January 16, 2014
The Mine Safety and Health Administration (MSHA) has released the investigation report on a September 18, 2013, fatality at a crushed and broken limestone operation involving a 56-year-old front-end loader operator who was killed when he was engulfed by material in an operating pug mill hopper while trying to remove a lump of stone that would not feed onto the belt conveyor below.
According to the investigation report, the root cause of the accident was that “[m]anagement failed to establish policies and procedures for safely clearing a pug mill hopper. The hopper’s discharge operating controls were not deenergized and locked out before [the victim] worked on or near equipment and he did not wear a safety harness and lanyard, which was securely anchored and tended by another person, prior to entering the hopper.”
Following the fatality, operation management implemented the following corrective action: “Management installed a grating designed to cover the top of the chute. It has been welded to the top of the hopper to prevent persons from accessing the hopper. This grating also prevents lumps from clogging the discharge chute.”
MSHA also noted a second root cause to be that “[m]anagement failed to ensure that Ferrill was task trained to recognize all potential hazardous conditions and to understand safe job procedures to eliminate all of the hazards before he began work on the hopper.”
The following corrective action was implemented for the second root cause: “Management established written policies and safe work procedures to ensure that miners are task trained when working near bins, hoppers, silos, tanks and surge piles. All miners received training regarding working near bins, hoppers, silos, tanks and surge piles. The task training included revised lockout procedures, lockout responsibility, and procedures to restore equipment and/or circuits to service. Requirements for wearing a safety belt or harness equipped with a lifeline when entering such facilities were also discussed.”
MSHA issued two citations on September 18, 2013, to the operation.
The first was under the provisions of Section 103(j) of the Mine Act, which “prevent[s] the destruction of any evidence which would assist in investigating the cause or causes of the accident. It prohibit all activity of the pug mill area of the mine, including the CAT 988H loader S/N 233817, Cat 345 excavator # 8525 and including the back gat to the point of road leading to the main plant.”
MSHA modified the initial order and proceeded under the authority of Section 103(k) of the Mine Act, which “is intended to protect the safety of all persons on-site, including those involved in rescue and recovery operations or investigation of the accident. The mine operator shall obtain prior approval from an Authorized Representative of the Secretary for all actions to recover and/or restore operations in the affect area.”
The second citation was issued under the provisions of Section 104(d)(1) of the Mine Act for a violation of 56.16002 a(c). MSHA notes: “Mine management engaged in aggravated conduct constituting more than ordinary negligence by allowing the miner to enter the hopper without wearing a safety belt or harness equipped with a lifeline suitably fastened and did not station a second person near the hopper. Additionally, the pug mill hopper was not locked out while the victim was attempting to remove the lump of material. This violation is an unwarrantable failure to comply with a mandatory standard.”
MSHA also issued an order under the provisions of Section 104(d)(1) of the Mine Act for a violation of 46.7(b). MSHA notes: “Mine management engaged in aggravated conduct constituting more than ordinary negligence by not providing task training with safe work procedures for persons entering the pug mill feed hopper to remove material that could clog the feed chute. This is an unwarrantable failure to comply with a mandatory standard.”
To read the full investigation report, click here.