Another video that shows how people neglect procedures in place because they seem to be burdensome but end up causing massive damage, and in this case death. The story also highlights how “tribal” knowledge can end up not being captured. I feel when the changes were made no one thought they would need to explain how the system now works – and they would never recommend opening the heat exhanger without having the vent engaged, but, like many times, that information got lost in translation to paperwork.
I think something like having a lockout tag on the 2nd valve would of been noticed if someone did a thorough MOC but, as stated in the video, some questions were left blank.
I have been thinking of this accident in Canada. Not only was the issue with putting the hand brakes on with the air brakes on already as a root cause, but also the leaks in the air line that must have lowered the air pressure in the system. Air leakage is accepted as normal and no one really spends much time fixing but this accident should reflect on how something so simple as an air leak can cause a disaster.
Fittings around air piping are a typical air leak problem. Simple checks and using higher grade tape could of assisted. I am not the only person to wonder http://about this – here is a great article with more depth of the issue. One good quote from this article:
“Hand Brakes should have been redesigned many years ago, to make them easier to use and more likely to work properly. The problem is, no one is pushing for it. Costly air leaks should have been addressed and improved, but nobody is pushing for that either.
It’s difficult to explain in this format just how much leakage the railway industry is OK with. Locomotives are equipped with an air flow sensor that shows the engineer how much air is flowing/leaking. Get the picture? Leaks are OK, we just have to manage them. Our Lac Magentic engineer was driving the train, so he knew what the leakage was on that train”
The movie really hit me after watching it last night. The quote I see sometimes on social media is “you can’t tell from the outside what people are suffering inside”. This was the main point I got from this movie and the pain people carry around with them. As the character Lee said, “I can’t break it” – it is not as easy to say snap out of a bad mood when you have serious weights in your life you carry.
Your life can be looked at as a existing between 2 goal posts ~ one being the worst pain you have ever felt in your life and the other being the most happiness. Some peoples goal posts are very narrow with a low standard deviation of a bell curve and some with high ones. In this movie they tell a story of someone who has lived though things no one should have to do. It really made me think deeper about what people’s tolerance to suffering. Also it was a movie to reflect on how people’s own selfishness gets in the way to see other’s humans pain.
Also the filming style was really low key and added to the feeling of flowing in sorrow with the main character Lee. I recommend seeing it because it is something to reflect on your own life.
Last new years eve i put a list together that included a serious step goal for the upcoming year. I was looking at a real stretch goal that would keep me active the entire year. The best thing about a step goal when you have a fitbit, is the way you can monitor the number every day/hour/minute.
Review of steps over the years: 2013 (started August 1st,) 2,272,141 (pro-rated to 5,453,138), 2014 – 4,565,228, 2015 – 4,333,751, and 2016 – 5,000,000!
It was a serious goal – I needed an average of 13,700 steps a day to reach. But with a serious amount of “sticking to it” dedication I reached it.