NTSB -- NTSB releases final report on 2009 monorail collision at Walt Disney World

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NTSB PRESS RELEASE

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National Transportation Safety Board

Washington, DC 20594

FOR IMMEDIATE RELEASE: October 31, 2011

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NTSB releases final report on 2009 monorail collision at

Walt Disney World

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WASHINGTON - The National Transportation Safety Board (NTSB)

issued a report today citing a shop panel operator's failure

to properly position a switch-beam and the central

coordinator's failure to verify the position of that switch-

beam before authorizing a monorail train to move in a

reverse direction as the probable cause of a 2009 fatal

accident on the monorail system.

On Sunday, July 5, 2009, two monorails, which move

passengers to and from locations within its resorts,

collided on a fixed guideway system within the Walt Disney

World Resort in Lake Buena Vista, Florida. The accident

occurred when a Pink monorail backed through an improperly

aligned switch-beam and struck a Purple monorail which was

on the same line. At the time of the accident, there was an

operator and six passengers on board the Purple monorail and

one operator on board the Pink monorail. The operator on the

Purple monorail was fatally injured; the six passengers were

uninjured. The operator of the Pink monorail was treated at

a hospital and was released.

The NTSB also determined that contributing to the accident

was Walt Disney World Resort's lack of standard operating

procedures which led to an unsafe practice when reversing

trains on the monorail system.

Since the accident, Walt Disney World Resort has taken

numerous steps to address the operational and performance

deficiencies identified by the NTSB during its

investigation. These actions have included revising

operating procedures for monorail drivers and guidelines for

monorail central coordinators; providing additional training

for monorail employees; updating monitoring system software;

installing additional direct-feed video cameras; and planned

reconfiguring of the monorail braking system.

The accident report is available online at:

http://www.ntsb.gov/investigations/fulltext/RAB1107.html

# NTSB #

Contact: NTSB Public Affairs

Peter Knudson

Keith Holloway

202) 314-6100

The National Transportation Safety Board (NTSB) is an independent federal agency charged with

determining the probable cause of transportation accidents and promoting transportation safety,

and assisting victims of transportation accidents and their families.

For more information, visit: www.NTSB.gov.

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