YORKSHIRE MAIN COLLIERY

Map of the accident site.

The investigation  

Notices were exhibited at the arrestor describing its correct method of operation and two clear notices were exhibited as suitable intervals on the slope requiring drivers to drive in first gear.  Extracts from the Manager's Transport Rules relevant to manriding operations were posted at 5's Paddy Station.

Picture of the notice board at the site of the arrestor.

No 18 Locomotive.

This locomotive which was externally undamaged, was put back on the track and the engine restarted by hand. After recharging the compressed air receivers , air leakage tests were found to be satisfactory.  Service and emergency braking systems were tested and found to be in good order and the mechanical brake successfully applied the braking shoes to all four wheels.  When the locomotive was moved, slight 'flats' were noted on both rear wheels.  Skid marks were seen on the track from the position of the rear wheels to the approximate position of the rear of the first carriage.

The Godwin Warren Arrestor

An inspection of the Godwin Warren arrestor indicated that it was in good mechanical condition.  The friction pads had not moved, confirming that the arrestor had not received an impact.  The head was easily depressed but did not always automatically return to the safe position, apart of the impact head tended to rub on one side of the concrete pit but a slight pressure on the operating lever was sufficient to return the impact head to the operative position.

Matters arising out of the Investigation

During the investigation it became clear that all drivers and conductors had not been properly trained and authorised.  Some were trained merely by experience over a number of years.  Allott was placed on conducting duties, admittedly in error, without formal training or authorisation.  Shone had been trained as a locomotive driver and was authorised to drive on 29 October 1978 - 23 days before the accident.  Experience can only be gained by logging up many hours of actual driving and it seems likely that he had had insufficient experience to cope with the situation which developed.

The locomotive driver, Shone, was trained in the technique of skid correction on a surface test track using a locomotive with different characteristics and controls to the locomotive in use underground at Bentley which he was later authorised to drive.  Driver training should be related to the type or class of locomotive which he will be expected to drive on normal duties at his mine.

The Godwin Warren arrestor was equipped with red and green lights to indicate the position of the impact head.  These lights had not been properly maintained and for a  number of weeks locomotive drivers had been driving past a permanent red light. Where control lights are provided it is essential that they are maintained in correct working order and strictly obeyed, otherwise their value is negated.

Men should not board manriding trains until told to do so by the conductor and this requirement is embodied in the Manager's Transport Rules.  Permission for men to board trains should not be given until the trains have been checked and tested and are in a position for departure.  There was widespread failure to comply with the Manager's Transport Rules and no one who was there at the time, whether official or workmen should feel satisfied with his conduct.

Conclusions 

The accident was caused by the train running away on the incline and getting out of control before crashing into the roadway supports at the D04/D06 junction.

There was no evidence that any of the deceased or any others had attempted to jump off the moving train.  In all probability their injuries were caused either by the canopies as they were torn asunder, or by coming into violent contact with the roadside as they were dragged from the carriages.

The driver stated that he intended to move only about 20-30 feet down the incline to enable the second locomotive to couple to the two carriages parked inbye.  He also stated that he engaged second gear and was thereafter unable to stop or control the speed of the train.  Engagement of second gear was contrary to the Manager's Transport Rules and in disregard of posted notices which required first gear to be engaged.  Tests carried out on the surface showed that had first gear been selected the speed of the train would not have exceeded 6.5 mph even with the locomotive throttle fully open.  With second gear engaged the train would have reached 7.8 mph and taken four seconds to travel 30 foot, at the bottom of the incline its speed would have been 13.7 mph after 47 seconds and at this speed it is probable that the vehicles would have derailed at the curve on D04/D06 junction.

The driver stated that he tried to control the train by the mechanical brake and service brake without success.  However service tests showed that the mechanical brake and service brake of the locomotive, each acting alone, could bring the train to rest on an average gradient of 1 in 15.2 from 12.2. mph.  There seems little doubt therefore that had the brakes been properly applied the train would have been brought to rest.

Emergency brake valves provided in the second and fourth carriages had not been operated and operation of either of these would have caused the emergency brakes to have been applied on the locomotive and first three carriages irrespective of action by the driver.  The guard was not in his position to operate the emergency valve in the fourth carriage.

The Godwin Warren arrestor had been deliberately defeated and could not, therefore, arrest the runaway.  There had been previous experience of this arrestor successfully arresting runaway vehicles and there is no doubt that it could have done so in this incident.

There was no evidence to show that the condition or maintenance of the locomotive contributed to the accident.

Locomotive hauled manriding on steep gradients depend for their safety on the skill of the locomotive driver and also on a sequence of operational procedures being carried out by the driver and conductor. Appointment of an unqualified conductor, failure to follow recognised procedures and lack of discipline, all contributed to the accident.

Recommendations

Strict discipline and adherence to the Manager's Transport Rules are fundamental requirements in all manriding operations.  Management and Trade Unions should take firm action to ensure full compliance with operational procedures.

The certification and authorisation of locomotive drivers should be specifically related to the type of locomotive on which they have been trained.  Drivers should have a reasonable period of post-certificate driving experience before being permitted to drive manriding trains.

Efforts should be made to modernise or replace older types of locomotives so that they conform to current design standards and in particular, every locomotive should be fitted with a speedometer irrespective of its age, horse power or speed capabilities on a level track.

In the design of new manriding carriages, consideration should be given to the strength of the vehicle body to give maximum protection to the passengers.

The provision of a retractable energy absorbing arrestor is commended and methods of automatic retraction should be developed for normal speeds.  For excessive speeds the arrestor would remain in the operative position.

Names of casualties

Killed

Robert Aitcheson,  Age 54, Faceworker

Donald Box, Age 39, Faceworker

Kenneth Green, Age 38, Faceworker

David R Hall, Age 21, Face Trainee

Geoffrey Henderson, Age 39, Faceworker

Michael Edward Hickman, Age 18, Face Trainee

James Mitchell, Age 55, Faceworker

Seriously Injured

Thomas J Rush, Age 26, Supply Man

Paul Thompson, Age 26, Ripper

J Butcher, Age 57, Shift Charge Engineer