Inquiries & Recommendations

Ngā ketuketutanga me ngā tūtohunga

On 24 March 2026, the Commission recommended that the chief executive of KiwiRail review and improve KiwiRail’s training on the air-brake operation system and include the associated risks of not following the required procedures.

On 24 March 2026, the Commission recommended that the chief executive of KiwiRail takes action to put in place trackside information to assist train crews to respond appropriately to signals, monitoring the train’s speed and progress.

On 25 February 2026, the Commission recommended that the Ministry of Transport, when monitoring NZTA’s regulatory performance, ensures that NZTA is fulfilling its safety oversight role effectively, including NZTA’s response to the increase in KiwiRail’s signal passed at danger incidents.

On 25 February 2026, the Commission recommended that NZTA, when monitoring KiwiRail’s performance against their safety objectives, including monitoring of key performance indicators, ensures that the safety risk of KiwiRail’s high signal passed at danger ratio is being well managed and controlled, including in non-metro areas.

On 25 February 2026, the Commission recommended that KiwiRail utilise engineering safety controls in areas of its rail network where none currently exist, to mitigate the risk of human error by locomotive engineers and reduce signal passed at danger incidents.

On 25 February 2026, the Commission recommended that Airbus revise its standard documentation about operating the thrust levers in the Flight Crew Operating Manual and the Flight Crews Techniques Manual, to ensure that pilots are fully aware of the risk of unintentional thrust lever positioning so they can be more prepared to operate the thrust levers and correctly select their intended settings.

On 19 November 2025, the Commission recommended to the Director of the Civil Aviation Authority that the Authority conduct a comprehensive review of the lower level airspace around Whangārei to determine what changes are required to mitigate the risk of mid-air collisions or serious incidents and to then take appropriate action.

On 19 November 2025, the Commission recommended to the Secretary for Transport to work with the Civil Aviation Authority to address gaps in the Civil Aviation Rules relating to airspace reviews, namely to: - clearly define which agency is responsible for conducting regular comprehensive airspace reviews in New Zealand - ensure comprehensive airspace reviews are conducted to identify current and emerging aviation safety risks that may require airspace solutions or other mitigations to achieve an acceptable level of safety for all airspace users.

On 2 July 2025, the Commission recommended that the CAA notify and work with EASA to ensure appropriate action was taken to identify and replace any defective fire switches.

On 26 June 2025, the Commission recommended that Shanhaiguan Shipbuilding Industry Co Ltd implement quality assurance practices to ensure all rudder pintle assemblies are effectively installed.

On 26 June 2025, the Commission recommended that Maritime New Zealand investigate and submit papers as appropriate to the IMO (through the appropriate sub-committee) to promote standards that ensure sufficient quality assurance for rudder systems throughout the process of installation, alterations, major repairs and maintenance.

On 28 May 2025, the Commission recommended that KiwiRail review its national project management structure to ensure there is sufficient oversight of and ongoing support for all project staff at all levels to maintain safe working conditions and manageable workloads.