Inquiries & Recommendations

Ngā ketuketutanga me ngā tūtohunga

Formally structure compliance monitoring for newly-appointed staff to include input from experienced shunting staff where appropriate.

Review the supervision of inexperienced controllers with a view to preventing the development of undesirable habits and unsatisfactory techniques.

He emphasise to pilots on low level cross country exercises a need to consider, during pre-flight briefings, the action to be taken in relation to unattended aerodromes close to the planned track in the event of a diversion due to weather.

Review the current procedures for the procurement of critical aircraft components, with a view to requiring the components to be supplied through an approved distributor or the component's history be positively established by documentation, before they can be fitted to a certificate aircraft.

The distance between the compulsory stop line and the rail corridor at the Beach Road level crossing at Paekakariki is 10.5 m. The bus involved in this accident was 12.6 m long. Many other buses and various configurations of trucks are longer than 10.5 m. This means that when one of these long vehicles stops at the stop sign (as it is required to do) the back of the vehicle will foul the rail corridor and be at risk of being struck by a train. Technically then, any such vehicles intending to turn right to State Highway 1 cannot comply with the road rules when using this level crossing.

Review the periodicity and suitability of pit inspection to detect loose tyres on Electric Multiple Units before lateral movement on the wheel is possible.

It was recommended to the Secretary for Transport that he address the status of the National Rail System Standard and the relationship between these standards and rail participants' safety cases and underlying safety systems is not clear. For example, it is not clear whether KiwiRail's safety case and its underpinning safety system can be required to comply with the NRSS as a minimum, or whether the NRSS is subservient to KiwiRail's safety system. An approved (by the regulator) change to KiwiRail's safety system could then by default become an approved change to the NRSS.

Require all commercial jet boat operators to incorporate any manufacturer's recommended maintenance schedule in their own inspection and maintenance system.

Amend his standard load plans to specify the baggage or cargo conditions that must be met if pilots are to rely on the plans to keep the centre of gravity within limits.

In view of the presence of several level crossings close to busy main roads in the Borough, he establish a working party with the Tauranga District Council, New Zealand Rail Limited, and Transit New Zealand to review the adequacy of the road and rail layout, the warning devices, and the passive signs on all level crossings in Mount Maunganui as soon as practical.

Take appropriate action to reduce the possibility of similar incidents occurring at any other localities where adjacent signals capable of giving medium speed indications under similar routing patterns could lead to similar misunderstandings.

Assess the suitability of the Paremata Harbour navigation aids for each new commercial operator and make the necessary upgrade, or place the necessary restrictions, to ensure safe operations within the harbour.