A track worker leapt from a hi-rail vehicle moments before a freight train ploughed into it near the Kaimai Tunnel last year after a chain of miscommunications left the pair working with no protection from rail traffic.
The Transport Accident Investigation Commission, which released its findings on Friday, found the two workers believed a rail protection officer had arranged protection, while train control had no idea anyone was in the tunnel at all.
The workers finished maintenance inside the tunnel, on the East Coast Main Trunk line, at about 12.40pm on April 6, 2025. They each got into a hi-rail vehicle and drove along the line towards Tauranga.
Soon after they came out of the tunnel, a westbound freight train appeared from around a bend ahead. The worker driving the leading vehicle jumped out before the train hit it. The vehicle was substantially damaged, the locomotive was not, and nobody was injured.
Two work groups had been operating near the tunnel that morning, and the Commission found they did not share the same understanding of what protection was in place.
"In fact, train control was unaware the workers were in the tunnel and the workers in the tunnel had no protection at all," the commission said in its report.
Phone call nobody else could hear
Radio coverage inside the tunnel was too poor for the two groups to speak directly, so the rail protection officers used mobile phones instead.
That left train control and other rail workers unable to hear the conversation. The Commission said there was "no opportunity to intervene if they had recognised the misunderstanding".
KiwiRail has since extended train control radio coverage to a nearby on-tracking pad and introduced a dedicated maintenance channel running from Hemopo, through the tunnel, to Whatakao. The Commission considers that issue addressed.
Investigators also found KiwiRail's own paperwork contradicted itself over whether train control had to be told before track workers entered the tunnel, with the relevant standard and the local Kaimai Tunnel instructions pointing in different directions.
Non-compliance and miscommunication 'recurring themes'
"Clear and consistent procedures are important because workers' actions need to be predictable," the Commission said, adding that the ambiguity "increased the risk of work being carried out without adequate protection".
KiwiRail has accepted both recommendations, one covering procedures for track workers in tunnels and the other covering how safety-critical information is passed on when staff use mobile phones. New forms that formally record protected work-area limits are due to come in from January 1, 2027.
The commission's watchlist warns that anyone in the rail corridor risks serious harm or death if a train enters their worksite unexpectedly.
The Transport Accident Investigation Commission recommended changes to operating rules, permit-to-enter processes, engineering controls and fatigue management since 2011, but said non-compliance and miscommunication "remain recurring themes".
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