On 27 March 2009 an eastbound District Line train 103 passed a signal controlling the approach to Hanger Lane junction at danger at low speed. The train stopped with its leading end approximately five metres past the signal, and the train operator (driver of the train) reported the incident to the signaller by telephone. The signaller gave the train operator authority to proceed across the junction. Shortly afterwards, and before train 103 had started to move, a westbound Piccadilly Line train crossed the junction in front of it creating the potential for a collision. The signaller had initially overlooked the presence of this train, and had then been unable to contact the train operator of train 103 once he became aware of the situation.
The immediate cause of the incident was the signaller giving train 103 the authority to proceed towards Hanger Lane junction before it was safe to do so.
The causal factors were that the operator of train 103 passed signal WM1 at danger and the signaller did not bring all trains to a halt to protect the junction before giving train 103 authority to proceed.
RAIB has made six recommendations concerning the guidance provided to assist signallers in dealing with incidents; use of simulation techniques during training; training of safety critical communication skills; issuing of medical advice to managers; and preparation of post-incident reports.
Response to recommendations:
- RAIB will periodically update the status of recommendations as reported to us by the relevant safety authority or public body
- RAIB may add comment, particularly if we have concerns regarding these responses.