Report says human error probably caused fatal train crash
Cites failure to follow rules in Woburn
The collision of a commuter train and a maintenance truck, which killed two track workers in Woburn last year, probably resulted from human error and a failure to follow safety procedures, officials at the National Transportation Safety Board said in a probable cause report released yesterday.
A train dispatcher failed to provide proper signaling, and a work crew did not use a device that would have provided additional signal protection to the tracks where they were working, investigators said. They also said that the track engineer who died tested positive for marijuana.
"This tragic accident occurred because several employees of the railroad failed to do a very important part of their job," Mark V. Rosenker, chairman of the Safety Board, said in a statement. "Simply stated, following required safety procedures would have saved lives in this accident."
The crash occurred on Jan. 9, 2007, when the engineer of southbound Massachusetts Bay Transit Authority Train 322 received a clear signal as he passed a curve in the tracks at 62 miles per hour, officials said. When the engineer saw the track maintenance vehicle, officials said, he slammed on the breaks and hit the truck at 44 miles per hour, killing James Zipps, the track engineer, and maintenance worker Christopher Macaulay. Maintenance workers John Hickey and Edwin Olson were seriously injured.
Investigators found that the train dispatcher had "removed the block on the track segment" where the crew was working, clearing the signals for the train to enter the tracks. They also found that the track foreman failed to apply a shunting device to the tracks, which would have kept the signals red regardless of the dispatcher's actions.
The report recommended that railroads examine their train-dispatching systems to ensure "appropriate safety redundancies"; require additional signal protection to prevent similar accidents; broaden requirements for those employees who must undergo drug testing; and promote the prevention of alcohol and drug abuse.
Neither relatives of the victims nor the injured men returned calls.
In a statement, James F. O'Leary - general manager of the Massachusetts Bay Commuter Railroad Company, which employed the maintenance workers - called the report "positive steps in our effort to provide a safe work environment."
O'Leary said the company supports the NTSB's recommendation for mandatory random and post-accident drug and alcohol testing for those who serve in sensitive positions.
He added that his company and the MBTA are working to improve compliance with railroad operating rules, worker safety programs and federal regulations. They also plan to add training for dispatchers to improve on-track safety, and require dispatchers to log every train that passes through an area of closed track where work is taking place.
"Working with agencies like the NTSB and the Federal Railroad Administration, as well as labor representatives, we can ensure continued strength of the program," O'Leary said.
MBTA officials added they expect their efforts will increase safety.
"The MBTA is confident that MBCR has implemented, and will continue to implement, all of the safety measures necessary to prevent a repeat of this tragedy," Daniel A. Grabauskas, MBTA general manager, said in a statement.
