Prevention of Future Deaths reports · 2018

Darren Urquhart

Regulation 28 report to prevent future deaths, reference 2018-0291, written 10 Sep 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report10 Sep 2018
Reference2018-0291
DeceasedDarren Urquhart
CoronerGeoffrey Sullivan
Coroner areaHertfordshire
CategoryRailway related deaths
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

Signed by Geoffrey Sullivan
Title Senior Coroner
Juristiction Hertfordshire

| REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: Network Rail

CORONER

| am Geoffrey Sullivan Senior Coroner for Hertfordshire

CORONER’S LEGAL POWERS

| make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and regulations
28 and 29 of the Coroners (Investigations) Regulations 2013.
http://www. legisiation.gov.uk/ukpga/2009/25/schedule/5/paragraph,

http://www. legislation gov.uk/uksi/2013/1629/part/7/made

INVESTIGATION and INQUEST

On 21" November 2017 | commenced an Investigation into the death of Darren Robert URQUHART. The
investigation concluded at the end of the inquest 29th August 2018. The conclusion of the inquest was
Suicide

Medical Cause of death:

1a Multiple Traumatic Injuries
| CIRCUMSTANCES OF THE DEATH

On the 13th November 2017 Darren Urquhart was struck by a train after jumping from platform 1 of
Hitchin Railway Station. Police and paramedics attended and he was confirmed dead at the scene at
21:13 hours.

CORONER’S CONCERNS

During the course of the Inquest the evidence revealed matters giving rise to concern. The matters
outlined below were not found to have caused or contributed to the death. In my opinion, however
there is a risk that future deaths will occur unless action is taken. In the circumstances It Is my statutory
duty to report to you.

The MATTERS OF CONCERN are as follows. —

(1) The position of the trespass mat referred to in the report of T.Ramskill at recommendation 2 of his
site report.

(2) The lack of gates at the south end of platforms 1 and 2.

(3) The inadequacy of the fencing shown In image 6 of T.Ramskill’s report and the position of the trespass
deterrence mat low down on the ramp.

The Old Courthouse, St Albans Road East, Hatfield, AL10 OES
01707 292707

| ACTION SHOULD BE TAKEN

in my oplnion action should be taken to prevent future deaths and | believe you Network rail have the
power to take such actlon.

| YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report, namely by
Tuesday November 27" 2018. |, the coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken, setting out the timetable for
action. Otherwise you must explain why no action Is proposed.

| COPIES and PUBLICATION
| have sent a copy of my report to the Chief Coroner and to the following Interested Persons:

Ms R Urquhart, sister of the deceased.
British Transport Police

lam also under a duty to send the Chief Coroner a copy of your response.

The Chlef Coroner may publish elther or both in a complete or redacted or summary form. He may send a
copy of this report to any person who he believes may find it useful or of interest. You may make
representations to me, the coroner, at the time of your response, about the release or the publication of

your response by the Chief Coroner.

| 10/09/2018

Signature —
Geoffrey Sullivan Séni ertfordshire

#DW<<corAddren>>
Tel ##DW<<corTel>> | Fax ##DW<<corFax>>

Related reports

Other reports by Geoffrey Sullivan

See all →

More reports categorised “Railway related deaths”

See all →

Track Railway related deaths

See every Prevention of Future Deaths report matching Railway related deaths, and how often a new one appears.

What would an alert for this have sent me? Search the full text

Free to try — the preview shows the real matches and how many arrived in the last 12 months. Your first email alert is free.

These reports are published by the Chief Coroner's office at judiciary.uk and are © Crown copyright. The text here is reproduced from the published PDF so it can be searched. If something on this page is wrong, or you are a person named in it and want it reviewed, email drcjar@gmail.com and we will act promptly.