the amendment of its rail industry standard on management of route knowledge for drivers, to clarify how ‘transferred-in’ route and traction knowledge should be assessed by a new employer
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