Inspection Detail

Inspection: 109486258 - R & C Corporation

Inspection Information - Office: San Francisco Ro

Investigation Summary

Employee #1, a personnel hoist operator for R & C Corporation, died when the hoist cage he was operating went over the top of the hoist tower and fell about 175 feet to the bottom of an interior elevator pit. About 300 employees, including seven contractors, were onsite. A 25-level cast was being constructed at the hotel tower. At the time of the accident, the cast was complete up to about the 17th level. Employees on the top level were installing concrete forms and tying rebar for additional concrete pours. Employees on the lower levels were installing metal studs, electrical equipment, windows, and elevators. All of the subcontractors used the hoist. The personnel hoist was purchased by the onsite management contractor from the parent company in Japan. The onsite management contractor provided installation instructions to the subcontractor. The personnel hoist was installed in an interior elevator shaft. The installation began about three months prior to the incident, and the hoist tower was extended about every two weeks after another level of the structure was complete. About four weeks prior to the incident, a platform was built on top of the hoist's cage. A subcontractor worked off of the platform to enlarge the elevator door on the second level opening with a jackhammer. Apparently, the control arm for the over travel limit switch was damaged when the platform was constructed. Later, the control arm was removed. This was the only safety device installed on the hoist to prevent it from traveling over the top of the hoist tower. The platform was removed from the hoist after about two days, and the hoist was used without the control arm. Investigators found that the employer did not prohibit the use of the damaged hoist. The manufacturer's specifications were not followed, and dog plates were not installed to activate the hoist upper limit switch. The gear rack used to drive the hoist up the tower was not removed from the top section of the hoist tower, and the control arm that controlled the over travel limit switch was intentionally removed. The employees who were expected to inspect the hoist were never instructed on how to inspect the hoist safety devices. Investigators determined that his employer failed in four areas. First, they failed to prohibit the use of the defective hoist. Second, they failed to instruct the installers and erectors of the hoist on how to inspect the safety devices. Third, they failed to have a competent person supervise the inspection of the hoist. Finally, they failed to follow the manufacturer's specifications.

Keywords: HOIST, FALL, ELEVATOR, TOWER