Minister Wee: Overlooked SOPs led to Kelana Jaya LRT collision

According to the findings from the report, the empty ‘timed-out’ Train 40 experienced technical difficulties


OVERLOOKING critical standard operating procedures (SOPs) has led to the Kelana Jaya light rail transit (LRT) collision on May 24, Transport Minister Datuk Seri Dr Wee Ka Siong said.

According to the findings from the report compiled by the Investigation Committee, the empty “timed-out” Train 40 experienced technical difficulties and the vehicle on-board communication (VOBC) system was halted on one of two of its VOBC systems at 6.26pm.

The standby VOBC then kicked in and in line with proper safety procedure, Train 40 then vacated passengers and remotely brought to the Lembah Subang depot via automated train operation (ATO) mode for the necessary maintenance.

However, at 8.13pm, the second VOBC on Train 40 halted and lost communication (time-out) with the Operations Controlled Centre (OCC) while en route to Lembah Subang depot.

As a failsafe system, when a train experiences time-out, it will come to a complete stop. Train 40 stopped between KLCC and Kampung Baru LRT stations.

During this time-out, the OCC was unable to detect and remotely control Train 40. A hostler (train driver) was then called to manually reset both VOBCs and drive Train 40 to the ‘re-enter’ point near Dang Wangi LRT station (after Kampung Baru station), in an attempt to return operation of Train 40 to ATO mode.

It was during the process of resetting both VOBCs and driving the Train 40 manually to the re-entry point, both the hostler and OCC’s train controller had over looked and missed critical procedures.

This inadvertently resulted in Train 40 being manually moved towards KLCC station instead of south-bound towards the designated re-entry point at Dang Wangi station.

At the same time, Train 81, with passengers on board and on the same track, was held back at KLCC LRT station and a protective manual route reservation (MRR) was implemented while Train 40’s situation was being resolved.

However, the MRR was lifted and Train 81 prematurely made to depart KLCC station towards Kampung Baru station without the proper verification that Train 40 had been safely reset and re-entered into ATO mode. This led to the collision between Train 40 and Train 81.

Investigation committee chairman Datuk Isham Ishak (picture) said from the findings, the committee found the maintenance conducted by Prasarana Malaysia Bhd is in order and according to the manual that they have already established.

“In terms of maintenance of the trains, we do not see any discrepancy or any anomaly. The trains are all well-kept and in order. It’s just that the SOPs were not followed thoroughly,” he said.

He also clarified that VOBC’s failure seldom happens but when it does, there must be a SOP where everyone must understand and follow.

Wee said the government views this incident seriously and has directed Ministry of Transport to strictly ensure that every effort is taken to review and revamp safety procedures and operating guidelines in Prasarana and Rapid Rail Sdn Bhd’s rail services and asset maintenance.

The Cabinet has accepted the Investigation Committee’s 23 recommendations for improvements which Prasarana and Rapid Rail should implement to achieve these systemic improvements expeditiously.

The recommendations consist of five short-term changes, 11 medium-term changes and seven long-term changes that would take more than six months to implement.