All the adjustments in policy and procedures have already been made, employees disciplined, OSHA fines levied, and the family’s lawsuit settled. All that we have been waiting for is the final federal investigation’s Accident Report. Today the National Transportation and Safety Board released that report putting a period on the end of a long sentence that I’m sure Disney World would like to put behind them.
That sentence started with a conflagration of errors by operators, management, and poor enforcement of existing policies that ended in the tragic death of a Walt Disney World Monorail Operator early on the morning of July 5th, 2009.
The report itself, issued this afternoon (releasing something on a holiday is almost like intentionally burying it, I wonder if that was coordinated in any way?), is written a very factual manner and in a plainly stated way. The facts outlined clearly put majority of the blame on inadequate procedures and failure to enforce the exact safety procedures that would have prevented the accident. To its credit Disney has made a lot of changes to correct what went wrong, but even if Disney had just enforced one of the common sense errors, this tragedy could have been averted.