Clapham Junction accident causes

The causes of the Clapham Junction accident were fairly clear from the beginning. But the reasons for the King s Cross accident were not immediately understood and intensive investigations surrounded the inquiry. Apart from the Court of Inquiry and the assessors appointed to advise on technical matters, a team of consulting engineers was appointed to advise on technical matters. A scientific committee was also established. 

Moves towards an apparently systematic and rigorous approach to health and safety had already begun during the data collection period for this research. This approach emerged in response to a variety of influences, some of which were specific to the industry and others of which were general and extended beyond the railway industry. The specific events were the aftermath of the King s Cross and Clapham Junction accidents, which caused the whole railway industry to reappraise completely its approach to health and safety (see Ch. 3). 

The psychological phenomenon called hindsight bias plays such an important role in attribution of causes to accidents that it is worth spending time on it. The report on the Clapham Junction railway accident in Britain concluded ... 

Such analysis differs from what would normally be conducted during an accident investigation. For example at Clapham Junction the immediate cause was human error, yet several underlying factors or systematic failures were also present. Table 1 summarises the author s assessments, classifying the systematic failures by type and by primary or secondary. 

The King s Cross report made 157 recommendations and the Clapham Junction Inquiry resulted in 93 recommendations. These covered a wide range of issues such as those addressing the immediate cause of the accident recommendations to improve the response of the railway companies staff, training, communications, and management of safety and recommendations about the role of the Railway Inspectorate. I want to focus briefly on the Clapham recommendations as it is these which are most pertinent for this study. They are particularly interesting as they are another source of information about occupational health and safety on BR and one which was contemporaneous with this study. 

Procedural problems are frequently cited as the cause of major accidents, contributing to some of the world s worst incidents, such as Bhopal. Piper Alpha and Clapham Junction. In the major hazard industries, fit-for-purpose procedures are essential to minimise errors, and to protect against loss of operating knowledge (eg when experienced personnel leave). 

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