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LOST TIME INJURY REVIEWAND DISCUSSION 20141030/LTI, 15 July 2014, PNOMS… · The crew utilized a...
Transcript of LOST TIME INJURY REVIEWAND DISCUSSION 20141030/LTI, 15 July 2014, PNOMS… · The crew utilized a...
LOST TIME INJURY REVIEW AND DISCUSSION
15 July, 2014: At approx. 11:45 hrs the crew was just
finishing up in the TM 850 D3 East Sill and preparing to
screen the face. The crew utilized a scissor lift to install the
ground support on this particular day and everything was
progressing fine. During the process the Front Line
Supervisor and the Safety Coordinator visited the heading
and ground support was being installed above and beyond
the required standard. Due to talc conditions in the
heading, the crew opted to extend the screen further down
the right wall than was required by the print and rebar was
being used to pin the screen on the walls as opposed to
split sets.
LOST TIME INJURY CONT.
Before they could install the screen on the face, a
hydraulic hose broke underneath the deck near the rear
axle and they were unable to continue.
A mechanic was called to the site and climbed under the
unit to further assess the situation. He discovered that
there were several rocks on top of the rear axle and tried
to remove them by hand, but they were too big and
awkward. The deck was fully lowered at the time and
attempts to raise it were unsuccessful because the deck
got hung up on the rear corner of the back wall and could
not be fully raised.
LOST TIME INJURY CONT.
The deck was then side shifted to the right and when raised,
the railing caught the wall near the shoulder of the drift at the
back corner. The bolter attempted to side shift the platform to
the left in order to clear the wall, but the Victaulic clamp on
the bull hose was catching the ladder, preventing the deck
from being side shifted to the left. The intention at this time
was to raise the deck high enough to install the safety pins for
the platform. The unit was then shut down because of
continual oil loss through the broken hose.
The mechanic then tried to remove the rocks using a scaling
bar from the left side of the deck, the injured worker asked
for a scaling bar from the bolter on the deck and proceeded
down the right wall towards the face.
LOST TIME INJURY CONT.
The bolter saw the face start to fail and hollered a warning,
the mechanic immediately retreated away from the face and
heard the injured worker yell. Loose had fell from the face
struck the worker on the head and shoulder and pushed him
into the back of the deck. The bolter proceeded around the
right side of the deck and he got as far as the rear wheel
where he could see the injured worker crawling out along the
right side of the wall.
The bolter and mechanic loaded the injured worker in a
Toyota and brought him to surface where he was transported
to hospital for treatment.
INJURIES
• 17 stitches to close wound in the back of his head
• 16 stitches to close puncture wounds on his neck and
shoulder
• 12 broken ribs, front and back
• Left punctured lung and right collapsed lung requiring drain
tubes
• 2 broken vertebrae in lower back (Transverse Processes
which are the small tabs on the vertebrae)
10 days in Sudbury hospital, 6 in ICU
Still not fully recovered and is on modified duties but making
steady progress to a full recovery and returning to full duties.
*Shared with Permission
LOST TIME INJURY INVESTIGATION
Underlying Causes: Failure to secure and make safe,
Improper position for the task, poor judgment,
preoccupation or frustration, failure to warn, improper
attempt to save time, ground conditions.
Remedial Action: The accident was reviewed with all U/G
crews at both sites stressing the importance of not
exposing yourself to unsupported ground. The heading was
shut down pending an investigation. The MOL attended
the scene on July 18th. It was reinforced with the crews
that working safely, takes precedence over production.
RECOMMENDATIONS
1. Crews are to notify their Supervisor when equipment break downs
occur. In areas where adequate ground control has not been completed
or other hazards exist, the equipment shall be moved to a safe location.
Where the equipment cannot readily be moved, the Supervisor will
provide written instructions on the Zero Harm Safety Card. A SOP will be
developed to provide guidelines and will require Supervisory notification
by the crew.
2. A mechanic servicing equipment in the field is to ensure that a
production supervisor has been contacted and additional written
instructions have been given (indicated on the Zero Harm Safety Cards)
for work on equipment in areas where adequate ground control has not
been completed or other hazards exist. If additional written instructions
have not been given he is to ensure that the production supervisor has
been contacted. This will also be included in the SOP referred to in the
previous recommendation.
RECOMMENDATIONS
3. The accident is to be included in the U0028 Scissor Lift training
module. Precautions to be taken when repairs and maintenance on
equipment in hazardous locations will be reviewed with all new trainees.
4. This accident will be presented at the next Porcupine Northeastern
Ontario Mines Safety Group meeting in October.
5. The Maintenance group will examine the scissor decks to determine
what can be done to re-route or protect the hydraulic hoses under the
deck from being broken. Re-routing, guarding and sourcing a better
quality hose are some of the options.
RECOMMENDATIONS
6. The policy with respect to unsupported ground is being reviewed with
each crew and this accident will be reviewed in more detail at the
August Safety meetings. At the meetings the crews will be asked what
they would have done in the same situation, what lessons were learned
and what they will do to prevent a recurrence.
7. The McLean bolter was being utilized in this heading prior to the date
of the accident. The McLean was down, so the crew opted to use the x-
lift. Review with crews the non-routine hazardous task process (in the
event it has to be applied) or additional written instructions from their
supervisors on the Zero Harm Safety Cards when conditions in the
workplace change (management of change). The deck was fine to use,
but when the hose broke, the process "fell apart".
HOW TO PREVENT A RECURRENCE
• Review with crews the importance of hazard recognition with respect
to face and wall conditions in large development headings.
• When the things change in the work area (equipment failures, damage
etc..) the focus must remained on the hazards and not be focused
solely on the task at hand.
• Review policy with respect to unsupported ground: At no time is a
worker to work or go under unsupported ground, caution must also be
taken with an unsupported face or wall.
• The mining culture of “get the job done” by accepting undo risks must
be curtailed, employees must never place themselves in a position of
risk for the sake of production.
• The effects of an injury is far reaching, there is pain and suffering of
the injured worker, but friends, family and co-workers also feel the
pain and effects.
Discussion:
In a similar situation what would you do,
what lessons were learned and what will
we do to prevent a recurrence.
Discuss as a group.