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OSHA Occupational Safety and Health Administration
U.S. Department of Labor

Process: Hazardous Energy

 

Control of Hazardous Energy in Shipyard Employment

Case History #1

On October 16, 2005, a worker onboard a fish-processing vessel was cleaning a vat used to process fish paste. The augers at the bottom of the vat suddenly started up, trapped the worker's feet and legs, and drew them into the machinery. It took coworkers two hours to free her from the machinery and another half day for a helicopter to arrive and airlift her off the vessel. The helicopter flew the employee to a hospital in Anchorage, Alaska, where her legs were amputated below the knees.

Analysis & Preventive Measures
Example: auger

Example: auger

While the switch providing power to the vat and its augers was off, nobody rendered the equipment inoperative through the use of a lockout or tags-plus application. Additionally, there was no signage (e.g., danger tag) posted to indicate hazardous conditions could arise if the equipment became energized - - such as "Do Not Start," "Do Not Open," "Do Not Close," "Do Not Energize," or "Do Not Operate." This serious incident was preventable if an effective program was in place and a means of protection applied before starting work.

Case History #2

While a worker was attempting to crawl feet-first out of a bin through a hydraulic gate, his body contacted the electronic eye of the machine. This maneuver activated the hydraulic gate, causing it to lower and fracture the worker’s neck, killing him. According to the employer, the gate's hydraulic valve was in the open position after being shut off earlier that day.

Analysis & Preventive Measures

The employer had no lockout/tags-plus procedures in place, nor did the worker receive training on the hazards associated with the equipment that the employer installed seven months prior. An effective program, with proper training, would have informed the worker that the hydraulic gate needed to be deenergized and made inoperable before placing any part of his body into the machine, thereby preventing this incident.

locks and tags

Case History #3

On November 15, 2006, three workers were replacing a coupling on a waste-evaporator system on a pump motor located below an evaporator tank. This repair was necessary because of the pump’s inability to remove the build up of water in the tank. The tank, mounted about 11 feet above the ground, was approximately 6 feet wide by 13.5 feet high. The tank had severe metal deterioration that was evident from rust and previous welding repairs. During the repair, the system was running with no lockout or tagout procedures in place, and water continued to fill the tank as they worked. The weight of the water in the tank caused the tank to rupture, rapidly releasing several hundred gallons of water that was about 200 to 300 degrees Fahrenheit. One of the workers received severe burns, requiring hospitalization.

Analysis & Preventive Measures

The evaporator tank needed to be shut down while the repair work was in progress. The tank pump’s inability to remove the build-up of water added stress to its already deteriorated state, leading to the rupture and injury to the worker. Similarly, replacing the deteriorated evaporator tank would require that workers follow appropriate deenergization and isolation procedures. These procedures would involve emptying and shutting down the tank, followed by closing and locking a valve (or closing and tagging the valve, plus installing a blank at the pump) before starting servicing.

Case History #4

On June 15, 2009, a maintenance worker was performing a preproduction service check of a machine known as the "Portioner." This machine electronically scans and slices whole fish filets. Inside the machine is a knife blade used for slicing that rotates clockwise on a wheel-type track. When the maintenance worker saw that the conveyor belt was not advancing smoothly and that the conveyor motor was wobbling, he reached into the machine without deenergizing it. The knife blade contacted his left forearm, cutting it. The worker required hospitalization and surgery as a result of his injury.

Analysis & Preventive Measures

The maintenance worker did not receive the training necessary to recognize the hazards of the “Portioner” machine, nor did the employer establish a specific lockout/tags-plus program for the machine. An effective program, with training, would have informed the worker that the machine needed to be deenergized and rendered inoperative before placing any part of his body into the machine.

Example danger/warning tags, used to indicated that hazardous conditions could arise if equipment becomes energized

Example danger/warning tags, used to indicated that hazardous conditions could arise if equipment becomes energized

E-13 and E-14

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