It's been more than three years since a woman and child were hit by a GO train crossing Lancaster Street in Kitchener.
On Thursday, the Transportation Safety Board of Canada (TSB) released its report on the incident, saying a number of issues at the crossing led to the crash and multiple levels of oversight were unaware of the safety concerns.
“This accident illustrates the critical and pervasive issue of railway crossing safety, which is the second leading cause of fatalities in the railway sector,” said TSB Chair Kathy Fox in the report. “Crossing safety is a shared responsibility. Pedestrians and motorists need to obey the rules at crossings; and the railways, road authorities and regulator need to communicate with each other when risks are identified and take appropriate action to improve safety and prevent further crossing accidents.”
THE GROUP WAITS
The incident happened in November of 2019, and left a woman and a child seriously injured.
According to the TSB report, the woman and child were part of a group of six adults and five children on their way back from playing at a park when they stopped and briefly waited at a railway crossing.
A PEDESTRIAN CROSSES
According to the TSB, a pedestrian crossed the track heading towards the group as a CN train pulled away.
When the pedestrian crossed the warning signals were still active, the TSB said.
PEDESTRIANS WARNED OF INCOMING TRAIN
The TSB said another group of pedestrians prepared to cross, but the CN train operator warned them of the approaching GO train on the tracks. The pedestrian then turned back.
“There were a lot of signs that the crossing was routinely blocked by trains, and that was perhaps influencing people to cross against the grade crossing warning devices when they were active,” said Fox
PEOPLE BEGIN CROSSING THE TRACKS
“The crossing gates, warning bells and flashing lights were activated, as a Canadian National Railway (CN) freight train was performing switching operations on the siding track and occupying the multi-track crossing,” the report said.
As the CN train moved out of the way, some members of the group began to cross, even though the warnings were still activated.
The report noted the group was unable to see the approaching GO train and therefore associated the crossing warning solely with the CN freight train exiting the crossing.
“The pedestrians also did not receive an early warning of a second train approaching due to the anti-whistling designation at that crossing,” the report said.
THE TRAIN STRIKES TWO PEOPLE
“Unaware of the approaching train, two adults from the group, both accompanied by a child, began to cross. The first adult and child ran across the crossing. As they cleared the crossing, the second adult and child pair, who followed about 15 feet behind them, were struck by the train,” the report said.
A 30-year-old woman and 6 year old boy were airlifted to a local hospital.
The TSB found that there were a number of hazards at the crossing that various oversight bodies weren't aware of.
The investigation determined that CN’s use of the crossing for switching activities resulted in the crossing warning devices being frequently activated, sometimes in excess of the five-minute regulatory limit, which influenced some users to adopt the risky behaviour of entering the crossing while the safety measures were activated in order to avoid delays.
According to the TSB, Metrolinx commuter trains, VIA passenger trains and CN freight trains all operate at the crossing.
At the time of the collision, the TSB said an average week day would see 23 Go trains and four VIA rail passenger.
"Despite the clear need for thorough safety oversight, as it is vital in identifying and addressing risks present at crossings, none of the parties involved – CN, Metrolinx, the Region of Waterloo, and the MTO – were aware of the observed hazards that existed at the crossing," the report said.
THE VIEW FROM THE TRAIN
“The Ministry of Transportation of Ontario, which is the regulator for this provincially regulated railway, didn’t have and doesn’t have an effective oversight regime or the personnel to effectively oversee provincially regulated railways,” Fox said.
"WORK IS ALREADY WELL UNDERWAY"
“We are carefully reviewing the findings of this report and investigation. Prior to the release of this report, Minister Mulroney directed ministry staff to conduct a complete review focused on exploring avenues to strengthen and enhance provincial rail safety oversight - this work is already well underway,” MTO senior media relations advisor Aruna Aundhia told CTV News in an email.
Aundhia said actions taken to date include amending the process for how the MTO receive inspection reports, and continuing to work with Metrolinx and municipalities to ensure safety at grade crossings.
“As part of our ongoing work, MTO will continue to work closely with its agencies, including Metrolinx and the Ontario Northland Transportation Commission to ensure the safety of our regulated railways,” Aundhia said.
“PEOPLE ARE TAKING MORE CARE”
A number of improvements have been made at the Lancaster Street crossing, including a pedestrian gate, signs warning of a second train and improved fencing.
“What I do notice is that people are taking more care, there is more caution there is more awareness in that area,” Joseph Pozeg, New Trend Corporation owner said.
Pozeg works at a business near the tracks, and was there when the woman and boy were hit.
“We kind of backed-off because there were already a lot of people there and we couldn’t really help,” he said.
The said the safety improvements have helped, but more could be done.
“The long term the only solution is doing either an underpass or over pass, that’s the only real long tern solution,” said Pozeg.
The full report can be watched here.
