Dr Zarkoff Wrote:
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>> If the manager was cognizant that many employees had "inadequate knowledge and training",

> If you carefully re-read the report's text and think about it, particularly the part you boldfaced, you'll find that this became known only after the fact (most likely because of the investigation), which means the rest of your assertion: that should have been should have been, is at best armchair quarterbacking.

We don't know to what extent the manager may have been of the opinion that many of his co-workers had "inadequate knowledge and training". It may have been a glaring problem, staring him in the face, or he may have thought all of his co-workers were Albert Einsteins. We don't know.

From the report:

". . .the Vancouver maintenance foreman recalled having told the manager about the "hot box" problem and asked the manager to contact the maintenance foreman at Jasper, Alberta, to have him perform a bearing inspection."

Knowing that, how much effort would it have been for the manager to have simply followed through on the request of the Vancouver maintenance foreman, as a degree of respect for that man if nothing else? Especially on a safety-related issue. Managers can preach "safety-first" until they're blue in the face. What matters is what they practice. The manager who was concerned about on-time performance probably had some sleepless nights, wondering if the wreck could have been avoided if he had simply passed along to the Jasper maintenance foreman that a thorough inspection be conducted there. And it wouldn't have even involved taking any money out of his pocket. To do what the Vancouver maintenance foreman requested wouldn't have cost him a cent. Not following through on requests from your fellow managerial co-workers, on safety-related issues no less, is simply bad management.