Inquiries & Recommendations

Ngā ketuketutanga me ngā tūtohunga

On Wednesday 19 August 1998, Cessna 402C aeroplane ZK-VAC was on a scheduled flight from Stewart Island to Invercargill when both engines failed. After the successful ditching in Foveaux Strait five passengers were rescued, but three passengers and the pilot, who were without lifejackets, did not survive. One passenger is missing presumed dead. The cause of the double engine failure was not conclusively established but may have been associated with systemic fuel management. Safety issues identified included:

On Tuesday, 18 August 1998 at about 1845 the passenger cargo vessel "Stella" had an apparent loss of steering in heavy weather when attempting to turn around and head out of Omaha Bay. The vessel was on passage from Tryphena to Auckland with three persons on board. Due to a navigational error the "Stella" approached Omaha Bay although intending to approach the Auckland main channel. The "Stella" was held approximately in position under tow by the vessel Great Barrier Express. "Stella" was towed to the shelter of Bon Accord Harbour by HMNZS Kahu.

At about 1525 hours on 17 August 1998 a group of secondary school students were crossing the Henderson rail yard at the south end. A cyclist in the group dismounted to cross the rails, and while pushing his bicycle fell in front of train 2125, a southbound diesel multiple unit passenger train. The youth received serious injuries requiring amputation of one leg.

On Thursday, 13 August 1998, at about 0120, the fishing vessel "San Rakaia" grounded on Ninepin Rock at the entrance to Pelorus Sound. The vessel had been on passage from Nelson to the Cook Strait fishery with seven persons on board. There were no injuries. With assistance of other vessels the "San Rakaia" was refloated on the next high tide. Safety issues identified included: • inadequate management of the crew working routine, leading to fatigue • under utilisation of available navigation aids • lack of a watchkeeper monitor alarm for single-handed bridge operation

At 1249 on Wednesday 29 July 1998, the Ro-Ro cargo vessel "Union Rotoma" had encountered heavy weather in the Great Australian Bight while on passage from Sydney to Adelaide. Four containers stacked two-high on the weather deck toppled, and while this event was being investigated, three larger waves caused the ship to roll heavily, resulting in a more substantial shift of cargo above and below deck. Three containers were lost overboard in the shift.

[A preliminary investigation showed that the circumstances were not likely to have significant implications for transport safety. Consistent with section 13 of the TAIC Act the Commission discontinued the investigation and no report was published.]

On Sunday 28 June 1998, at approximately 1650 hours, Train 902, the northbound Southerner express passenger, derailed at Islington at slow speed. The rear of the train was routed to the down main when motorised points moved under the train. There were no injuries. Causal factors were non-compliances with intended procedures for points operation. Safety issues identified were the suitability of those procedures and the effectiveness of compliance monitoring. A number of safety actions were taken by the operator and 5 safety recommendations were made to address the safety issues.

On Tuesday, 2 June 1998, Train 482 was running from Putaruru to Kinleith with a rake of six empty wagons. At approximately 0510 hours the train was stopped by a member of the public waving a torch just ahead of a main line blockage caused by wagons in the Tokoroa timber siding which had run away and derailed fouling the main line.

On Sunday 17 May 1998, at 1530 hours, the carriages of Glenbrook Vintage Railway Train 31 ran away down a grade and collided with the engine which had been detached for coaling during a scheduled stop at Pukeoware. One minor injury occurred to a passenger as a result of the low-speed collision.

On Friday 15 May 1998, at approximately 2220 hours, Train 411, a southbound express freight, was mistakenly routed on to the wrong main at Ngaruawahia. This operating irregularity was not responded to appropriately and the train was permitted to continue running in the down direction on the up main to Te Rapa, some 12 km south.

On Friday 8 May 1998 Air Nelson Metro ZK-NSJ, Airlink (RLK) 8611, was being operated on a scheduled service at night from Hokitika to Christchurch when the incident occurred. Unforecast fog occurred at the destination and alternate aerodromes. The aircraft made four ILS approaches before being able to land at the destination. No alternative course of action remained available to the crew at that stage because of the low amount of fuel remaining. Safety issues identified are: • the procedure for crews to release company agents from departure aerodromes

On Thursday, 30 April 1998, at about 0250, the Ro Ro cargo vessel "Spirit of Vision" grounded in French Pass. The vessel had been on passage from Nelson to Lyttelton with eleven persons on board. There were no injuries. Attempts to refloat the vessel immediately after grounding were unsuccessful despite the assistance of the fishing vessel "Rockfish". The vessel refloated without assistance on the next rising tide and was able to continue the passage to Lyttelton, although the starboard engine could not be used due to propeller damage sustained in the grounding.