Inquiries & Recommendations
Ngā ketuketutanga me ngā tūtohunga
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Aviation
AO-2018-008
The Commission is providing New Zealand’s Accredited Representative participating in the Indonesia National Transportation Committee’s investigation of a fatal accident involving a New Zealand-manufactured Pacific Aerospace Ltd 750XL aeroplane
Incident date: Publish date:
Aviation
AO-1991-013
The aircraft collided with trees immediately after taking off from a farm airstrip. The aircraft descended into a bush clad gully and caught fire. The pilot succeeded in vacating the cockpit but received extensive burns. He died in hospital 14 days after the accident.
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Rail
RO-1993-117
On 18 October 1993 a shunting locomotive struck a car on the Matapihi Road level crossing, Mount Maunganui, fatally injuring the motorist. The safety issues identified in this report are the location and substance of the passive signs prior to the crossing, and the number and location of the active warning devices at the crossing.
Incident date: Publish date:
Aviation
AO-2018-006
A Robinson R44 helicopter disappeared while on a short flight over Lake Wanaka. Searchers found an oil slick on the lake surface and some debris on land nearby.
Incident date: Publish date:
Rail
RO-2019-104
A work train was allowed to travel through an area where a hi-rail excavator was on the track. The excavator driver cleared the track. No damage, no injury. A local procedural work-around had been prioritised over established safety rules -- risky. TAIC recommends KiwiRail review its Rules and Procedures to provide appropriate guidance for operation of work trains.
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Rail
RO-2019-106
Passenger train 804, Irregular disembarkation of passengers, Rolleston, Canterbury, 3 September 2019
A train was wrong routed onto a line not adjacent to a station platform. Two passengers got off and walked across the Main Line. Train control didn’t know, and rail traffic wasn’t blocked from passing through. Nobody hurt. KiwiRail fixing wrong routing of passenger trains at Rolleston, instructing crews on disembarking passengers when platform unavailable. Safety-critical personnel must communicate about who is doing what, when, to complete tasks safely.
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Rail
RO-2019-107
A passenger train leaving Wellington station ran a red light because a radio call distracted its driver. The red signal protected an inbound passenger train. Both trains stopped just in time. TAIC reminds KiwiRail of 2017 TAIC recommendation to urgently minimise risks for trains in Wellington rail yards. In the meantime, Train drivers must be more cautious, concentrate.
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Aviation
AO-2017-009
TAIC has resolved this inquiry, satisfied that the Interim Report published in May 2018 identified the salient safety issues, which Rolls-Royce had already addressed. The Commission’s early investigations prompted the engine manufacturer to improve its system for forecasting when the fatigue might happen. Affected turbine blades have been replaced in 99% of the global flying fleet.
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Aviation
AO-2017-010
TAIC has resolved this inquiry, satisfied that the Interim Report published in May 2018 identified the salient safety issues, which Rolls-Royce had already addressed. The Commission’s early investigations prompted the engine manufacturer to improve its system for forecasting when the fatigue might happen. Affected turbine blades have been replaced in 99% of the global flying fleet.
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Rail
RO-1997-112
On Friday 17 October 1997, Train 1605 was conveying approximately 60 passengers from Masterton to Wellington on its scheduled service. At 1050 hours when 2.5 km into the 8.8 km long Rimutaka Tunnel the train was stopped as a result of an electrical failure in the locomotive control gear. At 1258 hours a relief locomotive was able to clear the disabled service from the tunnel. There were no injuries.
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Rail
RO-1998-103
On Monday, 9 March 1998, at about 0655 hours Train 1603, a Masterton to Wellington suburban passenger service, collided with a transition head which had fallen from the locomotive cowcatcher. Damage to the underside of the train resulted in a 3000 litre diesel fuel spillage. The cause of the collision was a transition head becoming displaced in transit due to inadequate stowage details. Safety deficiencies identified were: • The lack of adequate investigation of the work necessary to convert overseas rolling stock for New Zealand coupling requirements.
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Rail
RO-1993-112
On 25 August 1993 Train 901 - the "Southerner" passenger express - collided with a concrete mixer truck on a level crossing at Rolleston. Three passengers on the train were fatally injured and seven seriously injured. The truck driver received minor injuries.
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