A high speed train with motion blur from the speed as it passes the camera during the day

ATSB Report: Wallan Train Derailment

The ATSB has concluded its investigation into the Wallan train derailment that resulted in two fatalities.

ATSB Publishes Final Report on Wallan Train Derailment

The Australian Transport Safety Bureau (ATSB) has unveiled its concluding report on the 2020 Wallan train derailment.

The ATSB identified that lapses in risk management processes led to the XPT passenger train’s derailment in Victoria.

On 20th February 2020, the NSW Trainlink XPT passenger train ST23, travelling from Sydney to Melbourne, derailed at a speed between 114 and 127 km/h while entering a crossing loop. The maximum allowed speed for entering the loop was 15 km/h.

The train’s front power car capsized and slid before halting. Tragically, the driver and a qualified worker, present in the power car to oversee a level crossing activation, lost their lives. Eight passengers were hospitalised with severe injuries, and 53 passengers, along with five service crew members, suffered minor injuries.

The ATSB’s safety investigation, spearheaded by Victoria’s Chief Investigator Transport Safety and supported by the New South Wales Office of Transport Safety Investigations (OTSI), presented 37 findings, including 15 safety concerns.

The report elaborated that a signalling hut fire earlier that month led the rail infrastructure manager, ARTC, to implement administrative protocols. These allowed train drivers to traverse a 24 km track stretch between Kilmore East and Donnybrook while the signalling was non-functional.

On the day of the accident, trains were directed through the Wallan loop to cleanse the track before signal system repair tests.

“In the 12 days leading up to the mishap, the driver had navigated the XPT service through Wallan eight times, always on a straight track with a 130 km/h speed limit,” stated ATSB Chief Commissioner Angus Mitchell.

“Yet, there was no established procedure to verify the driver’s comprehension of the altered directive, without any mandate for the driver to reiterate or acknowledge the instructions to the network control officer.”

The investigation discerned that the train management during the signalling system’s downtime diverged from ARTC’s network rules, and the risks introduced by this deviation were not effectively managed.

Chief Investigator of Transport Safety, Mark Smallwood, commented, “Several safety elements heightened the risk, including ARTC’s risk management shortcomings, the train working protocols, and an over-reliance on manual processes.”

The study also underscored that the XPT driver’s cab design exacerbated the outcomes for the driver and the accompanying qualified worker. Additionally, passenger briefings and onboard instructions did not adequately inform all passengers about emergency procedures.

The investigation further revealed that NSW Trains lacked an effective method to access safety-critical data for its Victorian operations from the ARTC web portal.

Smallwood emphasised the significance of robust risk management, especially during planned and unplanned track works, as demonstrated by the Wallan signalling loss incident.