Calgary Alberta - The locomotive engineer operating the Canadian Pacific Railway (CP) train that derailed in Calgary's Alyth Yard in February 2016 had been awake for 23 hours when the incident occurred, according to the Transportation Safety Board.
In Investigation Report R16C0012 released Wednesday, the TSB identified employee fatigue as a contributing factor in the incident, which saw 13 cars derail when a CP freight train was performing a switching operation at the rail facility in Inglewood.
There were no injuries or dangerous goods released, and the train was only moving four km/h at the time.
According to the report, which also cites inadequate train handling as a contributing factor in the derailment, the engineer involved had woken up at 07:00 the day before the incident, expecting to be called to work sometime in the afternoon.
However, when he consulted the train line-up later in the day, he learned that his call would likely not come until much later.
By the time the call came, at about 20:20 the engineer had not taken any opportunity to rest and reported for duty at 22:05.
He had worked an eight-hour shift at the time of the incident.
In its report, the TSB said fatigue continues to pose a risk for the safe operation of trains in Canada, adding the issue will remain on its watch list until Transport Canada completes a promised review of railway fatigue management systems and, together with the railways, implements further action.
"Fatigue management is a shared responsibility," the TSB states in its report.
"Employees have a responsibility to make every effort to report to work well rested while the company has a responsibility to provide a system that allows them to do so, including procedures to remove themselves from eligibility for duty without fear of discipline."
Fatigue on the rails has been an ongoing issue at CP, which has been butting heads with the union that represents approximately 3,000 of its conductors and engineers over the best way to address the problem.
Conductors and engineers currently work on an on-call basis without set shift schedules or lengths.
While mandatory rest periods aren't part of the system, employees can take advantage of numerous voluntary opportunities for time off and rest when they want it.
The system has been referred to as "dysfunctional" by the union, the Teamsters Canada Rail Conference (TCRC).