On a sunny, warm day in 2012, John died due to head injuries sustained in an unwitnessed fall from a trailer. The truck trailer had been loaded with empty kegs which had been shrink-wrapped and placed on pallets. After the trailer was loaded, John drove the semi -truck/trailer to the fueling area. He opened the trailer door to place the shipping manifest in the semi-trailer. Although the injury sequence of events was unknown, John most likely used the ICC bumper to access the trailer deck. It is unknown if he was on the ICC bumper or had stepped up onto the deck at the time of his fall. In an attempt to regain his balance, it appears he grabbed the shrink-wrapped kegs, and as he fell, the kegs and pallet were pulled down with him.
THE TRUCK OPERATOR
John had 4.5 years of experience as a part-time (20-25 hours/week) truck porter at his employer, a beverage wholesaler. His job responsibilities included driving the switcher tractor to pull loaded trailers out of the dock and replace them with empty trailers as well as prepare trucks for transport (fueling and washing trucks and placing shipping manifests in the trailer).
John had positioned two trucks/trailers at the fuel island. While one truck was fueling, it appeared that he was attempting to place the shipping manifest in the pocket on the trailer wall at the rear of the incident semi-trailer. He had opened the passenger side rear trailer door. For reasons unknown, he had an unwitnessed fall. A coworker noted the empty kegs on the ground and walked to the trailer to assist in loading the kegs back into the truck. The coworker found him lying on his back on the ground with a wooden pallet on his legs and empty kegs strewn around him.
The semi-trailer was loaded with empty beer kegs destined for return to their respective brewery. The trailer involved in the incident was a 54-foot-long rear load trailer with two access doors that opened outward. The ICC bumper “step” was located 24 inches above the ground and the trailer deck was located approximately 48 inches from the ground. The trailer had been loaded with 25 stacks of pallets in a honeycomb pattern. Each stack contained four specifically designed keg pallets which held four kegs each. The last two pallets loaded were shrink-wrapped with plastic to provide added stability and to prevent them from falling when the trailer doors were opened. Company personnel indicated that forklift drivers were instructed to place the last two shrink-wrapped pallets approximately 12 inches to 18 inches from the rear of the trailer. Each stack of four pallets weighed approximately 470 pounds.
- Develop a written truck yard health and safety program that includes safe work procedures for truck porters.
- Ensure access ladders are available to workers to climb onto trailer deck.
- Employers and/or trailer manufacturers should consider mounting the shipping manifest pocket at a height easily accessed from ground level
Department of Medicine
Occupational and Environmental Medicine
909 Fee Road, Room 117 West Fee Hall
East Lansing, MI 48824-1315
Safety Issues is presented by the FACE (Fatality Assessment and Control Evaluation) Programs of California, Iowa, Kentucky, Massachusetts, Michigan, New York, Oregon, New Jersey, and Washington and the National Institute of Occupational Safety and Health (NIOSH) in partnership with the National Truckers Association (NTA). 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.
The complete detailed MIFACE INVESTIGATION REPORT: #12MI054 includes additional report information recommendations and discussions. This report can be found at http://www.oem.msu.edu/MiFace/12MI054.pdf and is for educational purposes only. Additional MIFACE Investigation Reports, Summaries of MIOSHA Inspections, and Hazard Alerts can be accessed through the MSU Occupational and Environmental Medicine program at http://www.oem.msu.edu/miface_program.aspx
The Safety Issues and Investigation Reports are the products of NIOSH Cooperative State partners and are presented here in their original unedited form from the states. 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