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Occupational Safety and Health Administration OSHA

Accident Report Detail

Accident: 202588034 - Worker Is Crushed While Inspecting Crane

Accident: 202588034 -- Report ID: 0950614 -- Event Date: 10/24/2012
InspectionOpen DateSICEstablishment Name
31531971510/24/20124491Marine Terminals Corporation Dba Ports America
At approximately 9:15 a.m. on October 24, 2012, Employee #1 was working as a crane mechanic for the Marine Terminals Corporation (MTC), dba Ports America. He was the lead person for the northern California crane shop. The terminal where he was working, the Ben E. Nutter Terminal, was operated by Seaside Transportation Services, a Ports America company. There were approximately 470 employees working at their Port of Oakland operation. Employee #1 had been employed by Ports America for 15 years. He was a member of the International Machinist Association. On the day of the incident, Employee #1's work shift was 7:00 a.m. to 4:00 p.m. On the previous day, Employee #1 worked with a coworker from 7:00 a.m. to 6:00 p.m. On October 24, 2012, the day of the incident, Employee #1 and his coworker were preparing to conduct a pre-operation inspection of a ZPMC crane. Over the course of a few months, Employee #1 and the coworker had been troubleshooting a problem wherein the flange on the wheels of the crane trolley had been wearing on the crane beam rails. Employee #1 and his coworker used Motorola handheld transceivers to communication during operations on top of the trolley. These radios were necessary when maintenance or troubleshooting work was being performed on the top of the trolley and the trolley had to be moved. Workers operating the trolley from the trolley's cab were not able to see other workers on top of the trolley. Employee #1 made the decision to inspect the trolley wheels while the coworker moved the crane. They had agreed that Employee #1 would inspect the left rear wheel. Employee #1, however, unbeknownst to his coworker, decided to inspect the left front trolley wheel. The coworker moved the crane forward at slow speed while Employee #1 was lying on the front left Olio bumper, looking down at the left front wheel. At approximately 9:15 a.m., the coworker heard a "squelch" sound on his two-way radio and stopped the crane. He then found Employee #1 on the Olio bumper. Employee #1's chest had been crushed between the trolley's Olio bumper and the trolley position sensor guard, which was in a fixed location on the crane frame. Emergency personnel were contacted; they responded immediately. Two other coworkers responded first to the incident and attempted CPR. At approximately 9:47 a.m., emergency medical technicians arrived at the scene and took over treatment. At approximately 11:55 a.m., Employee #1 was pronounced dead. The Cal/OSHA Oakland District office received a call from the Oakland Fire Department and a business agent for the Longshoreman's union of the serious injury to Employee #1 on that same day. During the investigation, a substantial amount of time was spent attempting to determine what, if any, recommendations the crane manufacturer, ZPMC, had in regard to servicing and maintaining the crane. Title 8 CCR Section 3328(b) required that "Machinery and equipment in service shall be inspected and maintained as recommended by the manufacturer where such recommendations are available." ZPMC had provided ten different manuals to Ports America. Nine of these ten manuals were technical in nature and provided little narrative text and minimal safety information. These nine manuals included only a line or two of safety information. The other manual, "ZPMC Quayside Container Crane Configuration and Maintenance Manual," was provided to the employer during a training session. This manual included numerous safety recommendations, including specifying the need for a spotter. One section appeared particularly relevant to this accident investigation: Section 2.2.1, "Safety rules for operation," stated: "5) Where inspections or work is being performed when a device is in motion or rotation, sufficient spotters must be present watching each worker and ready to depress an "Emergency Stop". Radios should be used to maintain communications with the operator. When a person stands on the trolley during maintenance, he must wear a s
Keywords: longshoring, maintenance, dock, emergency response, mechanic, caught between, crushed, untrained, crane, poor visibility
Employee # Inspection Age Sex Degree Nature Occupation
1 315319715 Fatality Other Heavy equipment mechanics

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