Citation

Punzet L, Pignata S, Rose J. Safety Sci. 2018; 110B: 89-99.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.ssci.2018.05.015

PMID

unavailable

Abstract

A common safety issue in the rail industry is a Signal Passed at Danger (SPAD) occurrence in which a train encroaches into a section of track without authority, usually by passing a signal at stop. This study aimed to analyse SPADs using the Human Factors Analysis and Classification System (HFACS) modified to suit the rail industry (HFACS-RR) to examine the human factors involved in the occurrences and identify trends. An analysis of an Australian freight rail organisation's investigation reports (N = 35) into SPADs was undertaken. The analysis revealed at least one HFACS-RR category for each of the events examined. It was found that 97.1% (n = 34) of the events had an 'operator act' category, with 74.3% associated with operator errors. Contraventions (e.g. violation of signal approach speed) and distraction (e.g. focus on other non-critical tasks) were the most common types of errors. Mitigation strategies to address these errors are discussed. These include a single methodology to investigate SPADs; train driver performance monitoring; and training strategies focussed on route knowledge, all of which have the potential to reduce SPADs and thereby minimise risk and improve safety. Future research into SPADs may include utilising a larger sample from various organisations, and examining potential differences in the frequency and types of errors of single versus two-man crewed trains.

Language: en

Keywords

HFACS; Human error; Human factors; Signal Passed at Danger; SPAD