It was late. John (not his real name) had been working the late shift for the past 12 hours. He was tired and ready to go home. At about 5 a.m., he had just finished repairing a gravel train and was in the process of moving it from the maintenance shop to the rear parking lot, a task he performed many times as a mechanic. The semi tractor's running lights were on but John did not turn the headlights on. He drove past the open parking space, turned the truck around in the wide open area, and headed back to the open parking space. As he began to make his turn into the open space he heard an unfamiliar crunching sound...
THE TRUCK OPERATOR
John was a truck mechanic who worked the night shift at a family-owned trucking company that delivered and moved site construction materials. He had many years of experience driving the tractor trailer units but he did not have a CDL. Police reports state that John awoke the previous day at about 11:30 a.m. He had been on duty since 4:30 p.m. that day. His last 15-20 minute break was at 12:30 a.m. on the day on the incident. He had been awake for 17+ hours.
One of John’s coworkers, a 52-year-old truck driver who was wearing a reflective vest, was walking in the open space to get to his truck, Truck 85. John knew he hit something just before pulling into the open parking space. As soon as he heard a “crunch” he stopped the vehicle, exited the truck and noticed a lunch box on the ground by the front driver's side tire. Looking around, John did not see or hear anyone. He picked up the scattered items on the ground and put them back into the lunch box. He got back into the truck and backed up approximately 13 feet in an attempt to reload the parking brake. It was then that he noticed the truck driver lying on the ground. John immediately ran back to the maintenance shop and called for emergency help. Other individuals in the shop ran to the scene and checked for a pulse; they did not find one. When emergency response arrived, the truck driver was declared dead.
The initial investigation identified possible factors in the incident: 1) Fatigue. John had been up for over 17 hours when the incident occurred; and 2) Poor Lighting. The parking lot was dark because two corner pole lights located at each corner end at the rear of the parking lot were not functional. John did not turn on the truck’s headlights and four-way flashers. Interviews indicated that employees requested that truck headlights not be on when moving trucks in the lot as a matter of courtesy to those walking. This request was not in compliance with company policy. Additionally, the firm was unaware that the mechanic had a restricted license. The firm restricted anyone from driving in the yard if the individual was restricted from driving in public.
- Truck operators should always use vehicle headlights in parking lots when the vehicles are moving during dusk through dawn hours.
- A training/awareness program should be instituted to educate shift workers, especially those working 12 hour shifts at night, about sleep/fatigue management and the potential safety and health issues such as “sleep debt.” Information on sleep debt may be found at http://www.webmd.com/sleep-disorders/news/20100115/sleep-debt-hard-to-repay.
- Develop an interior/exterior facility inspection checklist to identify and remedy safety and health concerns, such as non-functional pole lights.
Department of Medicine, Occupational and Environmental Medicine
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Safety Issues is presented by the National Institute for Occupational Safety and Health (NIOSH) in partnership with the National Truckers Association (NTA), with major contributions from State partners funded by NIOSH through the Fatality Assessment and Control Evaluation (FACE) Program. The goal of the FACE Program is to prevent occupational fatalities across the nation by identifying and investigating work situations at high risk for injury and then developing and disseminating prevention strategies to those who can intervene in the workplace. State partners who contribute Safety Issues postings based on recent investigative reports are California, Iowa, Kentucky, Massachusetts, Michigan, New York, Oregon, New Jersey, and Washington.
This month’s Safety Issues is based on an investigative report from the Michigan FACE Program. The complete detailed Michigan FACE INVESTIGATION REPORT: #09MI085 includes additional case information, recommendations and discussion. This report can be found at http://www.oem.msu.edu/MiFace/09MI085.pdf. Additional MI-FACE Investigation Reports, Annual Reports, Hazard Alerts and other publications can be accessed through the MSU Occupational and Environmental Website at http://www.oem.msu.edu/MIFACE_Program.aspx
The Safety Issues and Investigation Reports which are the products of NIOSH Cooperative State partners are presented here in their original unedited form from the states. They are intended for educational purposes only. The findings and conclusions in each report are those of the individual Cooperative State partner and do not necessarily reflect the views or policy of the NIOSH.