PHYSICAL FACTORS INVOLVED

The accident occurred at the contractor's rail car repair area located at the Arch Street plant. This area was located at the far end of the main railway, approximately 1800 feet from the load-out facility. Two additional rail lines, a passing track and a short switch track ran parallel to the main line. The passing track provided a by-pass for traffic around the load-out facility. The short track provided a siding where cars could be switched out and parked.

A portable derailer was available in the area, but was not used. There were no other devices to prevent rail cars from entering the car repair area.

The rail car involved in the accident was a 70-ton, bottom-dump, ore car. The coupler and draft gear on one side of the car had been removed. Bolts, which secure the coupler to the car, had been removed and the mounting holes had been enlarged with a torch to accommodate a larger bolt.

The car was situated between a locomotive, and a crane truck. Attached to the opposite end of the locomotive were twenty-eight cars, of which thirteen were loaded. The truck was sandwiched between the car being repaired and a string of five other empty cars.

The locomotive involved was a GM, EDM, SW12 diesel locomotive. It was manufactured in 1965 and was identified as number 403. Safety features included a strobe light and a warning bell. The stobe light was difficult to see in the daytime and the bell was not audible over ambient noise levels. The braking system for the locomotive was inspected and found to have safety defects. However, the defective brake system was not considered a factor contributing to the accident.

Operation of the locomotive was by a Control Chief, model MDR 8450, radio remote control system. The range of the radio control was 1000 feet as rated by the manufacturer. Testing conducted during the investigation determined the range to be beyond the rated distance. The locomotive was being operated at distances up to 1300 feet and out of the operator's sight.

The crane truck was a 1973 Chevrolet C65. It sustained damage to the grill and radiator.

The actual speed the locomotive was travelling when the collision occurred is unknown. Witness accounts suggest it was moving relatively slow, and likened it to walking speed.

DESCRIPTION OF ACCIDENT

On the day of the accident, Trenton Oliver (victim) reported for work at 7:00 a.m., his usual starting time. He worked at various tasks throughout the day.

At about 2:20 p.m., Oliver, Raymond Bradford, a co-worker and Wayne Vaughn, foreman, were all working on the rail car draft gear (shock absorber for the coupler). Oliver was under the car between the wheels and the draft gear housing, preparing to enlarge the holes in the tie strap. Bradford noticed the locomotive approaching and it didn't appear to be stopping. He shouted a warning to Vaughn, who stepped from behind the car to look for himself. Vaughn, realizing that the locomotive was not going to stop, yelled for Oliver to come out from under the car. He then ran to the locomotive to apply the emergency brakes. Unfortunately, by the time he applied the brakes, the locomotive had already collided with the parked car. The chain of vehicles traveled for approximately forty feet before coming to a stop. Oliver was run over by the car he had been working on.

Vaughn ran to the mine office and placed a call to the local 911 emergency number. The Little Rock police responded as did a local ambulance service. Paramedics assessed Oliver's condition,but could do nothing to help him. Oliver was pronounced dead at the scene a short time later.

CONCLUSION

The cause of the accident was failure to install a derailing device or other means of preventing rail traffic from entering the work area and the inability of the remote operator to see the locomotive.

VIOLATIONS

3m Company

Order #7871849 was issued on May 8, 1998, under the provisions of Section 104(d)(2) of the Mine Act for violation of Standard 56.9302:

A fatal accident occurred at this mine on 5-4-98, when a contract car repairman was run over by the rail car he was working on after it was struck by the mining company's locomotive. There were no stop blocks, derail devices or other devices being used to insure that persons were protected against moving or runaway rail equipment. The locomotive was being operated by remote control from several hundred feet away on the same track where the contractor was repairing rail cars. A derail device was laying near the tracks, but was not used. Steve Wright, foreman did not instruct the train operators on how and when to install the derail devices nor did he install one himself. This failure to protect the contract workers by insuring that the locomotive could not enter the car repair area constitutes aggravated conduct with more then ordinary negligence and is an unwarrantable failure to comply with a mandatory safety standard.

This order was terminated on June 10, 1998, after the mine operator began using a derailing device and initiated a written policy accordingly. All future car repairs will be conducted in an area that is isolated from the main flow of traffic.

Order No. 7871850 was issued on May 8, 1998, under the provisions of section 104(d)(2) of the Mine Act for violation of Standard 56.14214 (c):

A fatal accident occurred at this mine on 5-4-98, when a contract car repairman was run over by the rail car he was working on after it was struck by the mining company's locomotive, which was operated by remote control. The locomotive was provided with a bell that rang constantly when the unit's brakes were released and when it was in motion; however, the sound was not audible above the surrounding noise levels. The locomotive was also provided with a manually operated horn, but the horn was not sounded when approaching the area where the accident occurred. The train operator's vision of the rail car repair area and the locomotive was obscured. The failure to provide a warning device that was audible above the surrounding noise level constitutes aggravated conduct with more then ordinary negligence and is an unwarrantable failure to comply with a mandatory safety standard.

This order was terminated on June 10, 1998, after the mine operator repaired the air leaks on the locomotive. The repairs reduced the ambient noise and the bell could be heard above the surrounding noise level.

Order No. 7871851 was issued on May 8, 1998, under the provisions of section 104 (d)(2) of the Mine Act for violation of Standard 56.18002:

A fatal accident occurred at this mine on 5-4-98, when a contract car repairman was run over by the rail car he was working on after it was struck by the mining company's locomotive, which was operated by remote control. Steve Wright, foreman, had been on the property this day but did not conduct or assign a competent person to conduct a daily workplace examination of the track switching area or the contractor's work area where the accident occurred. There were no records indicating that this area had ever been examined even though switching of the rail cars was a daily occurrence. A workplace examination would have found that the derail device was not in place and the need for it to be in place was known by the mine operator. Failure to conduct thorough work place examinations constitutes aggravated conduct with more then ordinary negligence and is an unwarrantable failure to comply with a mandatory safety standard.

This order was terminated on June 10, 1998, after the company produced records that document work place examinations for the track switching area are being conducted.

Wizard Transportation Services

Citation No.7871852 was issued on May 8, 1998, under the provisions of Section 104 (d)(1) of the Mine Act for violation of Standard 56.9302:

A fatal accident occurred at this mine on 5-4-98, when a contract car repairman was run over by the rail car he was working on after it was struck by the mining company's locomotive, which was operated by remote control. There were no stop blocks, derail devices, or other devices being used to insure that persons were protected against moving or runaway rail equipment. The foreman, Wayne Vaughn was present on the day of the accident and did not install or see that the derail device was installed, which would have prevented the accident. Failure of the contractor to protect his employees constitutes aggravated conduct with more then ordinary negligence and is an unwarrantable failure to comply with a mandatory safety standard.

This citation was terminated on June 10, 1998, after the contractor moved the rail car repair area to a safer location. The contracter, who no longer works at this mine, was made aware of the mandatory requirements of this standard.

Order No. 7871853 was issued on May 8, 1998, under the provisions of 104 (d)(2) of the Mine Act for violation of Standard 56.18002:

A fatal accident occurred at this mine on 5-4-98, when a contract rail car repairman was run over by the rail car he was working on after it was struck by the mining company's locomotive, which was operated by remote control. Wayne Vaughn, foreman for the contractor was present at the rail car repair area on the day of the accident. A thorough workplace examination would have found that the derail device was not in place. Installation of the device would have prevented this accident. Failure to conduct work place examinations constitutes aggravated conduct with more than ordinary negligence and is an unwarrantable failure to comply with a mandatory safety standard. requirements of 30 CFR 56.14105.

Related Fatal Alert Bulletin:
FAB98M21