‘Significant risk’ – Coroner findings into Thunder River Rapids ride
Coroner James McDougall has delivered a scathing report into the deaths of four passengers on the Thunder River Rapids ride at Dreamworld in 2016.
Coroner McDougall reported “there is no evidence that Dreamworld ever conducted a proper risk assessment of the ride in its 30 years of commission”.
“Whilst there were various occasions when hazard identification risk assessment should have been triggered, this was never done,” he said.
Coroner’s findings on work health and safety issues
The court was told that the safe operation of the ride relied on administrative controls which involved operators observing for emergencies. A review of previous incidents in 2014 showed the possibility of rafts colliding and had recommended engineering controls.
It was reported that the ride had broken down five times in the week prior to the tragedy and was reset without investigation.
The Coroner’s report identified a range of work health and safety concerns including but not limited to:
- hazardous processes and environments where there is a risk of serious injury must be thoroughly risk assessed and the risk assessment should be subject to, at a minimum, annual review,
- confusion within the company as to whose responsibility was what,
- a lack of focused safety auditing,
- problems with the availability of suitably qualified ride consultant engineers,
- a lack of clarity in Australian Standards linked to rides,
- shortcomings in regulatory oversight,
- a lack of training for staff, and
- an overall lack of systems and processes within the company.
Coroner McDougall has referred the company, Ardent Leisure, to the Office of Industrial Relations and has recommended prosecution.
Importance of managing risks associated with plant and equipment
The findings from the report highlight the importance of managing the risks associated with plant and equipment in all workplaces.
- Engineering controls should always be used where available rather than an over reliance on lower order administrative controls, for example worker intervention.
- When a piece of plant or equipment fails it should be tagged out of service and inspected by a competent person before reuse.
- Hazard reports should always be followed up and an investigation conducted where necessary.
- Risk assessments and control measures should be thoroughly reviewed following an incident.
Work health and safety systems and procedures
Contact us to find out more about how we can support your business and ensure the appropriate work health and safety systems and procedures are integrated into your business operations.