Inspection Detail

Inspection: 116567512 - Kellogg Company

Inspection Information - Office: Omaha Area Office

Investigation Summary

Employee #1 was off-loading raw food products from rail cars. The cars were initially brought into the large, enclosed bulk unloading area by the railroad and company workers then used a car puller system that included a 5/8 in. steel wire rope to move them into the appropriate positions. The wire rope was set up as a loop with two pulleys on either end and a winch in the middle of the loop to control the direction of cable movement. There was a cage surrounding the main electronic controls for the winch, and an uncaged set of controls at one end of the system. During Employee #1's shift, he pulled the rail cars into different positions to unload the first of the three compartments on each. He had moved the last car, containing grits, and then was going to move the sugar car into a different position to unload the second of the car's three compartments. He lodged a stick into the cage housing the cable controls so he could move the cable end with the hook (used to hook up the rail car) without having to apply constant pressure with his finger. He then unhooked an air hose used to power a vibrator attached to the car, which helped shake out the residual sugar. At this point the cable broke and flew through the air. The hook end of the attachment struck Employee #1 on the head, killing him. The cable then wound out at the opposite end, hit an overhead door, and knocked out a glass panel. Subsequent investigation determined that the cable broke due to the excessive pressure placed on it. Employee #1 had pulled the cars with both the hydraulic brakes and the hand brakes fully engaged on all the cars. The force needed to do this caused part of the cable system to become slack. Then the cable began double-wrapping on the winch. The cable continued to wrap on itself, double-wrapping nine times and triple-wrapping at least three times. The cable reached a point where it was stretched beyond its capacity, and it broke. Apparently, coworkers in this job routinely lodged a stick between the cage and the control panel to move the end of the cable with the hook attachment to whichever car they needed. They later stated that they were always in the cage when they actually were pulling the railcars because they knew that there was a lot of force on the cable at this time. There were no witnesses to the accident.

Keywords: HEAD, WIRE ROPE, OVERLOADED, RAILROAD CAR, BROKEN CABLE, OFF LOADING, STRUCK BY, FLYING OBJECT, WINCH