DEPARTMENT OF LABOR
MINE SAFETY AND HEALTH ADMINISTRATION
COAL MINE SAFETY AND HEALTH
REPORT OF INVESTIGATION
Underground Coal Mine
Fatal Powered Haulage Accident
November 20, 2001
McElroy Mine
McElroy Coal Co.
Glen Easton, Marshall County, West Virginia
I.D. No. 46-01437
Accident Investigators
Ronald L. Sidwell
Coal Mine Safety and Health Inspector (Electrical)
Chris A. Weaver
Mining Engineer
Originating Office
Mine Safety and Health Administration
District 3
5012 Mountaineer Mall
Morgantown, West Virginia 26501
Timothy J. Thompson, District Manager
Release Date: February 11, 2002
OVERVIEW
On Tuesday, November 20, 2001, a track crew, consisting of one foreman and six other miners, were installing rails in the 2 Right 5 South Section. Shortly before noon, the foreman asked two of the crewmembers to help him switch out a supply car that was parked near the end of the track. Although they discussed their intentions in close proximity to the other miners, the remaining four crewmembers did not realize that the equipment was going to be moved and continued installing rails. Two of the miners were installing rail fishplates approximately seven feet inby a supply car loaded with rails that was coupled to a battery-powered locomotive (Figure 1).
The locomotive operator did not give an audible warning before attempting to move the trip in an outby direction. When he released the locomotive brake, the trip drifted inby toward the other miners. He then attempted to engage the motors in an outby direction. However, the trip continued inby, striking the two miners who were installing fishplates. The locomotive operator then reapplied the air brake and stopped the trip after it had traveled approximately 20 feet.
One of the miners was struck by, and then caught beneath, the rails that extended beyond the end of the supply car and was fatally injured. The second miner received injuries to the head and neck before he was able to roll out of the path of the rail car. The surviving victim was flown to a hospital in Pittsburgh, Pennsylvania, where he was treated and released the following day.
The accident occurred because an audible alarm was not sounded or another method was not utilized to ensure that all persons were in the clear and out of danger before starting or moving the equipment.
GENERAL INFORMATION
The McElroy Mine, I.D. No. 46-01437, is located near Glen Easton, in Marshall County, West Virginia. McElroy Coal Co., a subsidiary of Consol Energy, operates the underground coal mine, which employs 514 persons, including 454 underground employees. The mine produces approximately 6.5 million tons of coal annually, developing entries with four continuous mining machine units and retreat mining with a single longwall unit.
The mine accesses the Pittsburgh No. 8 coal seam by two slopes and eight shafts. Workers enter the mine by elevators at two portals: the Fish Creek Portal, located near the supply slope, and the Blake's Ridge Portal, located near the active sections. Coal is transported from the working sections to the surface via conveyor belts. Both battery-powered and trolley-powered rail-mounted vehicles are used to transport supplies and mine personnel. Only battery-powered vehicles are used in three-entry development sections where the track entry is the designated primary escapeway. Ventilation is provided by seven main mine fans that exhaust a total of 1,465,985 cubic feet of air per minute (cfm). The mine liberates approximately eight million cubic feet of methane every 24 hours.
At the time of the accident the longwall unit was about to be moved from the 1 Right 5 South panel that had been completed November 15, 2001. The headgate for the next panel would be located in the 2 Right 5 South entries (Figure 2), which were completed on November 19, 2001. These entries were developed from both directions. The inby portions of the 2 Right 5 South entries, including the longwall setup entries, were mined off the 1 Right 5 South Headgate development section earlier in the year, while the outby portion was mined directly off of the 5 South Submain from the opposite direction. The inby segment of the 2 Right 5 South entries became inaccessible to track-mounted equipment after the startup of the 1 Right 5 South longwall section in May 2001, because the section track system was removed from the active headgate entries as the longwall face was retreated. After the entries were connected, a span of approximately 800 feet remained between the two ends of the 2 Right 5 South track. Mine workers were in the process of connecting the track in this area when the accident occurred.
The principal officials for the McElroy Mine were:
D. R. Baker, PresidentThe last MSHA regular Health and Safety Inspection (AAA) was completed on September 30, 2001, and another was ongoing at the time of the accident. The Nonfatal Days Lost (NFDL) incidence rate during the previous quarter was 3.28 for the McElroy Mine as compared with a national rate of 7.01 for all underground coal mines.
J. N. Magro, Vice President - Operations
David Draskovich, Superintendent
Michael Sinozich, Safety Supervisor
DESCRIPTION OF THE ACCIDENT
At the start of Day Shift on Tuesday, November 20, 2001, Stanley Cwalinski, Section Foreman, was assigned to supervise the installation of the track system through the area where the two segments of the 2 Right 5 South entries were mined together. Miners assigned to the track crew were Richard Pauley and Dennis Studenc, Trackmen, and Frank Ondusko and John Mark Moore, General Laborers (both of whom recently transferred from another mine). The crew entered the mine at the Blake's Ridge Portal and traveled, via a rail-mounted personnel carrier, to their work site at the end of the 2 Right 5 South track. They arrived at the work site at approximately 8:45 a.m., where a previous work crew had parked a battery-powered locomotive with a supply car coupled to its inby end. The supply car was loaded with 29 rails, which extended up to seven feet beyond the inby end of the car, and a limited amount of other track installation materials. Several sets of loose rails had also been placed on the mine floor ahead of the existing track system. Since additional ties were needed to install the rails, Pauley trammed the locomotive and supply car to a track spur located just outby the work site where he and Studenc loaded additional ties on the supply car. They then returned to the work site with these materials and began installing the rails. Pauley and Studenc started clipping ties to the rails after showing Ondusko and Moore how to join the rails with the fishplates. They continued performing these tasks throughout the morning, pausing occasionally to move the locomotive and supply car toward the end of the track as the rails were installed.
Another crew under the supervision of Randy McKelvey, Foreman, was assigned to prepare the 2 Right 5 South longwall setup area for the upcoming equipment move. McKelvey's crew consisted of: Tim McMillan, Roof Bolter; Jack Rector, Rock Duster; Gregory Smith, General Laborer; and John White, Shuttle Car Operator. Since this area was still not accessible by track, they entered their work site from the Main East entries by walking through the bleeder entries. However, when they arrived at their work site, the batteries on the scoop car were discharged. McMillan, Rector, Smith, and White were then reassigned to help Cwalinski's crew install track. They walked approximately 3,000 feet in the 2 Right 5 South entries to the track installation site, arriving between 9:30 a.m. and 10:00 a.m. Cwalinski assigned White to use a scoop car to clean and prepare the mine floor inby the work site where additional rails would be placed. Rector operated the locomotive and moved the supply car inby as the track system was advanced. McMillan and Smith assisted the other crewmembers in placing rails and clipping ties.
Later that morning, Dennis Reynolds, Mine Foreman, visited the work site and noted that no one was bonding the track inby the area where the 2 Right 5 South entries were mined together. McMillan and Rector were reassigned to do this and, after loading bonds into the scoop car being operated by White, the three men traveled inby to begin bonding. Reynolds had also informed Cwalinski that a new track supply car was being delivered to the 2 Right 5 South work site. Cwalinski intended to switch out the old supply car for the new one, so that materials could be unloaded directly off the car at the end of the track. In order to accomplish this, two personnel carriers also needed to be moved outby.
Shortly before noon, Pauley pushed the old supply car toward the end of the track to unload the remaining ties before it was removed from the work site. Pauley and Cwalinski then unloaded the ties from the tight side (left side while facing inby) of the supply car. During this time Pauley informed Cwalinski that he needed to leave for a doctor's appointment. To facilitate switching out the supply cars, Cwalinski asked Pauley to take one of the personnel carriers and park it in a spur near the mine phone, and then call for a ride out of the mine from that point. Cwalinski then informed the crew that he intended to switch out the supply car and told them they could take lunch after the next rail was installed. At this time Smith and Studenc were clipping ties while Moore and Ondusko continued installing fishplates. By now, White had completed his assigned tasks, had parked the scoop car, and was walking outby toward the other crewmembers. As Pauley left to get his lunch bucket, Cwalinski met White near the end of the track and informed him that they needed to take all of the mobile track equipment to a spur so that the supply car could be switched out. Cwalinski then asked White to move the locomotive and supply car while Cwalinski and Pauley moved the two personnel carriers. Cwalinski and White then walked outby toward the vehicles, past Moore and Ondusko, who were installing the fishplates on the last rail on the clearance side of the track.
At approximately 11:55 a.m., as Pauley and Cwalinski began driving outby in the two personnel carriers, White prepared to move the locomotive. Moore and Ondusko were in a kneeling position, facing inby, as they tightened nuts on the fishplate bolts. Moore was between the rails and Ondusko was on the clearance side of the track next to Moore (Figure 1). Both men were approximately seven feet from the end of the rails that extended beyond the inby end of the supply car. Smith and Studenc were installing ties approximately 20 feet inby Moore and Ondusko. When White released the air brake on the locomotive, the trip began drifting inby toward Moore and Ondusko. White reacted by trying to engage the motor in an outby direction but the trip continued inby. Unaware that the trip was being moved, Moore and Ondusko were hit from behind by the rails that extended beyond the supply car. Ondusko was struck on the back of his head and neck and was knocked to the mine floor on the clearance side of the track. He immediately rolled toward the rib, out of the path of the approaching supply car. Moore was struck in a similar manner but was caught and pinned beneath the rails that extended beyond the supply car. Smith and Studenc heard yelling and looked outby. Smith, who was standing in the path of the approaching supply car, dropped his hammer and ran inby toward the nearest crosscut. Unable to reverse the locomotive, White reapplied the air brakes and stopped the trip just before the wheels of the supply car contacted Moore.
When the locomotive stopped, White saw persons flagging and heard yelling, so he exited the locomotive to see what had happened. Studenc ran past White and boarded the locomotive while Smith checked on Ondusko. Ondusko told Smith that he would be okay but that Moore was under the rail car. Studenc then moved the trip in an outby direction, revealing Moore who was lying unconscious between the installed track rails. Smith checked Moore for a pulse but found none. He then asked if anyone knew CPR before traveling outby to find help. Curt Mason, Electrical Foreman and EMT, was located approximately five crosscuts inby the accident site when he heard the miners yelling for help. Mason then ran to the accident site where he determined that Moore was not breathing and that he had no pulse. Meanwhile, Cwalinski and Pauley noticed "flagging" lights and returned to the accident site. Cwalinski then attempted to administer CPR to Moore, but failed to establish airflow to the victim's lungs. Mason then relieved Cwalinski, however vital signs remained absent. Pauley and Studenc traveled outby toward the section power center where they met Smith and Marc Cervo, Section Foreman, who had been working with another crew rerouting electrical cable at the time of the accident. Cervo, Smith, and Pauley gathered first aid supplies and transported them to the accident site while Studenc went to the mine phone and called the dispatcher. Cervo then traveled inby to the longwall setup entries to inform Reynolds and McKelvey of the accident.
Steve Buckhorn, Belt Coordinator and EMT, was working near Crosscut 37 in the 2 Right 5 South entries when he heard the radio transmission of someone calling for a paramedic. David Draskovich, Superintendent, who was nearby, asked Buckhorn to travel with him to the accident site, where they arrived approximately eight minutes later. Buckhorn then assisted Mason by checking Moore for vital signs and none were found. Buckhorn then assisted in treating and transporting Ondusko, who reached the surface at 12:30 p.m. Ondusko was flown to Allegheny General Hospital in Pittsburgh, Pennsylvania, where he was treated and released the following day. Moore was brought out of the mine and transported by ambulance to Reynolds Memorial Hospital in Glen Dale, West Virginia, where he was pronounced dead at 2:45 p.m. The cause of death was listed as blunt force, head and neck injury.
INVESTIGATION OF THE ACCIDENT
The investigation was conducted by MSHA in conjunction with the West Virginia Office of Miners' Health, Safety and Training (WVOMHS&T). The investigators were accompanied by representatives of McElroy Coal Company and the United Mine Workers of America. A list of those persons who participated in the investigation is contained in the Appendices of this report.
MSHA was notified of the accident at 12:05 p.m. on November 20, 2001, and a 103(k) Order was then issued. The underground investigation at the accident site was initiated during the afternoon of November 20, 2001, and was completed the following day. The investigation team captured video and still images to document conditions observed at the accident site. The affected area was also surveyed to determine the grade in the track entry and to accurately locate equipment and materials. Functional tests were performed on the locomotive, including tests to determine how the trip would react under conditions similar to those that existed at the time of the accident. Examination and training records were also reviewed. MSHA and WVOMHS&T conducted interviews of persons having knowledge of conditions and events relevant to the accident. Interviews were conducted at Blake's Ridge Portal on November 21 and December 3, 2001.
DISCUSSION
Physical Factors at the Accident Site
Rail elevations were surveyed in the track entry where the accident occurred. The survey was conducted with the locomotive and supply car located near their positions prior to the accident. Elevations of both the right and left rails from the end of the rails to 128 feet outby the accident site were determined. The survey confirmed that the track dipped in an inby direction (Figure 3). The average grade over the length of the trip prior to the accident was 0.58%. The average grade over the length of the trip at its most inby location during the accident decreased to 0.21%.
At the time of the accident the combined weight of the supply car and the loaded rails was approximately 14 tons. This load was well within the safe operating parameters for the locomotive on the existing grades. A typical section supply trip at this mine consists of three cars weighing a total of 33 tons.
Witness statements indicated that Moore and Ondusko were kneeling approximately seven feet inby the rails that extended beyond the supply car. Observations from the operator's compartment showed that the rails on the supply car would have significantly obstructed the locomotive operator's view of the miners kneeling inby. It is likely that only the top and back of their hard hats would have been visible to the locomotive operator. Based on witness statements, it is also likely that their cap lights were shining on the mine floor, away from the locomotive operator.
The distance the trip traveled during the accident was estimated relative to the victim's initial and final locations. The loaded rails extended seven feet beyond the inby end of the supply car. This placed the end of the supply car approximately 14 feet away from Moore prior to the accident. Ondusko indicated that Moore was located just inby the supply car wheels when the trip stopped. Measurements also showed that his final position was at least six feet inby his initial position. Therefore, the trip traveled approximately 20 feet during the accident.
Equipment Motion Tests
Tests were conducted to re-create the movement of the equipment during the accident. Each test was conducted with Locomotive #101 coupled to the outby side of the supply car, which was still loaded with the same rails and other materials as at the time of the accident. The trip was then positioned so that the inby end of the rails extending beyond the end of the supply car was seven feet from where the victims were installing fishplates at the time of the accident. A reference point was marked to ensure that each test was initiated from the same location.
� The first test was intended to determine the direction and distance the trip could have drifted after the brakes were released. The mechanical brake was released with the air brake set. No motion resulted. With the directional controller set in an outby travel position, the air brake was released and the trip drifted inby for a distance of five feet before coasting to a stop (brakes were not used to stop the trip during this test). The test was repeated four times with the trip traveling in an inby direction for 19.3, 6.7, 15.5, and 10.5 feet, respectively, after the air brake was released.
� A series of tests were then performed to determine how the locomotive would react when the driving axle was engaged in an outby direction while the trip was drifting in an inby direction. With the directional controller set in the outby travel position and in high tram (motors connected in parallel), the air brake was released, allowing the locomotive and flat car to roll in an inby direction. After the locomotive rolled approximately two feet (the point where the trip reached maximum velocity, as estimated during the previous tests), the operator engaged the speed controller at its highest point. This caused the motor contacts to drop out and the locomotive velocity decreased as it continued to drift inby. This test was repeated again with the same results. A variation of this test was then performed, with all factors remaining constant, except that the directional controller was placed in the low tram position (motors connected in series) for outby movement. The air brake was again released and the locomotive and flat car began rolling inby. When the speed controller was opened to the highest point, the trip immediately began to tram outby with little or no spin of the locomotive wheels. This test was repeated twice with the same results.
The results of these tests were used to analyze possible controller positions during the accident. White stated that he positioned the directional controller for moving the locomotive outby prior to releasing the air brake. This could not be confirmed since Studenc could not recall the position of the directional controller when he boarded the locomotive immediately after the accident. The test results did confirm that the trip would have drifted inby once the air brake was released. Assuming that inby motion had been initiated, the following reactions were considered:
� Motors engaged with the directional controller in the outby low tram position - In this case the test results showed that the trip would have reversed its direction of movement as soon as the motors were engaged. Therefore, this controller configuration was unlikely.
� Motors engaged with the directional controller in the high tram outby position - In this case test results showed that the motor contacts would have dropped out and the trip would have continued to slowly drift inby. The tests marginally showed that the trip could have traveled approximately 20 feet inby after the air brake was released. Thus, this control configuration was possible at the time of the accident. However, White's statement that the locomotive wheels spun as the trip continued inby was inconsistent with the test results and the condition of the rails at the accident scene.
� Motors engaged with the directional controller in the inby position - In this case the trip would have accelerated toward the victims and could have resulted in the inby movement that occurred during the accident. However, it would imply that the directional controller was positioned for the wrong direction of travel. In his interview statements, White gave no indication that this might have occurred. Although the directional controller was functioning properly, the position required for the intended direction of travel was opposite to that of the actual direction of travel. To move the locomotive outby, the directional lever had to be positioned so that it pointed in an inby direction. An arrow was painted on the controller to indicate the actual direction of movement with the controller pointed in the outby direction (Figure 4). A survey of other locomotives of similar make and model in use at this mine indicated that the directional controllers were unique on each piece of equipment. Concerns were raised during the investigation that these inconsistencies (where the required controller settings were opposite to the direction of intended movement) could cause operational errors. After the accident the mine operator modified the controller installations to eliminate these inconsistencies. It is further noted that White stated he had checked the breaker and switched the directional controller to the outby position prior to moving the equipment. This would imply that he looked at the labeled controller. Although this task was not part of his normally assigned duties, White had operated Locomotive #101 on various occasions prior to the accident.
Condition of the Mobile Haulage Equipment
Equipment involved in the accident was inspected during the investigation and functional tests were conducted within the affected area to determine its operating condition. Examination of the 15-ton battery/trolley-powered Locomotive #101 (Serial No. 438103), manufactured by Goodman Equipment Corporation, revealed the following facts:
� The sanding devices on the outby end of the locomotive would not work properly and the sandboxes on the inby end were empty. These devices were intended to provide additional traction when attempting to either accelerate or decelerate mobile equipment on slick rails. An interview statement indicated that the locomotive wheels spun as attempts were made to reverse the direction of locomotive travel during the accident. During the investigation, the rails were specifically examined for marks made by spinning or skidding wheels. There was no indication that sand was deposited on the newly installed rails. The contact surfaces of the newly installed rails were dry and slightly rusted and should have provided excellent traction for the locomotive. Buff marks would have been expected on the relatively dull surfaces of these rails if spinning had occurred, but none were found at the accident site. Also, little or no spinning occurred during tests in which the drive wheels were engaged in the outby direction while the trip was drifting in an inby direction. The braking performance of the locomotive was also evaluated to determine if the sanding devices would have been needed to stop the trip. Persons who operated the locomotive prior to and during the accident stated that the brakes functioned properly when applied. Tests conducted during the investigation also showed that, even without the sanding devices, the trip stopped immediately when the brakes were applied within the affected area. Thus, the condition of the sanding devices did not contribute to the cause of the accident.
� Several components of the locomotive's electrical system were not maintained in proper operating condition. All of the battery cells examined had water levels below the top of the battery plates. The DC voltmeter was broken and not operating properly. One of the ampere meters was not operating properly in that it indicated 320 amperes continuously. Despite these findings, operational tests showed that these deficiencies did not noticeably affect the locomotive's tramming or braking capabilities within the affected area. Therefore, the condition of the batteries and ammeter did not did not contribute to the cause of the accident
� The air-powered horn on the locomotive was not well maintained. Following the accident the locomotive's compressed air system was charged to its operating pressure (approximately 90 psig) and the air horn was actuated. When sounded, the horn emitted only a faint whistle. This horn was the only device on the locomotive specifically installed for giving an audible warning to persons that might be endangered by movement of the equipment. However, interview statements indicated that no attempt was made to sound the horn for this purpose on the shift during which the accident occurred. Prior to the accident the intended movement of the locomotive was communicated verbally, by flagging, and/or by rattling the locomotive control switch. An audible warning, verbally or otherwise, was not given immediately prior to moving the locomotive at the time of the accident. Interview statements by persons who operated the locomotive prior to the accident indicated that they were unaware of the horn's operating condition, and that they had no intent to use the horn in this situation. Thus, it appears that the condition of the horn had no bearing on the locomotive operators' method of warning persons who may have been endangered by the movement of the equipment.
� All other locomotive systems and devices inspected and/or tested during the investigation functioned properly. The battery charge gage and the control power switch were functioning properly. The light switch functioned correctly and the lights were working in both directions. The main circuit breaker was correct and operating properly. The tramming controls were also operating correctly. The directional controller lever was marked and actuated motion of the locomotive in the direction indicated. The manual brake, air brake, and dynamic brake were all working properly.
Work Procedures While Moving Mobile Equipment
A consensus of the crewmembers indicated that the locomotive and supply car were moved inby several times before the accident as the rails were advanced. In each instance (other than at the time of the accident), verbal warnings were given before moving the equipment, but Ondusko could remember the locomotive being moved inby only once. Thus, Ondusko and Moore may not have been aware in some instances that the equipment was moved. Two persons stated that, prior to the accident, they saw the locomotive and supply car being moved toward Moore and Ondusko while they continued working on the fishplates, to within approximately seven feet of their location. Cwalinski directed this practice on at least one occasion. During the investigation Ondusko could not recall this event. One witness to this event indicated that Moore and Ondusko did not react as the equipment was moved up behind them. The witness also commented that "�the track crew was extremely busy. They had their mind on the job and on what they were doing." While performing this job Moore and Ondusko were often facing inby to coordinate their work with that of other crewmembers. In doing so, they kept their backs to the locomotive and supply car as they worked. Accordingly, this increased the need for effective audible warnings before moving the equipment. A physical barrier, such as a stop-block or a derail, was not used to protect these miners from inadvertent and unexpected movement of the equipment.
Prior to moving the trip (immediately before the accident), the locomotive operator did not sound an audible warning device or directly communicate his intentions to Moore and Ondusko. Neither victim was directly involved in the conversation between Cwalinski and White when orders were given to move the equipment. Ondusko stated he did not know that the locomotive and supply car were being moved when the accident occurred. He first realized that the equipment was moving when the rails extending from the supply car hit him from behind. Other witnesses confirmed that an audible warning was not sounded immediately prior to moving the equipment. A total of four miners (Moore, Ondusko, Smith, and Studenc) were working in the potential path of the equipment at the time. The locomotive operator did make a visual check to see if anyone was located on the track before moving the equipment, but his view of Moore and Ondusko from the operator's compartment was obstructed by the rails on the supply car. Hence, without some additional precaution, such as direct audible and/or visual contact with all of these miners, he could not positively determine that all persons were in the clear before he moved the locomotive.
Training Issues
The mine operator's records showed that White was task trained to operate locomotives on August 6, 1995. Interview statements indicated that he has operated locomotives intermittently on an annual basis since that time. Other records showed that he received instruction as recently as June 18, 2001, during a safety meeting, on the need to determine that all persons are in the clear before moving equipment. Similar precautions are outlined in the mine operator's safety program.
While en route to the work site Moore and Ondusko informed Pauley and Studenc that they had no previous experience as trackmen. They did not relay this information to Cwalinski. Neither Cwalinski nor Mike Conjeski (the Shift Foreman who assigned the work crew) was aware that Moore and Ondusko needed task training prior to the accident. However, at the start of the shift, Jim Siburt, Assistant Mine Foreman, had informed Pauley and Studenc that they would be working with individuals that needed task trained for trackmen. He also informed Cwalinski that the experienced trackmen would be showing Moore and Ondusko how to perform their assigned tasks, however, no checklists or written instructions were provided to insure that the training would meet the minimum requirements for miners assigned to a task they had never performed. As a result Moore and Ondusko did not receive training on safe work procedures of the assigned task prior to performing such task, as required by the operator's approved training plan. This training should have included instruction on hazards incident to movement of mobile equipment. But for such training to be of benefit to the miners, they must know that equipment is being moved. Since an audible warning was not sounded or other methods utilized to ensure all persons were clear prior to moving the equipment, their lack of training did not conclusively contribute to the accident.
CONCLUSION
The accident occurred because an audible alarm was not sounded or another method was not utilized to ensure that all persons were in the clear and out of danger before starting or moving the equipment. The locomotive and supply car began moving in the direction opposite to that intended after the brakes were released on a slight grade that dipped inby toward several miners who were installing track. The trip continued to move toward the miners after the locomotive motors were engaged: either, in high tram against the direction of movement, which would have resulted in the contacts disconnecting; or, in the direction of movement, which would have accelerated the trip toward the victims.
ENFORCEMENT ACTIONS
1. A 103(k) Order was issued to ensure the safety of all persons in the mine during the investigation until the affected area and equipment were returned to normal.
2. A safeguard notice was issued pursuant to 30 CFR 75.1403. This standard states that: Other safeguards adequate, in the judgment of an authorized representative of the Secretary, to minimize hazards with respect to transportation of men and materials shall be provided. The criteria for haulage safeguards in 30 CFR 1403-10(f) states that: An audible warning should be given by the operator of all self-propelled equipment including off-track equipment, where persons may be endangered by the movement of the equipment.
The safeguard notice reads as follows:
On November 20, 2001, a fatal accident occurred in the 2 Right 5 South track entry. The accident occurred while two miners were installing fishplates approximately seven feet inby a supply car loaded with rails, which was coupled to a battery-powered locomotive. When a third miner attempted to move the locomotive and supply car in an outby direction, the trip unintentionally moved inby, striking and injuring the two miners installing the fishplates. The investigation revealed that the accident occurred because an audible alarm was not sounded or another method was not utilized to ensure that all persons were in the clear and out of danger before starting or moving the equipment. The practice of moving off-track, self-propelled equipment without first sounding an audible warning and ensuring persons are in the clear presents an even greater hazard due to the greater range of motion that is characteristic of off-track equipment.
This is a notice to provide safeguards requiring the operators of all self-propelled haulage equipment to ensure that persons are in the clear before moving such equipment and to sound an audible warning device whenever persons may be endangered by the movement of the equipment. The audible alarm must be distinguishable from surrounding noise and be loud enough to be heard by all persons potentially endangered.
FAB01C38
APPENDIX A
Persons Participating in the Investigation McElroy Coal Company/Consol Energy
Bill Blackwell, Safety DirectorUnited Mine Workers of America
Marc Cervo, Section Foreman*
Elizabeth S. Chamberlin, Corporate Safety Director
Mike Conjeski, Shift Foreman
Stan Cwalinski, Section Foreman*
David J. Draskovich, Superintendent
Dennis Hellgren, Safety Supervisor
Jack Holt, Vice President Safety
John Kulavik, Safety Inspector
Richard Marlowe, Chief Inspector
Curtis Mason, Electrical Foreman*
Jim Siburt, Assistant Mine Foreman
Mike Sinozich, Safety Supervisor
Rick Altman, Vice President, Local 1638West Virginia Office of Miners' Health, Safety and Training
Hoya Clemens, Mine Safety Committee President
Bob Kendrick, International Representative
Jim Lamont, International Representative
Tim McMillan, Roof Bolter*
Frank Ondusko, General Inside Labor*
Richard Pauley, Trackman*
Jack Rector, Rock Duster*
Greg Smith, General Inside Labor*
Denny Studenc, Trackman*
John White, Shuttle Car Operator*
Terry Farley, Health and Safety AdministratorMine Safety and Health Administration
John Larry, Assistant Inspector-at-Large
Brian Mills, Inspector-at-Large
Colin D. Simmons, District Mine Inspector
Linda Herbst, Mine Safety and Health Specialist (Training)* Persons Interviewed
Ronald Sidwell, Coal Mine Safety and Health Inspector (Electrical)
Chris A. Weaver, Mining Engineer