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Occupational Safety and Health Administration OSHA

Accident Report Detail

Accident: 200536381 - Confined Space Kills One Worker, Injures Two Rescuers

Accident: 200536381 -- Report ID: 0751910 -- Event Date: 01/21/2014
InspectionOpen DateSICEstablishment Name
31750083301/21/20147542Sully Truck Wash Inc.
At approximately 12:10 p.m. on January 21, 2014, Employee #1, Employee #2, a 36-year-old male, and a coworker, a 39-year-old male with Sully Truck Wash Inc., were engaged in cleaning out the interior of the tanker trailer. The equipment involved was a 6,500 gallon tanker trailer (Number 299, VIN 1S9T74229M0017133, Serial Number STE-5433, which was pulled in for interior cleaning. This tanker trailer was manufactured in May 1991 by Stainless Tank and Equipment Company, Cottage Grove, Wisconsin. Recycled water pumped from settling ponds on property. Work was being conducted by two shifts, a day and evening shift. Each shift consisted of four workers and a supervisor. Employee #1 was working alone with no attendant. The supervisor pulled the tanker trailer in to the wash bay after it sat outside all night in sub-freezing temperatures. The four-day shift workers were on morning break. The supervisor opened the man hatch located on top of the trailer and inserted the recycle water hose to start the initial rinse of the tanker. The supervisor opened the valves on the back of the tanker; they had frozen material in them. The supervisor then used a torch and hot water to remove the frozen materials. When the supervisor left the tanker trailer, water was flowing from the open, rear valves. When the workers returned to work, Employee #1 started to clean the tanker trailer. Employee #1 entered the tanker from the top hatch, the only entrance large enough for a human to enter. A ladder was inserted and used to climb down into the tanker. First rinse is completed with recycled water. Then cleaning was accomplished using hot water. Employee #1 was using the recycle water for the initial rinse. Employees #2 and #3 and one coworker were cleaning on livestock trailers. Apparently, this Employer's usual procedure to check on a worker inside a tanker trailer was to tap on the outside tank, and the worker inside the tank was to tap back. Someone tapped on the outside tank but no one tapped back. Employee #2 went onto top of tanker and looked down inside and saw Employee #1 lying on his back in the bottom of the trailer, with the ladder lying on top of him. Employee #2 yelled at Employee #1 but got no response. Employee #2 yelled at Employee #3 for him to get the supervisor and that Employee #1 was down inside the tanker. Employee #2 waited until supervisor arrived at the tanker before dropping down into tanker. Employee #2 first set ladder back up, then reached down to check on Employee #1 and passed out. The Supervisor and a coworker were now on top of tanker and saw both Employee #1 and Employee #2 passed out. The supervisor then enters tanker, pulls out his cell phone, starts to call 911 and passes out before completing call. Now with three people unresponsive inside the tank, another coworker goes to an office and calls for Emergency Medical Services. Five fire departments/EMS/ambulance, one hazardous materials response team, two air ambulances, county sheriff, and a county medical examiner investigator arrive at the scene. Employee #1 was killed in the event, Employees #2 and Employee #3 required hospitalization (note: injury line does not mention the fatality - only mentions two workers injured and hospitalized). Factors that contributed to this incident included; the Employer had no permit required confined space entry program, the Employer did not test for a hazardous environment prior to entry, and the Employer had not conducted any effective training for confined space entry. The Employer also had no written employee safety or health programs. The Sully Truck Wash was a truck wash and clean out service. Primarily, the company completed livestock trailer cleanout and sanitation. In two years prior to this fatality event, the company had started doing washing of exterior and some interior of tanker trailers. At the time of writing this it was not determined if an unknown chemical or lack of fresh air caused the death and two hospitalizati
Keywords: ventilation, confined space, venting, untrained
Employee # Inspection Age Sex Degree Nature Occupation
1 317500833 Hospitalized injury Other Vehicle washers and equipment cleaners
2 317500833 Hospitalized injury Other Occupation not reported

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