Electrical Near Misses Continue to Occur · 1 Electrical Near Misses Continue to Occur Electrical...

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1 Electrical Near Misses Continue to Occur Electrical safety occurrences are the most frequently reported near miss events across the DOE complex, and thus pose the greatest risk to workers. In 2002 and 2003, electrical safety occurrences were reported at a rate of two per week, with three-quarters of them categorized as near misses (to serious injury or death). Thirty-five of the electrical occurrences in this 2-year period involved shocks to workers; six resulted in electrical burns. An analysis of the electrical occurrences in 2002 and 2003 showed that about 50 percent involved electrical work performed by electricians and other electrical workers who install, remove, or maintain electrical equipment or components. DOE’s non- mandatory Electrical Safety Handbook (DOE- HDBK-1092-98) addresses these activities. While deviating from recommendations in the handbook and other electrical standards often contributed to occurrences involving electrical work, the root causes largely stemmed from basic conduct of operations deficiencies involving work planning, lockout/tagout, and configuration management. (The Electrical Safety Handbook is available at http://tis.eh.doe.gov/ techstds/standard/hdbk1092/ hdbk1092.pdf.) Electrical occurrences involving non- electrical workers (e.g., construction workers and vehicle drivers) comprised the remaining occurrences. In many cases, the electrical hazards in these occurrences resulted from errors and deviations previously made by electrical workers. Non-electrical workers are protected by general regulations, such as OSHA rules for construction, excavation, and vehicle safety. These workers’ activities are not directly addressed in the DOE Electrical Safety Handbook. The purpose of this report is to describe commonly made electrical safety errors and identify lessons learned and specific actions that should be taken to prevent similar occurrences. Electrical Work Near Misses Qualified electricians, linemen, instrumentation and control, electrical or electronic technicians, and trained operations or maintenance workers who installed, removed, and maintained electrical equipment were involved in electrical near misses in 2002-2003. All such electrical April 2004 www.eh.doe.gov/paa DEPARTMENT OF ENERGY ELECTRICAL SAFETY Operating Experience and Lessons Learned Report U.S. Department of Energy Office of Corporate Performance Assessment Workers Involved in 2002-2003 Electrical Safety Occurrences 27% 22% 28% 10% 13% Electrician / Lineman / Instrumentation and Control Technician Other Electrical Worker (e.g., Equipment Maintenance Worker) Construction / D&D / Excavation Worker Vehicle Operator / Passenger Other (e.g., Researchers, Custodians)

Transcript of Electrical Near Misses Continue to Occur · 1 Electrical Near Misses Continue to Occur Electrical...

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Electrical Near Misses Continueto Occur

Electrical safety occurrences are the mostfrequently reported near miss events acrossthe DOE complex, and thus pose the greatestrisk to workers. In 2002 and 2003, electricalsafety occurrences were reported at a rate oftwo per week, with three-quarters of themcategorized as near misses (to serious injuryor death). Thirty-five of the electricaloccurrences in this 2-year period involvedshocks to workers; six resulted in electricalburns.

An analysis of the electrical occurrences in2002 and 2003 showed that about 50 percentinvolved electrical work performed byelectricians and other electrical workers whoinstall, remove, or maintain electricalequipment or components. DOE’s non-mandatory Electrical Safety Handbook (DOE-HDBK-1092-98) addresses these activities.While deviating from recommendations inthe handbook and other electrical standardsoften contributed to occurrences involvingelectrical work, the root causes largelystemmed from basic conduct of operationsdeficiencies involving work planning,lockout/tagout, and configurationmanagement. (The Electrical Safety Handbookis available at http://tis.eh.doe.gov/techstds/standard/hdbk1092/hdbk1092.pdf.)

Electrical occurrences involving non-electrical workers (e.g., construction workersand vehicle drivers) comprised the remainingoccurrences. In many cases, the electricalhazards in these occurrences resulted fromerrors and deviations previously made by

electrical workers. Non-electrical workersare protected by general regulations, such asOSHA rules for construction, excavation,and vehicle safety. These workers’ activitiesare not directly addressed in the DOEElectrical Safety Handbook.

The purpose of this report is to describecommonly made electrical safety errors andidentify lessons learned and specific actionsthat should be taken to prevent similaroccurrences.

Electrical Work Near Misses

Qualified electricians, linemen,instrumentation and control, electrical orelectronic technicians, and trainedoperations or maintenance workers whoinstalled, removed, and maintained electricalequipment were involved in electrical nearmisses in 2002-2003. All such electrical

April 2004 www.eh.doe.gov/paa

DEPARTMENT OF ENERGY

ELECTRICAL SAFETY

Operating Experience andLessons Learned Report

U.S. Department of EnergyOffice of Corporate Performance Assessment

Workers Involved in 2002-2003Electrical Safety Occurrences

27%

22%28%

10%

13%

Electrician / Lineman / Instrumentation and Control Technician

Other Electrical Worker (e.g., Equipment Maintenance Worker)

Construction / D&D / Excavation Worker

Vehicle Operator / Passenger

Other (e.g., Researchers, Custodians)

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Electrician Burned by Electric ArcFlash in 2002

A journeyman electrician was replacing a20-amp circuit breaker with a 60-ampbreaker in an energized 480-volt, 1,600-amp distribution panel when an electricarc flash occurred. He received minorflash burns on his forearm and neck. Inviolation of procedures, the electriciantried to minimize downtime to the facilityby mounting the replacement breakerwithout de-energizing the panel. He thenplanned to isolate the panel with alockout/tagout before attaching thebreaker to the bus bar and load sideconnectors. However, as he wasattaching a mounting screw, hisscrewdriver slipped, made contactbetween a breaker lug and a groundedmounting plate, and created the arcflash.

workers are expected to know how toprotect themselves from the electricalhazards they will be exposed to whileperforming their tasks.

About three-quarters of the electrical workoccurrences were caused by either personnelerrors (e.g., procedure violations or“inattention to detail”) or work controlweaknesses. Common personnel errorsincluded working on energized equipment orcircuits without authorization or personalprotective equipment, wiring mistakescoupled with failure to verify safe-energyconditions, and leaving unsafe conditions(e.g., improper grounding). The mosteffective safety barrier against electricalenergy is to de-energize the source andcontrol it with a lockout/tagout process.However, mistakes in establishing andclearing lockout/tagouts were common workcontrol problems.

Weakness in configuration managementcontributed to about one-fifth of theoccurrences involving electrical work. In the

Arc-flash damage to distribution panel

Damaged screwdriver

Lockout/Tagout Requirements

• OSHA regulation 29 CFR1910.147(a)(3)(i) states: “Thissection requires employers to establisha program and utilize procedures foraffixing appropriate lockout devices ortagout devices to energy isolatingdevices, and to otherwise disablemachines or equipment to preventunexpected energization, start up orrelease of stored energy in order toprevent injury to employees.”

• OSHA regulation 29 CFR1926.333(b)(2) Lockout and Tagging,states: “While any employee isexposed to contact with parts of fixedelectric equipment or circuits whichhave been de-energized, the circuitsenergizing the parts shall be lockedout or tagged or both in accordancewith the requirements of thisparagraph.”

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Electrician Shocked while Workingon Energized Circuit in 2003

Electricians replacing light ballasts in acafeteria worked on the energized, 277-volt circuits in accordance with past-approved practices. Due to the confinedspace, one electrician did not wearprotective gloves. Design errors in thelength of the wires connecting a ballastwith a light fixture caused him to contacta live conductor. Current flowed into hisfinger and he sustained a burn on thelittle finger of his right hand, as well asexit burns on his right arm. After reviewof the incident, policies were changed torequire de-energizing all circuits andsecuring them by lockout/tagout.

• Ensure that lockout/tagout procedures orwork instructions include independentverification that the lockout/tagout hasbeen correctly performed.

• Ensure that purchased electricalcomponents and equipment areacceptance-tested before they are put intoservice.

• Work on energized circuits should beperformed only after obtaining specialapprovals and developing job-specificsafety controls.

• Always use electrical-rated personalprotective equipment (e.g., insulatedgloves and boots, ground-fault circuitinterrupters, double-insulated tools, andrubber mats) when working on energizedelectrical circuits and equipment(required by 29 CFR 1910.335(a)(1)(i)).

• Stop work if an unanticipated electricalhazard or condition is encountered andseek appropriate assistance.

Electrical Intrusion Near Misses

Excavation, construction, and demolitionworkers are often placed at risk from

occurrences caused by configurationmanagement problems, job planners wereoften at fault because they did not walkdown the work site to verify as-builtconditions and identify unexpected sourcesof energy. The lack of accurate drawingswhen needed to safely isolate electricalsystems is also a continuing problem acrossthe DOE complex. Changes in systemconfiguration due to upgrades, constructionwork, and decommissioning work are notalways incorporated into electrical drawings.

Measures to Prevent Electrical WorkOccurrences

• Walk down the work site to (1) identifyequipment to be worked on, (2) ensurethat equipment to be isolated is clearlymarked, (3) verify or modify drawings toreflect as-built conditions, and (4)identify additional hazards or othersafety issues.

• For decommissioning work, re-evaluateelectrical hazards as systems andequipment are dismantled and isolationsare removed.

• Ensure that lockout/tagout procedures orwork instructions include a zero-energycheck to confirm the effectiveness of thelockout/tagout installation. Alwaysperform a zero-energy check on thecircuit to be worked, as well as on othernearby circuits and terminals. Performthese checks any time new areas orequipment are accessed.

• Upon completion of wiring work, checkfor proper voltages, phasing, andgrounding.

• Use lockout/tagout processes if there is apossibility that work may be performedin close proximity to energized electricalconductors.

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Grader Snags an Energized120-Volt Line in 2003

Construction workers assigned to installan erosion control fence decided to use agrader with a ripper blade when theirditch-witch could not penetrate the soil.They accidentally snagged anunderground line running from an onsiteutility pole to a facility building. Theequipment operator checked the breakerfor the line and it was tripped.Environmental restoration personnel havealways used guidance known as the“1-foot rule” (i.e., if the soil will bepenetrated less than 12 inches anexcavation permit locating undergroundutilities is not necessary). The fenceinstallation required only 6 to 8 inchespenetration. What was not consideredwas that past activity at the site couldhave lowered the surface level in relationto the depth that underground utilitieswere originally installed. Workers did notrealize that they should have stoppedwork and informed management when theelectrical cable was discovered. Whenthe excavation permit was requested, thearea was not clearly defined. Facilitiespersonnel thought there were no utilitiesin the area specified and wrote “nounderground utilities” on the front of thepermit.

accidental intrusion into energized electricallines. Electrical intrusion events includeaccidental contact with underground utilitiesduring excavation and penetration ofembedded or concealed utilities withinstructures such as walls, floors, and ceilings.The workers involved are generally nottrained as electrical workers.

Such events can cause injuries ranging fromminor electrical shocks to severe burns toelectrocution, especially when personalprotective equipment is not used. Intrusionevents also incur monetary costs for therepair of breached wires and conduits andfor the lost time associated with repairs,power outages, and delays in tasks andfacility missions. Causes include inaccurateas-built drawings, procedure noncompliance(e.g., not hand digging as required), blindpenetrations, lack of zero energy checks, andinadequate component marking duringelectrical conduit demolition. The range ofvoltages involved 120 volts through 13.8kilovolts.

The review of these events was divided intotwo types: excavation and cutting/drilling.

Excavation Near Misses

Excavations that struck buried electricalutilities were reported at a frequency of onceper month during 2002 and 2003, with themajority occurring during construction. Theworkforce in these events consisted primarilyof subcontractors, and the voltage they wereexposed to was typically 480 volts. Themethod of excavation during theseoccurrences was almost evenly dividedbetween machine excavation and handexcavation. Machine excavation involvedbackhoes, trackhoes, loaders, and excavators;

Discovered Energized Wires CauseNear Miss in 2003

While excavating a hole by hand inpreparation for installing a counter-balance for a door, an equipment operatordiscovered unmarked wires in a corroded,broken conduit. The excavation workwas stopped and a utilities locatorreviewed the drawings, but could not findconduit and wires in that location. Anelectrician was dispatched to the site,and his initial checks of the wires did notreveal electric energy. The electricianthen removed the cover from an electricalelbow in a nearby facility and discoveredabandoned wires. To verify that the wiresin the excavation were the same as theabandoned wires, the electrician had theequipment operator tug on the wires tosee if they moved. Instead, an arcoccurred in the conduit as the operatorpulled the wires.

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Laborers Exposed to Energized480-Volt Cable Damaged by a

Trackhoe in 2003

An excavation operator cut into anenergized 480-volt cable while digging abuilding foundation with a trackhoe,causing a circuit breaker to trip. Thedamage to the cable was not apparentbecause it was still buried. Laborersentered the excavation to hand dig anduncover the cable but they did not knowthat someone had reset the circuitbreaker and reenergized the cable. Heatgiven off by the damaged cable causedwater in the excavation to release steamto the atmosphere. The laborersimmediately stopped work. Investigatorsdetermined that the subcontractor sitesuperintendent knew of the requirementto de-energize and lock out the cable,and did not. He knowingly sent workersinto the excavation to hand dig around anenergized cable in violation of procedures.Exposure to the energized cable couldhave been avoided if the circuit had beenlocked out.

while hand excavation involvedjackhammers, shovels, picks, digging bars,and posthole diggers. Although equipmentoperators were generally separated bydistance from the immediate hazard (e.g.,inside their vehicles), laborers were in closeproximity to the electrical hazard becausethey were using hand tools.

In many of the occurrences, inadequate as-built drawings or lack of drawings was citedas a major causal factor. Other causalfactors included failing to use locatingequipment or not complying with therequirements of the excavation permits, (e.g.,hand-digging within 5 feet of buriedelectrical line in order to save time). Also,there were some occurrences in which usingsurvey equipment did not provide a positivelocate. Only one worker received anelectrical shock while attempting to locateutilities.

In several occurrences, workers assumed thatutilities were abandoned or de-energized, orthey assumed the wrong depth or directionof buried utilities. In addition, many workersfailed to initiate a lockout/tagout when theyknew there were utilities in the area.

Cutting and Drilling Near Misses

Cutting and drilling into energized electricallines have been reported at a frequency ofonce per month. The majority of theseoccurrences happened during constructionand facility demolition. The workforce inthese occurrences primarily involvedemployees of the prime contractor, and

Cut electrical conduit

Craftsman Cuts into EnergizedElectric Line while Removing

Conduit in 2003

A demolition craftsman was removingconduit with a reciprocating saw and cutinto an energized 110-volt line. The workcontrol document explicitly requiredverification that the line was either de-energized and air-gapped or covered by alockout/tagout. Investigators learnedthat, based on work performed a monthbefore, the craftsman assumed thatelectricians had de-energized the circuit.He also failed to request a zero-energycheck or complete a thorough walkdownto verify that all electrical service wasair-gapped.

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typically they were exposed to 120 volts.These occurrences involved drilling intostructures (blind penetrations) or cuttingconduit using hand tools. This is significantbecause hand tools place the worker in closeproximity to the hazard (i.e., energizedsource).

The majority of the events occurred whilecutting conduit with saws or core drillingwith electric drills. One worker received anelectrical shock while cutting conduit with ahydraulic shear. For facilities that areundergoing closeout and demolition, atypical activity involves the removal ofelectrical conduit. In many cases, someelectrical systems may need to remainenergized (such as lighting circuits) whileother conduit and electrical systems are

being removed. This can present a challengeto ensure that circuits are properly markedand de-energized.

In many of the occurrences, workers failed toperform a zero-energy check before cuttinginto conduit containing energized electricalconductors. In some instances they justassumed the circuit was de-energized. Inother cases, workers failed to lockout theenergy source, failed to verify the circuit wasair-gapped (separated from an electricalsource), or failed to verify (physically trace)the power source. Other causes includedinadequately marked conduit or confusingmarkings on conduit to be removed. Also, insome of the excavation events, workerswrongly assumed the location or direction ofconcealed electrical lines.

Laborers Cutting Asphalt Severed a Buried Energized Line in 2003

Laborers performing an asphalt saw-cutting operation partially severed an underground208/120-volt electrical conduit. The location of the conduit was correctly marked on thesurface of the asphalt, but the depth was assumed to be 18 inches. The actual depth ofthe conduit below the surface was determined to be only 4 inches. However, because ofthe short distance of available conduit (20 feet), the depth locator on the locatingequipment had a high degree of inaccuracy. The manufacturer specifications for thelocating equipment stated that distances less than 50 feet would not produce accuratedepths on buried utilities and air coupling might result. The workers expected to find theconduit at 18-24 inches below grade based on Laboratory experience and the designlocate survey which showed a depth of 18 inches at the guard kiosk. Investigatorsconcluded that Ground Penetrating Radar (GPR) might have provided additionalinformation. GPR is used for locations when the locator believes the readings are suspector if the length of conduit/pipe identified is less than 50 feet in length. The GPR readingscompensate for the uncertainty in locating equipment when determining depth.

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Common Aspects of Electrical IntrusionEvents

Electrical intrusion-type events typicallyinvolve non-electrical workers (e.g.,equipment operators, laborers), performingnon-electrical work who may not have anytype of electrical safety training orexpectation that an electrical hazard exists.Fortunately there were no serious injuriesfrom such events in 2002 and 2003. Stop-work authority was almost universally usedwhen unexpected conditions wereencountered and in some cases, workersused personal protective equipment.

Determining the precise location of buriedand embedded utility lines is an industry-wide problem. As-built drawings should notbe relied upon as the only source for locatingunderground or embedded utilities,particularly if the accuracy of the drawingsis suspect. Scanning and survey equipmenthas been used successful to locate electricallines. However the technology haslimitations that need to be understood; forexample, embedded conduit and rebar havesimilar reflective properties. The generaluncertainties surrounding the existence andprecise location of these utilities demandspecial planning and execution of anyexcavation, penetration, or cutting activity.

The potential hazard of energized utilitiesshould be identified and controlled throughthe implementation of physical andadministrative barriers to help preventaccidents. Barriers include appropriatelyrated personal protective equipment,lockout/tagout, and verification of zeroenergy.

OSHA requirements and preventionmeasures generally apply to all types ofintrusion events, whether they were causedduring excavation, penetration, ordemolition work. OSHA defines concealedwiring as wiring rendered inaccessible by thestructure or finish of the building. Wires in

OSHA Requirements to PreventElectrical Intrusion

• 29 CFR 1926.416(a)(2) states: “Inwork areas where the exact locationof underground electric power lines isunknown, employees using jack-hammers, bars, or other hand toolswhich may contact a line shall beprovided with insulated protectivegloves.”

• 29 CFR 1926.416(a)(3) states: “Before work is begun the employershall ascertain by inquiry or directobservation, or by instruments,whether any part of an energizedelectric power circuit, exposed orconcealed, is so located that theperformance of the work may bringany person, tool, or machine intophysical or electrical contact with theelectric power circuit. The employershall post and maintain proper warningsigns where such a circuit exists. Theemployer shall advise employees ofthe location of such lines, the hazardsinvolved, and the protective measuresto be taken.”

• 29 CFR 1926.651(b)(1) states: “Theestimated location of utilityinstallations, such as sewer,telephone, fuel, electric, water lines,or any other underground installationsthat reasonably may be expected tobe encountered during excavationwork, shall be determined prior toopening an excavation.”

• 29 CFR 1926.651(b)(2) states:“Utility companies or owners shall becontacted within established orcustomary local response times,advised of the proposed work, andasked to establish the location of theutility underground installations priorto the start of actual excavation.”

raceways are considered concealed, eventhough they may become accessible bywithdrawing them. As shown in the textbox, OSHA sets safety standards foremployee protection.

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Measures to Prevent Electrical IntrusionOccurrences

• Mark all concealed electrical wiringwhen located.

• Drill pilot holes and penetrate no deeperthan is required for the job.

• Check drill holes frequently forobstructive material, such as wirefragments or rebar.

• Always wear personal protectiveequipment.

• Clearly mark components that are to beremoved and establish boundaries andhold points for zero energy verificationwhen performing demolition work.

• Conduct source checks for energy nearthe work, and not just at “known”energy sources.

• Exercise “stop work authority” ifunanticipated conditions areencountered.

• Use appropriate personal protectiveequipment that has proper electricalratings.

• Standardize methods for identificationand location of concealed or buriedelectrical utilities.

• M&O contractors should shareinformation such as locator data,drawings, and permit information withsubcontractors performing the work.

• Analyze the specific work activity and donot just base hazards controls onestablished standards and workpractices.

• Perform excavation and penetrationwork in a timely manner followingsurveys and marking of locations.

Markings can deteriorate over time, andconditions can change.

• Employ utility locator services or use thelatest survey technology available.

• Hand-excavate in close proximity to theexpected location of the utility ratherusing excavation equipment.

• Re-evaluate hazards analysis processesand associated controls for excavationand electrical penetration-type work.

• Place marking tape or electronic markersabove newly installed utilities orexcavated utilities to aid in futureidentification.

Vehicle Near Misses

Vehicles strike overhead electrical powerlines and other electrical sources within theDOE complex almost monthly. Suchoccurrences in 2002 and 2003 involveddump trucks, cement trucks, tractor-trailers,front-loaders, trackhoes, excavators, andforklifts snagging overhead utility lines withvoltages ranging between 120 volts and 13.8kilovolts. In a few occurrences, the vehicleshit utility poles, guy wires, messenger cablesand communication lines, and this damageindirectly severed the power lines. In somecases, live power lines fell onto the vehicles,

In 2002, excavator boom contacted13.8 kv overhead power line

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placing the drivers and passengers at riskfrom electrical shock.

In many of the occurrences, the vehicledrivers knew of the electrical hazards andinitially passed them safely — most likelygiving them a false sense of confidence.When the drivers’ tasks changed the vehicles’profiles (e.g., by raising a truck bed, boom,fifth wheel, or forklift mast), they neglectedto consider this effect and subsequentlysnagged the utility lines on their exit trips.

In one occurrence, a road was initially closedto truck traffic, and overhead lines werehung to an allowed lower clearance. Whenthe road was opened to truck traffic, sitepersonnel neglected to raise the overheadlines to the height required for trucks (seerequirements text box). Subsequently, aconcrete truck that had unloaded and wasexiting snagged four overhead lines, breakingthree utility poles. In recent years, a similaroccurrence resulted from raising a roadbedat a construction site but neglecting to raisethe lines crossing overhead.

In several occurrences, spotters were used asrequired by OSHA regulations (see text box)but the spotters lost communication with thedrivers or a single spotter was insufficient tosee all the hazards. In other cases, thespotters were effective only initially andeither left or became diverted before thesnagging occurred.

Measures to Prevent Vehicle/ElectricalOccurrences

• Job hazard analyses for tasks involvingvehicles need to include all work areasand travel routes to identify overheadelectrical hazards and to addressappropriate requirements for vehicleclearances and an adequate number ofspotters.

• Job hazard analyses should also considerthe possibility of changed vehicle profiles

Gravel Truck Contacts 13.8 kVElectrical Transmission Line in

2002

The driver of a gravel-hauling truck hadjust completed a gravel dump at a DOEsite and was lowering the truck bed whenthe bed came in contact with anenergized 13.8 kilovolt transmission line.The truck served as an electrical ground,blowing one tire and scorching two othersand causing a small grass fire. The driverwas aware of the transmission line buthad guessed incorrectly that he hadenough clearance to lower the truck bed.His escort had not been trained as aspotter. Although the escort expressedconcern over the clearances, he did notstop the operation. The driver and escortwere fortunate not to have been injuredor killed.

Vehicle/Overhead LineRequirements

• OSHA regulation 29 CFR1910.333(c)(3)(III)(A) states: “Anyvehicle or mechanical equipmentcapable of having parts of itsstructure elevated near energizedlines shall be operated so that aclearance of 10 feet is maintained.”

• OSHA regulation 29 CFR1910.550(A)(15)(IV) states: “A personshall be designated to observeclearance of the equipment and givetimely warning for all operations whereit is difficult for the operator tomaintain the desired clearance byvisual means.”

• Institute of Electrical and ElectronicEngineers Standards for OverheadConductor Clearances, Part 2, Table232-1 requires that for roads andother areas subject to truck traffic,the maximum sag for wires,conductors and cables is a height of15.5 feet .

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and load configurations, such as raisedtruck beds, the shifting of masts andbooms, and the increased heights ofvehicles after unloading.

• Spotters assigned to transports need to bededicated for the whole job, includingexiting.

• Drivers must be trained to stay incommunication with spotters and to beaware of the effect of changed vehicleand load configurations on clearances.

• Guy wires, utility poles and overheadlines need to be marked if not clearlyvisible to drivers and spotters.

Other Electrical Near Misses

A significant percentage of the electricalsafety occurrences could not be categorizedin the work activities discussed above. Forexample, researchers, security guards,cafeteria workers and custodiansexperienced electrical shocks. In thoseoccurrences, incorrectly installed ordeteriorated wires, plugs, receptacles andimproper grounding were the direct causes.In two separate occurrences, workersmowing grass cut unmarked electrical

extension cords used to power outsidemonitors.

In most of these “other occurrences,” thepeople affected were unaware of (orinadequately trained for) the electricalhazards to which they were exposed.Similar to the occurrences discussed aboveinvolving construction and excavationworkers, the workers were placed at risk bythe previous actions (or lack of action) ofothers.

Safety Responsibilities

When performing tasks that may involveelectrical hazards, roles and responsibilitiesshould be clearly defined, understood, andreviewed before beginning work. Inaddition, all workers must be aware of theirresponsibility to stop work whenever thesafety of the operation is questionable. Thefollowing questions, based on lessons learnedfrom recent electrical occurrences, pertain tothe safety responsibilities of all workers.

• Managers

− Has sufficient rigor been applied tohazards analyses, work planning,and equipment inspection in workenvironments involving multiple tiersof contractor and subcontractorpersonnel?

− Have site-specific electricalrequirements been provided tosubcontractors for implementation?

− Are workers aware of their stop-workauthority, and do they understandhow to invoke it?

− Do qualified supervisors overseepersonnel in training and briefings?

− Do electrical safety committees meetregularly and address emergingelectrical safety issues, benchmarkother site’s programs, share best

Student Researcher ReceivesElectrical Shock During 2002

A student researcher performing anexperiment was shocked when he touchedthe metal edge of a fume hood with onehand while the other hand held a stainlesssteel inspection mirror in contact with ametal reactor. An ungrounded cartridgeheater inside the reactor had failed andproduced the shock. Such failuresoccurred occasionally with this type ofequipment; however, unlike other hoodsat the facility, this one did not have aground fault circuit interrupter (GFCI)device to prevent shocks. A correctiveaction was to install a GFCI device.

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practices, self-assess their safetyprograms, and explore newtechnologies for locating concealedutilities and electrical hazards?

• Work Planners

− Are accurate drawings andequipment identification used? Havethe drawings and equipmentidentification been verified by walk-downs and subject matter experts toensure they reflect as-builtconfiguration?

− Have walk-downs also beenperformed to check for potentialhazards and anything that couldinterfere with the performance ofwork?

− Are measures taken to locateundetected buried and embeddedpower lines?

− Are workers assigned personalprotective equipment suitable forplanned tasks and for potentiallyundetected electrical hazards?

− Have an adequate number of spottersbeen assigned to tasks involvingvehicles, and are they dedicated untilthe vehicles complete their task orleave the site?

• Supervisors

− Do pre-job briefings identify allelectrical safety hazards?

− Do workers understand their tasksand the potential hazards involved?

− Do all workers understand thatimprovising is prohibited?

− Do workers understand theirresponsibility to stop work whenproblems emerge instead of taking ad-hoc compensatory measures?

− Are steps taken to ensure thatelectrical systems are not left in an unsafe condition at shift turnover?

− Are barriers (e.g., lockout/tagouts)adequate and in place?

− Are spotters and vehicle/equipmentoperators able to communicateverbally and visually?

− Have workers passed on relevant andaccurate information regardingelectrical safety issues to co-workersand supervisors?

− Do workers focus their attention onthe safety-significance of the task andremain alert to the potential impactfrom distractions?

− Do workers approach each task witha questioning attitude, thinkingthrough the steps and key decisionpoints before acting?

− Are post-job briefings held to critiqueperformance and identifyimprovements?

• Electrical Workers

− Do the components, procedures,tools, personal protective equipment,and resources provided satisfy therequirements of the planned tasks?

− Have checks been made to verify thatelectrical circuits/equipment are notleft in an unsafe condition?

− Are electrical equipment/componentresponses (e.g., voltagemeasurements) those that areexpected?

− Is equipment de-energized beforebeing serviced or maintained?

− Are correct shielding and insulatingmaterials and tools being used when

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working on electrical equipment/circuits?

− Has approval been given to work inenergized equipment/circuits?

− Are procedures for working nearenergized equipment being followedor used?

• Non-Electrical Workers

− Have steps been taken to identify andmitigate electrical hazards?

− Has personal protective equipmentbeen provided or have other measuresbeen taken to prevent risks fromundetected energized circuits duringdrilling, cutting and excavation?

• Vehicle Drivers/Equipment Operators

− Have overhead power lines andsources and their heights been

identified for the travel routes to betaken?

− Will any operation of the vehicleplace it, its mechanical equipment, orits load within 10 feet of overheadlines, utility poles, or supporting guywires?

− Are dedicated spotters provided forall travel routes and for all workactivities? (If not, why not?)

• Spotters

− Are there sufficient spotters to detectall hazards and communicate them tothe vehicle drivers/equipmentoperators?

− Have steps been taken to ensurecommunication with vehicle drivers/equipment operators?

U.S. Department of EnergyOffice of CorporatePerformance Assessment

Frank B. RussoDeputy Assistant Secretary(301) 903-8008(301) 903-1257 [email protected]

Office of Corporate PerformanceAssessment

The Office of Environment, Safety and Health,Office of Corporate Performance Assessment (EH-3)has two overarching responsibilities. These are toreview existing operational safety data streams todetermine if significant safety vulnerabilities exist,and to provide information in support of DOEdecision making. Significant safety vulnerabilitiesare communicated to appropriate management sothat intervention can take place before serioussafety issues or events arise.

Although safety is difficult to measure in terms ofaccidents prevented, existing safety operationaldata identify safety vulnerabilities both at a site-level and complex-wide level. The Office ofPerformance Assessment and Analysis strives toprovide line management with useful information todrive changes in the workplace that will continue toimprove safety performance across DOE.