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Recommendation issued to: Queensland Rail

Recommendation details
Output No: RR20050032
Date issued: 21 November 2005
Safety action status:
Background: Why this Recommendation was developed

Output text

The ATSB recommends that QR review their SPAD investigations and related Employee Management System procedures with focus on the following:

  • Ensuring that a system of investigation and counselling for relevant safetycritical staff exists, which adheres to strict timelines, to ensure SPAD incidents are fully dealt with in the timeliest manner.
  • Investigation of SPADs includes examination of individual actions and organisational factors so that all causal factors are identified.
  • Review the monitoring and management of employees who have returned to safety-critical tasks after involvement in a SPAD, particularly multi-SPAD or high-category SPAD employees.
 
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Last update 03 April 2012