Report 07/2019: Fatal accident at Stoats Nest Junction, Purley

Fatal accident at Stoats Nest Junction, Purley, 6 November 2018.

R072019_190711_Stoats_Nest_Junction

Summary

At around 00:28 hrs on the morning of 6 November 2018, a passenger train from London Victoria to Three Bridges, travelling at about 69 mph (111 km/h), struck and fatally injured a track worker in the vicinity of Stoats Nest Junction, near Purley. The accident occurred after the track worker had placed equipment on the track as part of the arrangements for the protection of an engineering possession. Having placed the protection equipment, the track worker then walked along the track until he reached the end of the protected area, and continued walking with his back to rail traffic on an open line. He may have been going to look at some lineside equipment, and believed that no trains would approach on the line he was walking along. He was probably fatigued, and may have been distracted by personal issues linked to the fact that a second person, the possession support assistant who was supposed to be with the track worker, was not present as he had not attended for work that night.

Underlying factors associated with the accident were the nature of the work which exposed the track worker to risk while he was putting out protection for the possession; that the labour supplier’s management processes had not sufficiently identified and addressed the risk of fatigue among zero hours contracted staff; and that the labour supplier’s management processes had neither identified nor prevented staff absenting themselves from work without being detected.

Recommendations

The RAIB has made two recommendations and identified three learning points. One recommendation is addressed to Network Rail, to improve the way its labour suppliers manage the risks associated with the use of workers on zero hours contracts, in particular the management of their lifestyle and fatigue. The second recommendation is addressed to Vital Human Resources Ltd, the labour supplier, to commission an independent review of the actions it has taken following the accident at Stoats Nest Junction to assess their effectiveness in detecting and preventing the type of behaviour seen in the accident, and reduce the risks from fatigue. The RAIB has previously made recommendations about reducing the exposure of staff to risk while carrying out possession protection duties, and these are still being considered by the railway industry.

A learning point highlights the need for safety-critical staff to be aware that distraction caused by family issues or other employment may affect their fitness for duty. Other learning points highlight the importance of track workers being alert to the risks on the railway, even when they believe that they are working under protection, and the limitations of the railway industry’s ‘Sentinel’ system if it is used for establishing the presence of staff on site.

Published 11 July 2019