Recommendation: 2022003-09

back to recommendations listing

Ref # 2022003-09
Status Further Evidence Requested
Occurrence Trend investigation into Signals Passed At Stop on the Luas network
Occurrence Date 03 January 2020

Basis for Recommendation

Transdev Dublin Light Rail (TDLR) do not have a formal Signal Sighting Committee (SSC) presently. In terms of Signal Passed at Stop (SPAS), an SSC can conduct a post-incident Signal Sighting Assessment and make changes to the asset or operational context to reduce the likelihood of a further accident or incident occurring. The RAIU consider that signals should be assessed after a SPAS event and as such make the following safety recommendation:

Recommendation

Transdev Dublin Light Rail (TDLR) should establish a formalised Signal Signalling Committee (SSC), to include stakeholders from the relevant internal and external departments (e.g. Transport Infrastructure Ireland (TII) and local authorities) to ensure that:
• In the event of a Signal Passed at Stop (SPAS) event an SSC is convened, where appropriate, to determine if any immediate actions can be taken at the signal location which may prevent a SPAS re-occurrence;
• Any changes to signalling sequencing (including the introduction of new signals) are carried out as per the relevant Safety Management System (SMS) procedure to ensure that risks are not inadvertently introduced at signals;
• Multi-SPAS signals are reviewed to see if there are any trend to the SPAS incidents;
• Previous recommendations, related to SPAS events, from internal investigations have been addressed.