The Kentucky Fatality Assessment and Control Evaluation (FACE) Program is tasked with investigating fatalities and making recommendations to ensure they do not occur again. This is one of their recent cases. On Friday, March 1, 2019, a medical IT consultant was driving on a major, six-lane interstate within the city limits of a metropolitan area, en route to a regional airport while on work-related travel out of state. This particular section of the interstate has three total lanes of westbound travel, with the victim traveling in the far-right lane in the moments leading up to the collision, traffic flow was light. At approximately 6:36 a.m., a police officer on routine patrol witnessed the crash. The police officer stated that as the victim passed his police cruiser on the right side, he observed the driver texting on a mobile phone while operating his 2019 Chevrolet Impala. At that moment, the victim’s vehicle began exiting the travel portion of the roadway onto the right shoulder. The victim attempted to regain control, but was unable to do so before striking the guardrail on the right shoulder. After contacting the guardrail, the victim attempted to regain control. Unfortunately, the force of the impact in addition to the driver overcorrecting, propelled the vehicle across all three travel lanes and into the concrete median barrier which separates east and west traffic flow. The vehicle struck the barrier on the front driver’s side bumper where it came to final rest. No other vehicles were involved in the collision. The police officer who witnessed the event was on scene immediately. As the officer approached the vehicle, he noticed the victim partially in the front passenger’s side seat. The officer observed that the driver was not wearing a seatbelt and appeared to be unconscious. The police officer immediately began resuscitation attempts on the victim until paramedics arrived on scene. The victim was transported to a local area hospital where he died ten days later. The cause of death was traumatic brain injury due to blunt force trauma sustained when the victims head struck the windshield of his vehicle. RECOMMENDATIONS 1. Implement a texting while driving policy with associated training.  Texting while driving was determined to be a contributing factor that lead to the occurrence of the collision. According to The National Highway Traffic Safety Administration (NHTSA), distracted driving was found to be the contributing factor that lead to 3,157 fatal collisions in 2016; 444 of the total distracted driving fatal collisions were attributed specifically to cell phone usage, which equates to 14% of all distraction-affected crashes2. Texting while driving is one of the most dangerous forms of distracted driving according to The Centers for Disease Control and Prevention. Texting while driving combines all three types of distraction: Visual: taking your eyes off of the road; Manual: taking your hands off of the wheel; and Cognitive: taking your mind off of driving. Kentucky law prohibits motor vehicle operators from texting while driving. In addition to requiring employees to follow each state’s laws, companies who require employees to travel should consider implementing a policy which prohibits texting while driving. By doing so, the employer sets an expectation and raises awareness surrounding the dangers associated with texting while driving. 2.  Mandate the use of seat belts while driving on company time. The victim was not wearing a seat belt at the time of the collision. Wearing a seat belt can greatly reduce the severity of injuries sustained in a crash. The Centers for Disease Control and Prevention estimates seat belts have saved nearly 250,000 lives from 1975 to 20084. All U.S. states - with the exception of New Hampshire - now mandate the use of seat belts for at least the driver. In addition to requiring employees to abide by each states law, companies who require employees to travel should consider implementing a safety policy mandating the use of seat belts while operating motor vehicles. 3. Implement defensive driver training for employees who are required to travel. Transportation and logistics companies have utilized defensive driver training for decades to educate drivers on the dangers of the highway and how to recognize hazards and tactics to prevent motor vehicle collisions. OSHA states that 40% of all occupational fatalities are the result of a vehicle-related crash5. Often times, if the primary function of a particular company isn’t focused specifically on transportation, safety training geared toward the safe operation of a vehicle is never addressed. If a company requires an individual to travel to perform his or her job, regardless of the primary function of the company, employees are at risk of being involved in a traffic collision. Employers who require employees to travel should consider implementing a defensive driver program in an attempt to mitigate potential risk associated with the operation of a motor vehicle. In addition to initial training, employers may consider implementing annual refresher training to address complacency. 4. Replace W-beam highway guardrails with cable barriers. Studies support that the use of cable barriers greatly reduce the severity of injuries sustained during vehicle vs. barrier crashes when compared to W-beam and concrete barriers. According to the Minnesota Department of Transportation, when cable barriers are struck, posts break and cables flex to absorb the kinetic energy and redirect the vehicle along the barrier6. W-beam guardrails are more rigid, which increase the probability of a vehicle being forced back into the travel portion of the roadway leading to overcorrection and a secondary impact. In this case, the initial impact occurred with a W-beam guardrail on the right shoulder of the highway. The force of the initial impact, in addition to the driver overcorrecting, propelled the vehicle across all three travel lanes and into the concrete median barrier which separates east and west traffic flow. The secondary impact with the concrete barrier resulted in the fatal injuries the victim sustained. The Kentucky highway department should consider installing cable barriers in place of W-beam guardrails in an attempt to reduce the severity of injuries sustained during motor vehicle vs. barrier collisions. In this case, the use of a cable barrier may have absorbed the force of the initial impact and redirected the path of the victim’s vehicle in a straight line preventing it from crossing all three travel lanes and striking the concrete median barrier. Let's block ads! (Why?)

At 8:00 p.m., on Thursday, Nov. 16, 2017, a traffic maintenance crew consisting of three workers were tasked with closing the eastbound left lane of a four-lane interstate in preparation of setting up a road construction site within a populous city. On the night of the incident, the three workers picked up traffic cones from the westbound lanes of the same interstate that had been placed several days before closing the left lane. The employees placed the cones in the beds of the three work trucks they were operating and drove to the left shoulder of the interstate travelling eastbound. Each work truck had operating brake lights, rotating strobe lights, and a 14-light split arrow Manual on Uniform Traffic Control Devices (MUTCD) type-D arrow board mounted on them. The arrows were all flashing to the right, indicating to oncoming traffic the need to merge before the lane ended. When the workers arrived at the assigned area, the first employee parked his work truck on the left shoulder of the interstate, exited the vehicle and rode with the victim who was operating the second work truck to a second location. The victim then instructed the operator of the third work truck to continue up the interstate. It is unknown the exact distance between the first and second work trucks as well as the distance between the second and third work trucks due to both being moved before emergency services arrived. In an interview with police, the operator of the first work truck noted that there was ‘some distance’ between the trucks. The third co-worker had pulled far enough forward that he was unaware of when the incident occurred. The victim drove his work truck onto the left shoulder with a portion of the vehicle’s rear protruding into the left lane. After the victim parked, he and his co-worker both exited the vehicle with the purpose of ‘staging the cones’. The cones would be placed on the left shoulder, spaced at distances of every other white lane marker. It was the intention of the workers to have the cones in position so that at 9:00 p.m. later that night, when the construction contractor would instruct the workers to close the lane, the employees would then move the cones from the shoulder into the left lane closing it to traffic. As the victim’s co-worker was standing on the driver side of the truck, fully on the shoulder, the victim walked around to the rear passenger side of the truck. As he was preparing to brief the co-worker on their expected work activities, the victim was struck from behind by a compact SUV that was unable to merge into the middle lane in time to avoid the crash. The victim was crushed between the SUV and his work truck and then pushed under the work-truck. When law enforcement officers arrived, they found the victim under the work truck and pulled the truck forward. Once the truck was moved, the officers observed that the victim had severe injuries to both legs. One of the officers retrieved a tourniquet and applied it to one of the victim’s legs, but did not have a second tourniquet. When emergency services arrived at the scene five minutes later, the employee had succumbed to his injuries. The cause of death was blunt force injuries sustained in pedestrian vs motor vehicle collision. CONTRIBUTING FACTORS Occupational injuries and fatalities are often the result of one or more contributing factors or key events in a larger sequence of events that ultimately result in the injury or fatality. NIOSH investigators identified the following unrecognized hazards as key contributing factors in this incident: Lack of hazard recognition. Unsafe driving practices. No physical barrier between moving vehicles and workers. Lack of laws regarding advanced warning systems. RECOMMENDATIONS Perform a job hazard analysis of the worksite. The Occupational Safety & Health Administration (OSHA) states that JHAs should take priority on the following types of jobs: jobs with the highest injury or illness rates; jobs with the potential to cause severe or disabling injuries or illness, even if there is no history of previous accidents; jobs in which one simple human error could lead to a severe accident or injury; jobs that are new to your operation or have undergone changes in processes and procedures; and jobs complex enough to require written instructions. Had a job hazard analysis been performed, it is likely the employer would have recognized the potential hazard of having employees performing work while standing on an interstate highway. Operators of motor vehicles should always practice safe driving actions and habits when in, or approaching, work zones.According to the Federal Highway Administration, in 2017, 799 people died in work zone accidents; 658 were motorists, 132 were workers3. In the same year, Kentucky saw 15 work zone fatalities4. In order to reduce the amount of work zone injuries and fatalities, the Federal Highway Administration (FHWA) recommends the following driving tips to maintain driver and worker safety: 1. Know the work zone signs2. Pay attention to other drivers3. Stay focused. Avoid distraction4. Expect the unexpected5. Keep your cool. Be patient. Due to the efforts of the FHWA, work zone fatalities fell from 1,058 in 2005 to 586 in 2010, a decrease of 44.5%. Had the driver practiced the recommended driving actions and habits, it is possible they may have noticed the cones that had already been placed on the shoulder, as well as the work trucks with the flashing yellow arrows, and avoided the accident. Law enforcement should be present to aid in traffic control when workers are attempting to close lanes on the interstate. In 2003, Kentucky legislators passed Kentucky Revised Statute (KRS) 189.930, known to many Kentuckians as the ‘Move Over Law’. Section five of the law reads, “Upon approaching a stationary emergency vehicle or public safety vehicle, when the emergency vehicle or public safety vehicle is giving a signal by displaying alternately flashing yellow, red, red and white, red and blue, or blue lights, a person who drives an approaching vehicle shall, while proceeding with due caution: (a) Yield the right-of-way by moving to a lane not adjacent to that of the authorized emergency vehicle… or (b) Reduce the speed of the vehicle, maintaining a safe speed to road conditions, if changing lanes would be impossible or unsafe.” If the police department’s workload allowed, an officer could have been present, engaged the vehicle’s light bar, and placed the cruiser between the first and second parked work-trucks. If the operator of the vehicle had seen an officer’s flashing lights, it’s possible they may have attempted to merge into the middle lane and out of the path of the victim. The Manual on Uniform Traffic Control Devices (MUTCD) should consider revising requirements for short-duration and mobile work to align with Traffic Incident Management Training. The Kentucky Labor Department conducted a fatality inspection that concluded on April 30, 2018. During the inspection, the assigned Certified Safety and Health Officer (CSHO) did not recommend a citation because the applicable law that was incorporated by reference into 1926.200(g)(2) does not provide a requirement for any advanced warning during short-duration or mobile work. During the CSHO’s review of the case, it was determined that the applicable standard for the employees was CFR 1926.200(g)(2), which states, “All traffic control signs or devices used for protection of construction workers shall conform to Part VI of the MUTCD, 1988 Edition, Revision 3, or Part VI of the MUTCD, Millennium Edition, incorporated by reference in Sec. 1926.6.” To determine work duration, Section 6G.026 of the MUTCD was reviewed, and because the workers were placing cones on the shoulder and then moving, the duration was defined at mobile - work that moves intermittently or continuously. Once the work duration had been defined, the CSHO looked at MUTCD Section 6G.03 Location of Work6. This standard states that, “When the work space is within the traveled way, except for short-duration or mobile work, advance warning shall provide a general message that work is taking place, shall supply information about highway conditions, and shall indicate how motor vehicle traffic can move through the temporary traffic control zone.” The company in this case had gone above and beyond the standard by having rotating strobe light, brake lights, and an arrow board that acted as an advanced warning system. The standard as written does not require any advanced warning system that would undoubtedly make this type of work unsafe. To prevent similar incidents from occurring, the MUTCD should consider revising their requirements concerning short-duration and mobile work to align with Traffic Incident Management Training. Traffic Incident Management (TIM) is a training developed by the Federal Highway Administration that addresses the safety needs of those workers who may render aid, clear roadways, maintain traffic flow, or conduct accident reconstruction. In the TIM training, those employees performing activities on the roadway use block positioning using a ‘lane plus one’, with the shoulder counting as a lane. Block positioning means using a large, easily visible vehicle with flashing lights in order to give workers an appropriate amount of space needed. In the incident, the employer provided three large work trucks with flashing arrows. The first and second trucks were both parked on the shoulder, leaving the employees in a vulnerable position of working in the left lane. Had the employers been required to park the second work truck in the left lane in a block position, it is possible the driver of the SUV who struck the victim would have seen the vehicle blocking the left lane and either stopped or merged into the middle lane. Workplace Health and Safety Programs NIOSH encourages employers concerned about drug use among their workforce to implement health and safety policies and programs to both offer services and support to their workers, as well as take steps to create and maintain safe and healthy workplace environments. The form of a workplace health and safety plan or program will vary depending on the work setting and many other considerations. WORKPLACE DRUG TESTING  If workplaces include drug testing as part of such programs, the testing should be performed as part of an overall plan or program intended to assist workers who struggle with drug use, including those with any substance use disorder7. Allowing workers confidential access to screenings, support and treatment should be an important part of such workplace programs.Employers can also take other steps to prevent and treat addiction in the work environment: 1. Develop and/or maintain proactive and comprehensive occupational safety and health practices and programs to eliminate unsafe working conditions and prevent worker injury or illness.2. Identify providers that offer evidence-based treatment for injured workers, including the adherence to opioid prescribing guidelines.3. Provide adequate leave and other benefits after workplace injury including flexibility in scheduling and receiving medical care, support during recovery, and return to work.4. Take steps to manage workplace stressors and job insecurity to the extent possible.5. Take steps to decrease the stigma associated with substance misuse through awareness building and supervisor training.6. Educate workers about how drugs impair work activities, including driving, and encourage them to notify their employers if they are taking medications that may affect their ability to work safely so that a safe solution can be determined.7. Develop and communicate clear drug-related workplace policies that include an offer of assistance to workers.8. Offer EAP services, or other psychological, social, and family support when needed. Let's block ads! (Why?)

The Kentucky Fatality Assessment and Control Evaluation (FACE) Program is tasked with investigating fatalities and making recommendations to ensure they do not occur again. This is one of their recent cases. On Monday, Sept. 10, 2018, at 8:00 a.m., a 16-year-old male roofer arrived at the worksite to begin roofing work on a private residential home. The homeowners, a husband and wife, contacted a local general contractor to replace the roof on their home. The owner of the general contracting company hired a subcontractor to perform the work, a process he informed authorities that he performs regularly. The crew began work on the back of the house and quickly worked together to complete the task. At approximately 12:00 p.m., the 16-year-old victim gathered a model D1828-2EQ Werner aluminum extension ladder and moved to the front of the house to begin work there while the other three men moved on to the side of the house. At the front of the house, there were two 4 ft. x 4 ft. boxwood bushes planted 3 feet from the home’s exterior wall at the point where the victim was attempting to access the roof. There were no witnesses, but it is believed that because of the bushes, the victim was having trouble accessing the roof. With the ladder still fully extended, the victim attempted to move it closer by lifting the ladder and walking between the bushes to find a suitable base. The ladder became unstable, causing the victim to lose his balance falling backwards. As the victim and ladder were falling, the ladder fell into a top phase power line carrying 7.2 kilovolts (7,200 volts). Because the victim was still in contact with the highly conductive aluminum ladder when it struck the power line, electricity was able to travel through the metal and into the young worker. He was immediately electrocuted. After hearing a noise from the front of the home, the owner of the subcontracting company went to investigate and found the victim lying unresponsive on the ground. He immediately knocked on the home’s front door and frantically tried to communicate to the wife what had happened and asked for help. The homeowner called 911 at 12:15 p.m. When EMS arrived eight minutes later, they observed the victim lying on the ground facing upwards. Both of the worker’s boots had burn holes near the fifth toe; burn marks were also present on the stomach area. He was pronounced dead by the county coroner minutes later. In an interview with the county sheriff’s office with the help of a translator, the coworkers stated that they were on the side of the home and did not observe this incident. The owner of the subcontracting company acknowledged that he had instructed the victim to move to the front of the house to continue work there. Both coworkers were aware that the victim was putting up a ladder to access the front roof and that the victim had not asked for assistance. Cause of Death The cause of death was high voltage electrocution. Contributing Factors Occupational injuries and fatalities are often the result of one or more contributing factors or key events in a larger sequence of events that ultimately result in the injury or fatality. National Institute Occupational Safety and Health (NIOSH) investigators identified the following unrecognized hazards as key contributing factors in this incident: Work performed outside youth employment regulations Lack of hazard recognition and safety training Use of a conductive ladder around high voltage lines Transporting an extension ladder in the vertical position Recommendations Employers should perform a job hazard analysis prior to performing a new task. In this incident, the employees were exposed to working at heights, working from ladders, and close proximity to high voltage power lines. A job hazard analysis would recognize the numerous hazards that the roofing workforce was being exposed to so that necessary safety precautions could be undertaken. Employers should become familiar with and comply with all federal, state, and local regulations associated with youth employment, including safety training and hazard recognition. Due to the high injury rate of minors in the workplace, the Commonwealth of Kentucky has very specific child labor laws, providing guidelines on how many hours per week young workers are permitted to work, what times of the day they are allowed to work, and what occupations are prohibited for minors under the age of 185. The Kentucky Labor Cabinet lists 19 occupations that are prohibited for minors, including #16: “Roofing operations and all work on or about a roof.” Subcontractors and contractors should familiarize themselves with Kentucky child labor laws and Federal child labor laws before employing youths in specific occupations. In addition federal laws apply Hazardous Occupations from the US department of labor: Eighteen is the minimum age for employment in non-agricultural occupations declared hazardous by the Secretary of Labor. The rules prohibiting working in hazardous occupations (HO) apply either on an industry basis, or on an occupational basis no matter what industry the job is in. Parents employing their own children are subject to these same rules. General exemptions apply to all of these occupations, while limited apprentice/student-learner exemptions apply to those occupations marked with an *.These rules prohibit work in, or with the following: HO 16.Roofing operations and all work on or about a roof. Employers should consider using non-conductive ladders when working near electrical lines. At the time of the incident, the victim was using an aluminum ladder to access the roof. Because of its extremely low resistivity and extremely high conductivity, aluminum is one of the best electrical conducting metals, behind only silver, copper, annealed copper, and gold. As the ladder contacted the overhead power line, 7,200 volts and 16 amperes (amps) travelled through ladder, into the victim, and exited his body via the stomach and each foot’s fifth (pinky) toe. At values as low as 100 milliamps (.1 amps), death can occur. Due to the high amount of amperes that entered the victim’s body, cardiac arrest occurred instantly. In order to prevent similar incidents, the employer should consider using a non-conductive ladder, such as those made of a fiberglass-reinforced polymer, when working around live power lines. Due to its low electrical conductivity and high resistance to corrosion, these ladders would make a safe and practical choice when working outdoors around electricity. However, employers should ensure that these fiberglass ladders are maintained properly as required by 29 CFR 1926.1053. Unmaintained ladders may accumulate excess dirt or moisture that can conduct electricity in the event it encounters a high voltage line. Employees should always lower the extended section and transport ladders horizontally. The victim was moving a model D1828-2EQ Werner aluminum extension ladder that weighed approximately 56 lbs. When collapsed, the ladder was 14 feet tall and had a maximum open extended length of 25 feet. At the time of the incident, the victim, who measured 5’10” tall and weighed 165 lbs., was moving the ladder, which was extended to the maximum length of 25 ft. As the ladder became unstable and began to fall, the victim may have been unable to support the ladder’s top-heavy design while standing on uneven terrain, which allowed it to contact the power line. In instances where an extension ladder needs to be relocated, employees should lower the extended portion of the ladder until it is appropriately collapsed, carefully lay the ladder down, and transport it horizontally while grasping the ladder’s middle section with both hands in order to safety manage its weight. Once the ladder is placed in the necessary area, ensure the base is secure and re-extend the ladder to the appropriate height. Had the ladder been lowered and transported horizontally, the high voltage line could have been avoided. Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in this document were accessible as of the publication date. This case report was developed to draw the attention of employers and employees to a serious safety hazard and is based on preliminary data only. This publication does not represent final determinations regarding the nature of the incident, cause of the injury, or fault of employer, employee, or any party involved.

The Kentucky Fatality Assessment and Control Evaluation (FACE) Program is tasked with investigating fatalities and making recommendations to ensure they do not occur again. This is one of their recent cases. On Friday, June 22, 2018, a dump truck driver was electrocuted when he stepped off the vehicle’s running board while the raised truck bed was in contact with a high voltage power line.  At 8:00 a.m., the victim and his brother-in-law arrived at a construction site to begin work. The 20-acre parcel of land had recently been purchased by a real estate development company with the intention of razing the area of all pre-existing structures and constructing up to 77 single-family houses. The townhouses on the land had recently been demolished, and the primary construction company subcontracted the victim to help clear the area of the debris. The victim’s job was to transport large pieces of concrete debris in his 1980 Ford L9000 2-axle dump truck to a rock crusher that was designed to reduce the rock to pieces of gravel. After the rock was pulverized, the victim would then take the load of smaller rock to a sink hole located near a tree where he would raise the truck’s bed and dump the gravel. At approximately 4:35 p.m., as the victim was raising the truck’s bed, he slowly backed up to dump a load of large concrete debris into the rock crusher. As the bed of the truck extended to its full raised height of 24 ft. above the ground, it made contact with overhead electrical lines carrying 7,200 volts. This caused electricity to travel through the vehicle and catch the back tires of the truck on fire. Realizing the truck was on fire, the victim honked the horn to attract the attention of his brother-in-law who was getting a drink of water. The brother-in-law saw that the truck’s tire had begun burning, and ran towards the truck. The driver, after getting his co-worker’s attention, attempted to exit the vehicle in order to escape the flames. The victim opened the door, stepped onto the metal running board with his hand on the exterior of the truck, stepped off with one foot, and contacted the ground. Due to being in contact with both the ground and the electrified dump truck, the victim became grounded, completed the circuit, and was immediately electrocuted. The victim’s coworker and employees from the primary construction company were able to pull him away and doused him with a fire extinguisher to put out the flames on his body. The victim sustained charred electrical burns as well as thermal burns caused by his blue jeans catching on fire. The electrical current entered and exited his feet and hands. KY FACELeft: Dump Truck while burning Right: Dump truck post fire The Public Service Commission investigated the scene and checked the height of the overhead power lines. They determined the power line that was contacted was found to meet or exceed the required clearance of 26 ft. from the original elevation, and the raised elevation of the site caused by debris allowed the bed of the truck to reach the high voltage wires at 24’9”. Contributing Factors and Recommendations Occupational injuries and fatalities are often the result of one or more contributing factors or key events in a larger sequence of events that ultimately result in the injury or fatality. NIOSH investigators identified the following unrecognized hazards as key contributing factors in this incident: Lack of hazard awareness Exiting the vehicle while in contact with high voltage lines Fire Elevated terrain Recommendation #1 Perform a hazard assessment prior to beginning work to be aware of the hazards in the immediate work area. Prior to commencing work, employers should perform a hazard analysis in order to determine what possible dangers are present and possible resolutions. OSHA described a hazard analysis as “a technique that focuses on job tasks as a way to identify hazards before they occur. It focuses on the relationship between the worker, the task, the tools, and the work environment. Ideally, after you identify uncontrolled hazards, you will take steps to eliminate or reduce them to an acceptable risk level.” If a hazard analysis had been performed, it is likely that the overhead power lines would have been identified as a hazard of the task due to the elevated terrain, and measures could have been taken to reduce the danger. Recommendation #2 Require drivers to have a spotter when working around electrical lines. In an interview with the victim’s coworker, it was determined that the dump truck the victim was driving did not have a back-up alarm, and due to the dump truck’s design, could not see what was directly behind or above the vehicle. According to CFR 1926.601(b)(4)(ii)3, No employer shall use any motor vehicle equipment having an obstructed view to the rear unless “The vehicle is backed up only when an observer signals that it is safe to do so.” Spotters should be a safe distance from the vehicle, have a set of predetermined signals that can be communicated to the driver, and instruct the driver to stop immediately if they lose sight of the spotter. Had the victim used a spotter to help guide him while the dump truck was travelling in reverse, it is likely that the spotter would have observed the truck’s bed getting close to the overhead power lines, and could have instructed the driver to stop before contacting them. Recommendation #3 Have motor vehicles working on site maintain a safe working distance from high voltage lines. Before beginning work near high voltage wires, it should have been determined how many volts the overhead lines were carrying in order to implement plans to keep any large equipment a safe distance away. According to CFR 1926.1408(c), “…the utility owner/operator of the power lines must provide the requested voltage information within two working days of the employer's request.” The overhead power line that the dump truck contacted was carrying 7.2 kilovolts (7,200 volts). According to ‘Table A – Minimum Clearance Distance’ found in CFR 1926.1409, the minimum safe distance the dump truck should have been from the power lines at that voltage was 10 ft. As a conductor of electricity gets close to a power line, especially those carrying high voltage, the electricity can ‘jump’, or arc, to the conductor. This happens when the voltage gradient (volts per meter) is sufficiently high, which can ionize gas molecules by ripping an outer electron off an atom and accelerating it. At higher voltages, electricity can arc further distances to the nearest conductor. If the voltage information had been determined, and a plan put in place to keep large equipment a safe distance from the power lines, it is likely the dump truck would never have contacted the power lines. Recommendation #4 Stay in the vehicle and call 911. When a vehicle contacts electrical power lines, best practice is for all passengers to remain in the vehicle and call 911. Due to the high voltage carried within power lines, electrical current can easily travel through the vehicle and into the ground below, electrifying a radius of up to 30 ft. from the vehicle. In this instance, one of the dump truck’s tires caught fire, requiring the victim to exit the vehicle before the power could be disconnected. In situations where employees must exit a charged vehicle, it is recommended to jump away from the truck as far as possible with both feet launching and then landing simultaneously. As you move away from the vehicle, do not lift your feet to walk. Instead, keep your feet on the ground and scoot away, not allowing the heel of one foot to move past the toe of the other. Continue this method until you are 30 ft. from the vehicle. If a tingle is still felt in the body after 30 ft., continue shuffling away from the vehicle until you no longer feel this effect

The Kentucky Fatality Assessment and Control Evaluation (FACE) Program is tasked with investigating fatalities and making recommendations to ensure they do not occur again. This is one of their recent cases. On Friday, March 2, 2018, at approximately 9:17 p.m., a police officer (the victim) was patrolling a road near the end of the city limits, when he drove his vehicle into floodwater that had overtaken the road. The officer radioed dispatch that he had driven his 2015 Ford Explorer off the road and needed a tow truck. Dispatch stated the officer was calm as he made the initial request. KY FACEScene where the victim and his vehicle entered the water. Two minutes later, at 9:19 p.m., the officer placed another call to dispatch, stating that his vehicle was sinking into the water very quickly and that he needed a rescue. The dispatcher stated the officer sounded panicked as he made the second request. A teenage witness who lived nearby stated he saw the officer climb onto the top of his vehicle and that the officer told him to stay back and not to enter the water. Five minutes after the first call, the water completely submerged the vehicle. The witness stated he saw the officer jump from the top of the vehicle and into the water, but never saw him resurface. Strong currents pulled the victim and his vehicle several hundred feet from where he entered the water. At the time of the incident, the victim was wearing his duty belt that weighed approximately 30 lbs. and a Kevlar vest weighing approximately 10 lbs. The weight of the officer’s equipment as well as the shock of entering the cold water likely added to the difficulty of swimming against the current. When interviewed, the police chief stated he was not sure why the victim was in that area since it had been flooded for several days due to heavy rain. The victim had worked the night before the incident from 7:00 p.m. to 7:00 a.m., and the chief felt sure that he was aware of the flooding in that area. When interviewed, the incident commander stated that because it was a Friday night, and because teenagers frequented the street to party, the officer might have been patrolling the area to look for underage drinking. As he traveled on the road, the victim crested a hill and drove approximately 500 feet before his vehicle struck and entered the water. As water submerged the vehicle, it slowly drifted towards the driver’s side off the road and into the flooded field. Due to the limited light, it is likely the officer was unaware that the terrain he had entered quickly sloped downwards, creating a pool of water approximately 12-15 ft. deep. Additional officers, as well as the Fish and Wildlife rescue dive team were on-site by 9:24 p.m., and at 9:33 p.m., incident command was established. The Fish and Wildlife dive team entered the water and discovered the vehicle approximately 150-200 yards from where it had entered the water. The vehicle was discovered on its side before swift waters rolled the vehicle onto its top. Due to strong underwater currents, the rescue diver could only dive to a depth of 12 ft. at the time, making it difficult to locate the victim. In order to locate the victim, the dive team had to drag the surrounding area. The dive team worked through the night in an attempt to recover the victim. At 5:10 a.m., the officer was located and brought to shore where the coroner on the scene pronounced him dead. Contributing Factors and Recommendations Occupational injuries and fatalities are often the result of one or more contributing factors or key events in a larger sequence of events that ultimately result in the injury or fatality. NIOSH investigators identified the following unrecognized hazards as key contributing factors in this incident: • Weather• Lack of physical barrier to flooded area• Insufficient roadside lighting• Possible overdriving of the headlights Recommendation #1 County road department should install a roadway sign that warns of quick flooding during rain and close the road as quickly as possible with temporary barricades. When questioned why there were no barriers to prevent vehicles from accessing the area, the chief of police stated the reason was that boaters would use the natural downward slope of the road to launch their boats into the water while the road was flooded, since the permanent dock for launching was under water and inaccessible. At the time of the incident, the only signage warning drivers of floodwaters was a permanent sign stating “Water Over Roadway”; however, since the sign was permanent and not removed during the dry season, it may have been easy for drivers to become complacent and ignore the sign. After the incident, two orange barrels holding a removable sign stating “Road Closed” was placed on the road blocking access to the water. The sign, however, was small and lightweight, and a driver could easily move the sign in order to obtain access to the water. To prevent all vehicles from entering the flooded area, the county road department should consider installing a roadway sign that warns of quick flooding during heavy rains and close the road as quickly as possible with temporary barricades when the road becomes impassible. Recommendation #2 City government should consider installing streetlights approaching the flood plains. The area had no streetlights or security lights beyond the subdivision making it difficult to see if water was over the roadway. Local electric companies were contacted and asked what the requirements or guidelines were for installing streetlights. The companies responded that the city government makes the determination for where streetlights are used, and once purchased, they could easily be installed wherever the city deemed necessary. By installing streetlights or security lights on the approach to the flood plain, drivers would be more likely to see if the roadway was flooded. Installation of streetlights or security lights also promotes security and increases the safety of pedestrians, particularly that of children who may live and play in the area. Recommendation #3 Employers should ensure each employee is aware of areas that flood during rainy season. The chief of police stated he personally took new employees around the area and showed them the fields that are prone to flooding. Annual retraining and pre-shift meetings reminding employees during the rainy months of potential high water areas would refresh employee’s awareness of the potential danger during the flooding season and areas to avoid. This is a very small department and the other officers employed are very familiar with the areas that flood during the rainy season. The victim was not from the local area and this was the first rainy season of his employment. The department should consider placing a map of their jurisdiction in a common area of the department that highlights which roads that are closed due to high water and task an officer with updating the map as water levels rise and fall. Recommendation #4 Employees should never overdrive their vehicle’s headlights. Overdriving headlights is defined: “where a driver is moving at a rate of speed that their stopping distance is farther then their headlights, creating a dangerous driving environment.” The speed of this road was 25 mph; the officer’s actual speed is unknown.The 2015 Ford Explorer weighs approximately 4,800 lbs., and if using low beams, a driver would have 180 feet of vision. If the officer was using the vehicle’s high beams, he would have had 350 ft. of vision. At a speed of 25 mph, the vehicle was moving at a rate of 36.67 ft. per second. If the officer was travelling at the speed limit, his thinking distance – the distance the vehicle travels in the time it takes the driver to see the hazard, decides to brake and actually apply the brakes and is directly proportional to speed – measured at one second was 37 ft. The officer’s braking distance – the distance the vehicle travels while the brakes are applied and is proportional to speed squared, was 31 ft. The equates to a total stopping distance of 68 ft., well within the sight of both the vehicle’s high and low beams.

The Kentucky Fatality Assessment and Control Evaluation (FACE) Program is tasked with investigating fatalities and making recommendations to ensure they do not occur again. This is one of their recent cases.     At approximately 2:45 p.m., a dump truck driver crossed into Kentucky from Ohio to pick up a load of #55 limestone gravel and deliver it to his assigned destination. The company stated the victim had driven this winding road many times over his 15-year tenure. As he traveled north, he approached a left angle curve.     Tire marks suggested the truck gradually drifted to the right, went off the road and into a small ditch area. The driver attempted to drive out of the ditch 224.10 ft. from the final resting spot of the truck. The deputy sheriff stated the truck driver was traveling over the recommended speed limit of 35 mph. While the speed limit along the state road was posted at 55 mph, the curve was posted at 35 mph with an advisory speed sign prior to the curve.     As the victim entered the curve, neighbors who lived in the vicinity stated they heard the driver trying to apply the truck’s compression release engine brake – commonly referred to as a Jake brake - in an attempt to slow the truck. The deputy stated the Jake brake failed to slow the truck to a safe speed, causing the loaded truck’s center of gravity to shift toward the passenger side, and the driver to lose control of the vehicle.     The truck left the roadway on the passenger side and flipped onto its right side into the culvert 8 ft. below the highway. As the truck flipped, the fuel tank struck a piece of rebar that was protruding from the concrete retaining wall leading to a water drainage tunnel under the highway. The fuel tank ruptured, causing a small fire in the engine that rapidly began to spread as fuel leaked from the tank. 1987 Western Star 4900 series dump truck (Stock photo – Kentucky FACE)     Two neighbors, a husband and wife who heard the crash and saw the smoke from their residence, ran to assist the driver. When they arrived and noticed the fire, the husband desperately tried to pull the unconscious driver out of the burning truck through the front windshield that had become dislodged, while his wife called for emergency assistance and the fire department. The couple stated the driver was thrown and trapped along the passenger side of the truck where the flames were hottest, making it impossible to pull his unconscious body from the burning truck. Crashed dump truck. (Photo courtesy of witness)     When the flames became too dangerous, the neighbors retreated to safety. Within four minutes, the cab became engulfed in flames. The local fire department arrived at the scene within five minutes of receiving the call and put out the flames. The truck driver was pronounced dead at the scene by the coroner. Contributing Factors and Recommendations    The cause of death was complications from a motor vehicle collision with post-crash fire. Occupational injuries and fatalities are often the result of one or more contributing factors or key events in a larger sequence of events that ultimately result in the injury or fatality. Investigation identified the following unrecognized hazards as key contributing factors in this incident: Not wearing a seat belt Excessive speed No guardrail Exposed rebar Puncture of fuel tank As a result of this tragic incident and the investigation, Kentucky FACE made the following recommendations for the prevention of future similar incidents: Recommendation #1    The truck driver was not wearing his seat belt, and as the truck flipped onto its side, he was thrown to the passenger side of the cab. The resulting force knocked the driver unconscious, and he became trapped. By wearing his seat belt, it is possible he would have been conscious and not trapped in the passenger side of the cab, allowing for an attempted self-rescue or better positioning for rescuers to extract him from the burning truck. Recommendation #2     The truck driver was traveling on a rural highway with several sharp, dangerous curves. Advisory speed signs and curve warnings were posted prior to the curve. Information on the speed of the vehicle was unavailable at the time of this report; however, not following the suggested speed may have caused the driver to lose control. The company stated the driver had traveled this road many times, suggesting that he may have become complacent, and exceeded the recommended speed limit, resulting in the crash. The posted speed limit is intended for passenger vehicles, not large trucks.4 Due to their high center of gravity, commercial motor vehicles should lower their speed before entering a curve in order to negotiate it safely.  Recommendation #3     Guardrails are safety barriers to protect motorists in the event of a crash. According to the Federal Highway Administration, “The guardrail can operate to deflect a vehicle back to the roadway, slow the vehicle down to a complete stop, or, in certain circumstances, slow the vehicle down and then let it proceed past the guardrail.”5 It is possible that guardrails might have prevented the dump truck from leaving the roadway, overturning, and the fuel tank rupturing.     A guardrail system of a TL4, TL5, or TL6 would be best for protecting commercial vehicle drivers, but are cost prohibitive and only used in specialized situations. A TL4 can withstand a single unit truck weighing 22,000 lbs. with a speed of 56 mph and a 15-degree angle of impact. The TL5 and TL6 can withstand 79,300 lbs. with a speed of 50 mph and a 15-degree angle of impact.     A trained engineer uses American Association of State Highway and Transportation Officials (AASHTO) roadside design guide to determine if a guardrail is needed. A slope steeper than a 3:1 warrants the consideration of guardrail, according to the Kentucky Transportation Cabinet Division of Highway Design, Recommendation #4     Large truck manufacturers should consider an engineering redesign and new placement of fuel tanks within all trucks. With the high number of truck crashes that result in fire, this redesign could save lives as well as equipment. According to the Bunn et al. (2012), large truck vehicle fire rates in Kentucky were significantly increased when compared to light trucks and passenger cars.6 The study recommended the fuel tanks would be better protected within the truck body and not exposed.     For the purpose of this study, ‘large trucks’ include semi-trucks and single unit trucks. According to the FMCSA, single unit trucks “are vehicle configurations designed to transport property, where the cargo carrying capability of the vehicle is integral to the body of the vehicle (i.e. - it does not carry its cargo in an attached trailer)” 7. Dump trucks, including the one featured in this investigation, should be considered for fuel tank redesign. Recommendation #5     According to the Kentucky Transportation Cabinet’s (KYTC) website page concerning roadway maintenance, the roadway maintenance branch is responsible for several programs, including “Contract maintenance activities such as upgrading existing roadside guardrail, drainage structure maintenance and replacement, concrete pavement repair, slide repair, asphalt patching and other miscellaneous maintenance contracts as required”8. Generally speaking, culverts are hydraulic conduits used to convey water from one side of a highway entrance to the other for the purpose of drainage, making their repairs the responsibility of the KYTC. In this incident, a single piece of rebar measuring approximately 16 inches was protruding from what is referred to as a ‘box culvert’ - a rectangular four-sided concrete structure used in managing and storing storm water. According to the Kentucky Division of the Federal Highway Administration, in instances when small culverts run on a private landowner’s property, it is the responsibility of the landowner to inform the KYTC of structural deficiencies.     The KYTC would then travel to the site and make repairs. An open records request filed by the KY FACE team revealed that no repair request for this particular culvert was submitted. In order to prevent similar incidents from occurring in the future, the KYTC should consider a campaign to educate landowners on how to file maintenance requests via the KYTC website when a road, bridge, or culvert that runs on the owner’s property is in obvious disrepair. Had the landowner informed the KYTC of the protruding rebar, it is possible the repair would have been made prior to the incident and subsequent fire. Recommendation #6     Prevention through design emphasizes anticipating possible hazards to workers who will use the system and “designing out” those hazards in the design and engineering phase. In this case, the company could invest in electronic stability devices or electronic logging device that attached to the engine and allows the company to view the driver’ speed and location. Although it is hard to project a return on investment for these products, the financial savings come via crash prevention through reduced speeds and decreased likelihood of rollovers. This case report was developed to draw the attention of employers and employees to a serious safety hazard and is based on preliminary data only. This publication does not represent final determinations regarding the nature of the incident, cause of the injury, or fault of employer, employee, or any party involved.DeAnna McIntosh currently serves as the safety specialist for the Kentucky Fatality Assessment & Control Evaluation (FACE) Program within KIPRC. With a focus on prevention, her reports analyze a variety of contributing factors to each case, and subsequently make prevention recommendations centered on administrative controls, environmental controls, PPE use and existing safety regulations.

An out-of-state roofing contractor was hired to remove and replace roofing and insulation as a part of a tobacco warehouse renovation project. A work crew of three roofers and one foreman were on site for approximately three weeks and were in the process of installing the new rolled fiberglass insulation and corrugated metal roofing materials onto a warehouse roof. The original skylights were being used and not replaced.The crew arrived at the worksite at 9:00 a.m. on Friday, Dec. 11, 2015. They had been using a Genie S-45 boom lift to access the roof and transfer roofing materials. Approximately three hours after arriving, the three roofers were positioned on the roof—near the roof’s peak. The foreman was located at the ground level. None of the roofers were wearing fall protection, and the nearby skylights were not guarded.The victim,a 25-year-old male roofer and father, was stretching roofing insulation near the peak of the roof when the insulation tore, causing him to lose his balance. He stepped forward onto a clear fiberglass skylight in an attempt to regain balance, causing the skylight to break. He fell approximately 30 ft. to the concrete below, fatally striking his head. He was pronounced dead at the scene by the coroner. Skylight through which the victim fell with torn insulation (A); interior of the building (B). (Photo credit: Kentucky Occupational Safety and Health, Kentucky Labor Cabinet.)The incident took place inside a former tobacco warehouse. The floor was littered with old insulation that had been removed and the new rolls of fiberglass insulation that were to be installed. The 1:12 pitch roof was being constructed of corrugated sheets of metal and had corrugated fiberglass skylights running through.  There was a tractor and van stored inside the building.  When the victim fell, he landed on the concrete surface below in a large puddle of water. The foreman witnessed the victim falling and called for emergency medical services.  The victim was pronounced dead at the scene at 12:23 p.m. by the coroner. Fiberglass corrugated skylight panels, similar to those on the roof (A); corrugated metal roofing panels, similar to those on the roof (B). (Photo credit: Home Depot.)Lack of Training, Personal Protective Equipment UseThe other roofers on the scene, including the foreman, stated that despite fall protection being available, they did not use it on the day of the incident and had no training on how to wear it properly. The foreman was working on the roof with the roofers off and on that day and the lack of personal fall arrest systems being worn was readily visible to onlookers. The roofers also stated that they had never received any type of worker safety training except lift operation training since being hired by the employer, as required by federal and state OSHA regulations.The use of the boom lift also required personal fall arrest systems, which were not used during boom operation.As a result of this tragic incident and the investigation, Kentucky FACE made the following recommendations for the prevention of future similar incidents:A job hazard analysis should be performed by a trained, competent person, before beginning a job. 29 CFR 1910.132(d)(2)“Job Hazard Analysis”. Occupational Safety and Health Administration. [PDF].Workers should always use personal fall protection when exposed to a vertical drop of 6 ft. or more.“Duty to have fall protection, 29 CFR 1926.501(b)(2)”. Occupational Safety and Health Administration”. All employees expected to work from heights of 6 ft. or more should receive training on fall protection use prior to beginning such work. Employers and forepersons should enforce worker safety policies and procedures that, at a minimum, adhere to federal OSHA regulations.Kentucky FACE uses the facts gathered from investigations to formulate and disseminate injury prevention strategies, with the hope of preventing similar future incidents.  The program does not determine fault or blame and does not enforce compliance with state or federal occupational safety and health standards. Kentucky FACE is grant-funded by the National Institute for Occupational Safety and Health (NIOSH) and operates from the Kentucky Injury Prevention and Research Center (KIPRC) at the University of Kentucky. KIPRC is a bona fide agent for the Kentucky Department for Public Health.