DEPARTMENT OF LABOR
MINE SAFETY AND HEALTH ADMINISTRATION
ACCIDENT INVESTIGATION REPORT
(Underground Coal Mine)
Fatal Powered Haulage Accident
Unicorn Mining, Inc.
I.D. No. 15-17437
Bledsoe, Leslie County, Kentucky
December 17, 1998
Billy A. Parrott
Coal Mine Safety and Health Inspector
Pittsburgh Safety and Health Technology Center
Originating Office-Mine Safety and Health Administration
HC 66 Box 1762, Barbourville, Ky 40906
Joseph W. Pavlovich, District Manager
Date of Release: March 24, 1999
At 11:15 p.m. on Thursday, December 17, 1998, a powered haulage accident occurred in the No. 4 track entry at the fourth crosscut inby the 001-section overcast. Basil D. Hall, a 32-year-old serviceman, with 48 weeks total mining experience, was fatally injured when he fell from a moving open personnel carrier onto the track and was run over.
Hall was riding in the open end of a J. H. Fletcher and Company Diesel Rail Runner personnel carrier, with five other miners when apparently repositioning himself to a more comfortable position, the vehicle encountered a small irregularity in the track. Hall then appeared to become unbalanced by the movement of the machine and fell over the front bumper onto the track into its path. After Hall fell, the machine traveled approximately 14 feet before coming to rest on top of him.
The accident occurred as a result of the mine operator's failure to insure that the removable guards which enclosed the open end of the diesel-powered personnel carrier were in place, thereby operating the machine in an unsafe condition. The total area of space available in the open end of the machine was approximately 40 square feet. This provided approximately 6.7 square feet of seating area for each of the six persons riding in the open end of the vehicle. This resulted in overcrowding which probably contributed to Hall repositioning himself.
GENERAL INFORMATION AND BACKGROUND
The Unicorn Mining, Inc.'s, Copeland Mine, is located at Bledsoe, Leslie County, Kentucky. The mine is developed into the Copeland seam through drift openings. The mine employees 43 miners on 3 shifts, 40 underground, 3 on the surface, and operates 5 days per week with 9 hour shifts. The mine has two working sections and produces an average of 2000 tons of coal per shift. Coal is transported to the surface on conveyor belts. The 001-0 section produces coal on the third shift, is idled on the second shift and performs maintenance on the first shift. The 002-0 section produces coal on both the first and second shifts and performs maintenance on the third shift. The mine is ventilated by an 84 inch Jeffrey Aerodyne Fan, powered by a 500 horsepower electric motor. The fan produces 250,000 cubic feet of air per minute and the mine liberates approximately 66,000 cubic feet of methane per 24 hours.
The Copeland Mine was placed in producing status on September 21, 1993. Coal reserves mined are owned by Hensley Heirs, Cyprus Southern Realty, Southern Realty, and Corum-Turner. The surface is owned by Straight Creek Coal Resources and Cyprus Southern Realty.
The mine roof is supported with 42 inch minimum length fully grouted resin bolts. Entries are advanced on 60 to 90 foot centers and crosscuts are mined on 55 to 90 foot centers. A miner's representative was not designated at this mine.
The last regular (AAA) Mine Safety and Health Administration (MSHA) inspection was completed December 2, 1998.
The principal officers of the operation are:
|Eddie Spurlock||Mine Foreman|
|Lonis Mitchell||Safety Director|
DESCRIPTION OF ACCIDENT
On Thursday, December 17, 1998, at approximately 10:30 p.m., the third shift crews entered the mine to begin their normal work duties. At the location of the 001-0 section overcast the 001-0 section production crew exited the personnel carrier. The 002-0 section maintenance crew, under the supervision of Jimmy Morgan, section foreman, and the belt maintenance crew, under the supervision of Ronnie Skeens, belt foreman, switched from the battery powered personnel carrier that had transported them from the surface to a Fletcher Diesel-Powered Rail Runner personnel carrier to continue their journey to the working section. Hall, the victim, positioned himself in the left front corner of the inby open end of the machine along with five other miners. Morgan was operating the personnel carrier. Three other miners were riding in the enclosed outby end, with a total of ten miners being transported on the personnel carrier.
The personnel carrier continued in the direction of the 002-0 section. Based upon statements obtained during the investigation of the accident, the machine had traveled approximately four crosscuts when Hall attempted to reposition himself. At approximately 11:15 p.m., as Hall was moving, the machine encountered an irregularity in the rails. This irregularity was a small, but noticeable, angular bend that was present in the track at the location of the rail joints. Hall apparently lost his balance and fell forward from the open end of the machine. Morgan stated that he saw Hall falling and applied the brakes to stop. As Hall fell, he grabbed the jacket of Freeman Crosby, section repairman, who was seated in the front of the vehicle, adjacent to him on his right. At this point, Skeens unsuccessfully attempted to grab Hall. The machine traveled approximately 23 feet as Hall was in the process of falling and approximately 14 feet after he contacted the track, running over him. Hall was caught under the machine when it came to a stop.
All the miners exited the personnel carrier after it came to a stop. After visually observing the extent of Hall's injuries, it was apparent that there was no need to check for vital signs or administer medical assistance. Immediately, the crews began recovery operations utilizing a jack under the front bumper in an attempt to raise the vehicle from Hall. It was determined that a scoop that was located at the end of the track, approximately ten crosscuts away would be needed. Leman Asher, roof bolting machine operator, was dispatched to bring it to the accident location. After the scoop arrived, it was used to raise the machine, and Hall was removed from beneath the vehicle. Hall was placed on a stretcher, moved into the open end of the machine and transported to the surface.
On the surface, Hall was pronounced dead by Leslie County Coroner Greg Walker at 2:00 a.m. on December 18, 1998. He was then transported to Walker Funeral Home in Hyden, Ky.
INVESTIGATION OF ACCIDENT
At approximately 1:05 a.m., on December 18, 1998, D.F. Parks, MSHA Coal Mine Safety & Health (CMS&H) Inspector in Barbourville, Ky, were notified by Lonis Mitchell safety director that an accident had occurred. Parks immediately notified John Pyles Assistant District Manager for Enforcement. Pyles dispatched Billy Parrott accident investigator and John Arrington Supervisory CMS&H Inspector to investigate the accident. The team arrived at the mine at approximately 3:00 a.m. at which time the investigation started. Pyles also traveled to the mine and later dispatched Don McDaniel, accident investigator, to the mine that morning. A 103(K) Order was issued by Parrott at 3:00 a.m. on December 18, 1998 to ensure the safety of the miners until an investigation could be conducted. MSHA and the Kentucky Department of Mines and Minerals conducted a joint investigation with the assistance of mine management and miners. Stan Michalek, MSHA Pittsburgh Technical Support, provided technical assistance in the investigation and Tom Grooms, Office of the Regional Solicitor, Nashville, Tennessee, provided legal assistance in the investigation.
PHYSICAL FACTORS INVOLVED
The investigation revealed the following factors relevant to the occurrence:
- Transportation to the working section from the 001 section overcast was accomplished using a diesel-powered rail runner personnel carrier. The machine was a J.H. Fletcher and Company Diesel Rail Runner, Model RR, serial number 94500. This particular machine was manufactured on June 18, 1994. Inspection of the machine's brakes, sanders, lights and mechanical components following the accident revealed they were in satisfactory condition.
- The subject diesel-powered personnel carrier consisted of an enclosed personnel compartment
on one end with a permanent cover and an open platform on the other end. The operator's
compartment was located on the left side of the machine between the two compartments. The
vehicle was positioned on the track such that the open end faced inby and the enclosed end faced
outby relative to the operator's compartment. The distance from the front wheel on the rail
runner to the extreme front of the machine was approximately 7 feet.
- The open end of the subject machine was routinely used to transport materials and personnel
into the mine. The shape of the open area was formed by two adjoining geometric shapes. The
first, located closest to the operator's compartment, was rectangular in shape and measured
approximately 7 feet wide and 3.5 feet long. The second shape, in front of the rectangular area,
was trapezoidal. The base of the trapezoid, which was common with one side of the rectangle,
was approximately 7 feet wide. The top of the trapezoid, which was the extreme front end of the
vehicle, was approximately 5.5 feet wide. The height of the trapezoid was approximately 2.5 feet. The total area of the front compartment was approximately 40 square feet. The open area was bordered by a raised edge, approximately 4 inches in height. The front of the area included the machine's bumper, approximately 8 inches in height.
- Safety guard rails were originally included with the subject machine to enclose the open area on the front and on both sides. These guards were constructed of 2 by 2 inch square tubular steel welded together to form a safety railing with two horizontal rails. The safety guard rails were held in position by inserting the component vertical members into slots on the machine's frame. The distance from the floor of the open area to the location of the lower and upper rails was approximately 11 and 21.5 inches, respectively. These safety guard rails were not installed on the vehicle at the time of the accident.
- The track specifications were 60 pounds-per-yard with a design gage of 42 inches. The actual
gage, measured at various locations along the track, was found to vary from about 41 to 43
inches. Track construction at the mine consisted of preparing the base, laying metal crossties
perpendicularly with approximately 4 feet of spacing, and attaching the rails to the crossties using metal fasteners built into the ties. Ballast is added in soft areas. Ballast may consist of crushed stone or mine waste rock. Sections of track were joined with four bolt plates on the inside and outside of each rail. Observations during the investigation indicated that the track joints were generally in good condition. It was reported that the track was dry at the time of the accident.
- The accident occurred in the 002-0 Section track entry. Along this entry the rail line dips under the 001 Section return overcast and must travel uphill for a short distance. Joints in the right and left rails were approximately 49 feet from the inby edge of the overcast. The joints were offset by approximately 32 inches. The ground at the location of the joints appeared to be level and dry. The entry at this location was approximately 6 feet high and 20 feet wide.
- A small, but noticeable, irregularity (angular bend) was present in the track at the location of the rail joints. The extreme front of the vehicle extended approximately 7 feet beyond the front wheels.
- Six persons were riding on the front end of the subject machine, and three were riding in the enclosed rear compartment. The personnel carrier operator was positioned at the controls. Prior to the accident, the victim was positioned in the front left corner facing inby. The operator of the machine estimated the vehicle was traveling at approximately 4 to 5 miles-per-hour when the accident occurred. Based upon observations and statements of witnesses it was determined that the vehicle traveled approximately 14 feet after the victim fell. This was supported by evidence of disturbed ground along the tracks. The machine came to rest approximately 37 feet past the irregularity in the track.
Examination of records indicated that all required training had been conducted in accordance with Part 48, Title 30 CFR. Hall had completed his Initial 40-hour New Miner training on April 1, 1998, and his Newly Employed, Inexperienced Miner training April 2, 1998. Hall also received New Task training for a brattice person on April 6, 1998, and for a belt person on April 7, 1998. Removable safety guards, installed by the manufacturer, which are required when miners are being transported in the open end of the personnel carrier, had been removed prior to the accident. However, it could not be determined when or by whom these guards had been removed. These safety guards, consisted of a railing and post system designed to provide protection for persons riding in the front open end compartment. They were to be removed only when needed to facilitate the transportation of materials in that end of the vehicle.
Based upon statements obtained during interviews, it appeared that Hall was in the process of repositioning himself when the irregularity in the track was encountered. The lateral movement of the machine caused by the irregularity in the track, apparently resulted in Hall becoming unbalanced. When Morgan observed Hall falling from the machine, he instinctively applied the brakes to stop the vehicle. This sudden decrease in the speed of the vehicle further increased Hall's unbalanced state. Additionally, because of the distance between the front wheels and the front of the vehicle, any movement experienced by the front wheels, when they encountered the irregularity in the track, would be magnified at the front of the vehicle.
SUMMARY AND CONCLUSION
The following factors contributed to the accident:
The J. H. Fletcher & Co. Diesel Rail Runner personnel carrier had been equipped with removable safety guard rails that are required when persons are being transported in the open end. These had been removed and had not been reinstalled prior to the machine's use as a personnel carrier. The guards, which consisted of a railing and post system, were designed to provide protection for persons riding in the front open end compartment and were to be removed only when needed to facilitate the transportation of materials in that end of the vehicle.
The accident occurred as a result of the mine operator's failure to insure that the removable safety guards which enclosed the open end of the personnel carrier were in place, thereby operating the machine in an unsafe condition. The total area of space available in the open end of the machine was approximately 40 square feet. This provided approximately 6.7 square feet of seating area for each of the six persons riding in the open end of the vehicle. This may have resulted in overcrowding which may have also contributed to Hall repositioning himself.
- 103-K Order, No. 7450258, was issued to assure the safety of any person in the coal mine
until the investigation could be completed.
- 104-D-1 Citation, No. 7450261, for violation of Title 30, Part 75.1725(a) was issued
stating in part that the J.H. Fletcher and Company Diesel-powered personnel carrier was
not maintained in safe operating condition while miners were riding in the open end with
the factory guards removed.
- 314-B Notice to Provide Safeguards, No. 7450262 regarding Title 30, Part 75.1403-7(b)
was issued stating in part that a sufficient number of personnel carriers shall be available to prevent overcrowding of men.
- 314-B Notice to Provide Safeguards, No. 7450263 regarding Title 30, Part 75-1403- 6(b)(4) was issued stating in part that open type personnel carriers be equipped with guards of sufficient strength to prevent personnel from being thrown from such carriers.
Billy A. Parrott
Coal Mine Safety and Health Inspector
Pittsburgh Technical Support
John M. Pyles
Assistant District Manager for Enforcement
CMS&H, District 7
Joseph W. Pavlovich
CMS&H, District 7
Related Fatal Alert Bulletin: