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21 July 2016
Lack of Familiarity with Territory and Misinterpreted Communication Led to CP Train Exceeding its Limits of Authority Near Cranbrook


Gatineau Quebec - The Transportation Safety Board of Canada (TSB) found that a lack of familiarity with the territory and the misinterpretation of a communication contributed to a Canadian Pacific Railway (CP) train exceeding its limits of authority near Cranbrook, British Columbia, in March 2015, according to its Investigation Report R15V0046 released today.
 
No injuries were reported and no dangerous goods were involved.
 
On 11 Mar 2015 a CP traffic controller stopped a train, consisting of two locomotives and 130 empty cars near Mile 102 on the Cranbrook Subdivision, after the train had departed Cranbrook and travelled east for five miles without authorization.
 
There were no conflicting movements.
 
The investigation determined that the train had been operated past the east cautionary limits sign at Cranbrook without the required clearance.
 
During the train's approach to Cranbrook, the train crew had contacted the assistant trainmaster at Fort Steele by radio.
 
The crew members misinterpreted information from the assistant trainmaster, understanding it to be confirmation that the cautionary limits at Cranbrook extended all the way to Fort Steele.
 
As a result, they believed that no additional authority was required and that they could proceed past Cranbrook without requesting a clearance from the rail traffic controller.
 
These events occurred at about 01:20, a time of day that is close to a known circadian rhythm low point when alertness can be compromised.
 
During periods of reduced alertness, there is an increased risk of inadvertent errors such as the misinterpretation of communications.
 
Although they were qualified for their respective positions, the train crew of three CP management (non-unionized) employees were not familiar with the territory.
 
The investigation identified that if railway management employees who operate trains are not sufficiently familiar with the territory, the limits of operating authority may not be consistently observed, increasing the number of these occurrences and associated risks.
 
It also observed that if the regulations do not adequately address the requirements for training, certification, and territory familiarization for railway management employees who operate trains, trains may be crewed with management employees who are not sufficiently experienced, increasing the risk of unsafe train operations.
 
Following this occurrence, CP redesignated Cranbrook Yard as a siding.
 
The cautionary limits at the yard were removed, and an adjacent subdivision was combined to operate as one.
 
In addition, CP formalized a requirement for territory familiarization for management crews.
 
Anonymous Author.

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