Rail operator KiwiRail did not have proper communication in place to prevent a train from pulling out from a station while a wheelchair-bound passenger and her support person were still disembarking, a report has found.

Investigators say KiwiRail has since taken appropriate steps to fix problems after the June 2013 incident in Waikanae, north of Wellington.

A witness at the time reported screaming in horror and fearing the passenger and her support person would be injured.

In a report released today, the Transport Accident Investigation Commission (TAIC) said the Capital Connection train was fitted with a mobility hoist for passengers in wheelchairs.

The train manager was watching passengers come and go from the station platform near the front of the train.

He thought the disabled passenger had left -- and closed all passenger car doors from a train door operating panel. He then authorised the train driver to depart.

But at the back of the train, an attendant was operating the mobility hoist to help the passenger and her companion leave.

The train travelled about 1.7m before an attendant pushed the emergency stop button.

The commission said nobody was injured in the incident.

The report found there were "no effective means for the train attendant who was operating the mobility hoist to communicate with the train manager".

The TAIC said KiwiRail had since taken steps to improve operational procedures and improve communication between staff on trains.

These included placing high-visibility reflective tape on the hand rails of the mobility hoist to improve its visibility.

KiwiRail had also installed a light in the luggage van that shined onto the platform when the luggage van doors were open.

TAIC said these improvements meant the commission did not have to issue recommendations to KiwiRail or the wider industry.

Shortly after the incident, an eyewitness told the Kapiti Observer the train conductor apologised to the woman, and she accepted his apology.

"She was still on the ramp ... the train was creeping along. I was screaming out and the train stopped," eyewitness Warren Doughty told the Observer.