Fatality Assessment and Control Evaluation (FACE) Program |
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Ironworker Foreman Crushed When Bridge Support Element Broke During Dismantling |
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SummaryOn February 24, 2005, a 43-year-old male ironworker foreman, who was employed by a construction company, sustained fatal injuries when elements of a bridge support structure he was dismantling broke apart and he was crushed between them at a bridge construction site. On the day of the incident, the victim and a co-worker were dismantling a span of a temporary bridge support. The span was a steel framework consisting of two pairs of 77-foot-long steel W36 I-beams and several W12 I-beams. In preparation for dismantling, a triangular-shaped steel element, called a pile cap, weighing approximately 8,000 lbs., was welded and chained to the ends of the W36 beams by a steel chain. The span was then removed from the support and placed on a floating barge where the remainder of the dismantling took place. At the time of the incident, the victim and his co-worker were on the barge dismantling the third pile cap of the day. To safely dismantle a pile cap, the cap was to be rigged with a crane before cutting the welds with a torch to free the cap from the I-beams. However, prior to the incident, the victim had been seen operating a torch on top of the pile cap that was involved in the incident before the cap was rigged to the crane hoist. The victim was straddling the two sides of the cap near its tip and the co-worker was standing on the base of the cap when the cap suddenly broke away from the I-beams. The co-worker was thrown into the river and was not injured. He swam to the barge and was pulled out of the water. The victim, however, was crushed between the pile cap and the ends of the W36 beams. The cap hung on the chain above the water, with the victim lying on the pile cap partially submerged in water. The site foreman immediately called 911 while other workers got into a motor boat to rescue the victim. They moved the victim into the boat and then onto the riverbank. Resuscitation efforts were performed on the victim before EMS’ arrival. The victim was pronounced dead at the scene. New York State Fatality Assessment and Control Evaluation (NY FACE) investigators concluded that to help prevent similar incidents from occurring in the future, employers should:
IntroductionOn February 24, 2005, a 43-year-old male ironworker foreman (the victim), who was employed by a construction company, sustained fatal injuries when elements of a temporary bridge support he was dismantling broke apart and he was crushed at a bridge construction site. NY FACE investigators learned of the incident on February 25th from an area office of the Occupational Safety and Health Administration (OSHA). On March 5th and 6th, a NY FACE investigator traveled to the incident site to conduct a fatality evaluation. During the site visits, the NY FACE investigator met with representatives of the construction company, observed the preserved incident scene, interviewed witnesses, and reviewed the company’s safety and health programs and employee training records. The case was reviewed with the OSHA compliance officer who investigated the incident. The police report and Medical Examiner’s report were also reviewed. The New York State Department of Transportation (NYSDOT), which owned the bridge, also conducted an investigation. The victim’s employer was a large civil and heavy industrial construction company that was founded in 1949. At the time of the incident, it employed approximately 2,000 non-union workers and served southern New England and New York State. The company provided all field employees with 30-hour construction safety training. Daily crew meetings were held at each job site to discuss specific hazards and preventive measures. Workers were provided with hard hats, safety glasses, gloves, steel-toed work boots, face shields for cutting or welding, life jackets and personal fall arrest systems. The victim had been employed by the company for eleven years. At the time of the incident, his job title was ironworker foreman. The company had strengthened its safety programs in 1987 after experiencing 14 worker fatalities during the previous 16 years. Since 1987, six employees, including the victim, have died in work-related incidents. Back to TopInvestigationAt the time of the incident, the company had been contracted by the NYSDOT
as a general contractor for a multi-phase bridge construction project
encompassing two construction sites. At one site, the company erected
a temporary bridge support structure to provide support for assembling
and erecting the new bridge. The temporary support structure was to be
dismantled and removed as soon as the new bridge was erected. The fatal
incident occurred during the dismantling of the temporary under-bridge.
On the morning of the incident, eight workers, including the victim, arrived at the site at approximately 7:00 a.m. A crew meeting was held to discuss the tasks of the day, the potential safety hazards associated with the tasks, the preventive measures, and the required personal protective equipment. The items discussed were recorded on a Daily Work Activity Hazard Analysis form and the form was signed by each of the workers who attended the meeting.
Work started immediately following the crew meeting. Workers entered the work platform on the floating barge through a ladder that was placed against the riverbank and a catwalk (Photo 3). The ladder served as the only access to the barge and was unstable. The top of the ladder was covered with ice and snow at the time of the incident. The major task of that day was dismantling the third under-bridge span along with the four pile caps attached to it. The span was placed on the barge approximately ten feet above the water. The company required workers to wear fall protection and to be tied to an anchorage when working ten feet in the air or higher. OSHA regulations require employees to be protected from falling if working on elevations of six feet or higher. The victim and his co-workers wore life jackets, but did not use fall protection on the day of the incident.
The victim, a co-worker, and a crane operator were assigned to dismantle the caps. To safely dismantle a cap, the workers were to follow five critical steps: 1) rig the pile cap with the crane hoist cable; 2) tension the crane cable; 3) remove the steel chain; 4) cut the welds with a torch to free the cap; and 5) signal the crane operator to lift the cap and place it on the land. These steps were not included in the written engineering project plan. According to company representatives, the crew had discussed the steps during the morning meeting that day. The victim and his co-worker safely removed the first two caps following the proper procedures that morning. By 10:00 a.m., the crew was ready to dismantle the third cap. The same crane that was used to lift the first two caps could not reach the third cap, and the crane operator had to switch to another crane that was located on the barge. At approximately 10:15 a.m., the crane operator started the second crane and waited for it to warm up. At the same time, the co-worker was on the barge setting up another torch and the victim was standing on top of the third pile cap with a torch. At least two witnesses recalled seeing the victim cutting on the cap with a torch, but no one could confirm what part of the cap he was cutting.
Just prior to the incident, the co-worker got on the cap to assist the victim with rigging. The victim was straddling the two sides of the cap near its tip and the co-worker was standing on the base of the cap (Figure 3). Before they were able to rig the cap to the crane cable, the cap broke apart from the W36 I-beams and swung on the chain towards the ends of the W36 beams. The victim was crushed between the swinging pile cap and the ends of the W36 beams. The cap hung on the test chain above the water (Photos 4 and 5) with the victim lying on the pile cap partially submerged in water. The co-worker was thrown into the river and was not injured; he swam to the barge and was pulled out of the water by two workers.
Immediately following the incident, the site foreman called 911 to summon emergency medical service, while two workers got into a motor boat and went around the barge to rescue the victim. They moved the victim from the pile cap into the boat and then onto the riverbank. A NYSDOT-contracted engineer who was CPR certified performed resuscitation efforts on the victim. EMS arrived at the site in eight minutes. The victim was pronounced dead at the scene. The post-incident examination revealed that the cap had been welded to the W36 I-beams with two welds. It appeared that both welds had been partially cut prior to the incident. The company’s original engineering plan dictated that all pile caps were to be bolted to the I-beams with four 7/8” A325 bolts and chained to the W36 beams with two 5,000 lb. test steel chains. Later, the job site superintendent proposed to replace the bolts with welds. The company professional engineer (PE) approved the request and specified that each cap should be welded to the W36 beams with four welds and chained to the beams with two 5000 lb. test steel chains. However the cap that was involved in the incident had been welded to the girders with only two welds instead of four, and all pile caps were chained to the W36 beams with a single 12,000 lb. test chain rather than two 5,000 lb. test chains. These deviations were not communicated to nor discussed with the PE. According to the company PE, the two welds on the cap would not have provided a sufficient safety margin to support the weight of the pile cap and the additional loads. Back to TopCause of DeathThe cause of death was listed by the Medical Examiner as crushing chest injuries. Recommendations/DiscussionRecommendation #1: Employers should provide task-specific employee refresher training addressing proper dismantling procedures.Discussion: Immediate employee retraining should be provided in the event of an incident, a near-miss incident, or changes in operational procedures or equipment. The proper procedure for safely dismantling pile caps should be included in the written project plan and reviewed with the crew. The employer should ensure that workers understand the importance of following the dismantling steps in the correct order. Workers should be encouraged to report any unsafe behaviors to the project supervisors and site superintendent. Management should increase supervision to ensure that workers follow appropriate safety procedures.
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