Timber mill circular saw 1 0 1 Tractor driven bird net roller (modified to roll reflective matting) 1 0 1 Hydraulic vehicle hoist 0 1 1 Loading ramp 0 1 1 Cement 1 0 1 Egg washing machine 1 0 1 Bell Logger (log moving vehicle) 1 0 1 Sand blasting hose 1 0 1 grinder 0 1 1 Total 6 5 11 Brief narratives and comments on the 6 design-related fatal incidents caused by ‘definite’ Unapproved modifications are presented below: A worker was hit in the chest by a piece of timber that was kicked back from a rip saw blade: the prosecution summary stated that the internal anti-kickback fingers had been removed, the rollers and sleeves were damaged, and employees were not precluded from standing in line with the in-feed of the machine. A worker was using a machine for winding up bird netting that had been modified to roll up reflective foil: the modification left a protruding bolt that caught the workers clothing. The WorkSafe authority recommended simply replacing the bolt with a collar and recessed grub screw to eliminate the hazard. A worker put his head inside the agitator of his cement truck to view an area that he could not reach from the top of the ladder: the prosecution summary states that a guard that would have prevented the worker from placing himself in danger had been removed. A fatal incident occurred because a switchboard residual current device protecting an egg washing and grading machine with an electrical fault was deliberately bypassed pending repairs that were then not carried out: the Coroner’s report stated that the primary fault was in the manufacture and testing of the machine. However, the fault could not have caused the fatality unless the switchboard protection had been bypassed pending the repairs that were then postponed. A worker died when he pressed the ignition button while outside the Bell logger vehicle that then started and ran over him: the prosecution summary stated that the neutral start safety switch had been bypassed, which allowed the machine to be started while still in gear. A worker lost control of a sand blasting hose while inside the hull of a ship: the WHS investigation found that the main cause of the fatality was a practice that had developed amongst workers to tape down the hand operated lever/switch that activates the charging of the high pressure line. This effectively disabled the fail-safe cut-off should a worker lose their grip of the hose.
Timber mill circular saw 1 0 1 Tractor driven bird net roller (modified to roll reflective matting) 1 0 1 Hydraulic vehicle hoist 0 1 1 Loading ramp 0 1 1 Cement 1 0 1 Egg washing machine 1 0 1 Bell Logger (log moving vehicle) 1 0 1 Sand blasting hose 1 0 1 grinder 0 1 1 Total 6 5 11 Brief narratives and comments on the 6 ‘definite’ design-related fatal incidents caused by Unapproved modifications are presented below: A worker was hit in the chest by a piece of timber that was kicked back from a rip saw blade: the prosecution summary stated that the internal anti-kickback fingers had been removed, the rollers and sleeves were damaged, and employees were not precluded from standing in line with the in-feed of the machine. A worker was using a machine for winding up bird netting that had been modified to roll up reflective foil: the modification left a protruding bolt that caught the workers clothing. The WorkSafe authority recommended simply replacing the bolt with a collar and recessed grub screw to eliminate the hazard. A worker put his head inside the agitator of his cement truck to view an area that he could not reach from the top of the ladder: the prosecution summary states that a guard that would have prevented the worker from placing himself in danger had been removed. A fatal incident occurred because a switchboard residual current device protecting an egg washing and grading machine with an electrical fault was deliberately bypassed pending repairs that were then not carried out: the Coroner’s report stated that the primary fault was in the manufacture and testing of the machine. However, the fault could not have caused the fatality unless the switchboard protection had been bypassed pending the repairs that were then postponed. A worker died when he pressed the ignition button while outside the Bell logger vehicle that then started and ran over him: the prosecution summary stated that the neutral start safety switch had been bypassed, which allowed the machine to be started while still in gear. A worker lost control of a sand blasting hose while inside the hull of a ship: the WHS investigation found that the main cause of the fatality was a practice that had developed amongst workers to tape down the hand operated lever/switch that activates the charging of the high pressure line. This effectively disabled the fail-safe cut-off should a worker lose their grip of the hose.
work-related-fatalities-unsafe-design.docx