DEPARTMENT OF LABOR
MINE SAFETY AND HEALTH ADMINISTRATION
REPORT OF INVESTIGATION
Surface Nonmetal Mill
(Crushed Granite)
Fatal Fall of Person Accident
December 4, 2001
Power Plant Maintenance (ERH)
Society Hill, Marlboro County, South Carolina
at
3M Pittsboro
3M
Pittsboro, Chatham County, North Carolina
Mine I.D. No. 31-02153
Accident Investigators
Joel B. Richardson
Mine Safety and Health Inspector
Steve J. Kirkland
Supervisory Mine Safety and Health Inspector
Originating Office
Mine Safety and Health Administration
Southeast District
135 Gemini Circle, Suite 212; Birmingham, AL 35209
Martin Rosta, District Manager
OVERVIEW
Robert B. Nance, steel worker, age 23, was fatally injured on December 4, 2001, when he fell 46 feet from a beam to the floor below.
The accident occurred because the victim had not attached the lifelines of his safety harness. The restricted clearance on the beam on which the victim was walking may have been a contributing factor.
Nance had a total of 2-1/2 years of construction experience, four months with this contractor as a steel worker, all at this mill. He had received training in accordance with 30 CFR Part 46.
The 3M Pittsboro mill, a crushed granite operation owned and operated by 3M, was located about 15 miles north of Sanford, Chatham County, North Carolina, along US Highways 15 and 501.
The mill was under construction with J. A. Jones of the Carolinas as the primary construction contractor. J.A. Jones crews worked three, eight-hour shifts per day, seven days a week. Total employment was 345 persons.
The victim was employed by Power Plant Maintenance, a subsidiary of J. A. Jones of the Carolinas. Power Plant Maintenance was contracted to construct the mill. The principal operating officials were Scott Johns, project manager for J. A. Jones of the Carolinas, and James A. Zieglmeier, senior project engineer for 3M. Power Plant Maintenance employed 185 persons that worked three eight-hour shifts per day, seven days a week at this mill.
The last regular inspection at this operation was completed on September 24, 2001. A regular inspection was conducted following the investigation.
On the day of the accident, Robert B. Nance (victim), reported for work at 7:00 a.m., his regular starting time. He attended a company safety meeting that lasted for about 20 minutes. Jimmie Rouse, supervisor, assigned Nance to work with two other employees on several different items that needed to be completed on the tripper floor in building number 16 and also in building number 17.
After work had been completed in building 17, the crew proceeded to building number 16. At about 1:50 p.m., they completed their assigned work and were preparing to move to another area. Jamie Cruz, steel worker, instructed Nance to assist Mike Schesneider, steel worker, in gathering tools and rolling up torch hoses. Cruz then left the area.
As Schesneider gathered tools, he saw Nance walking an inclined H-beam to the upper level where the torch hoses were located. As Nance was walking up the beam, he fell to the outside between two other H-beams. His head struck one of these beams as he fell to the kiln floor below.
Schesneider ran to the kiln floor and arrived there as other employees gathered around Nance, who was nonresponsive. They tended to his injuries while Bob Smith, general superintendent, radioed for emergency assistance. Local EMT personnel arrived at the site and performed resuscitation procedures but were unsuccessful in reviving Nance. The victim was transported to a local medical clinic where he was pronounced dead. Cause of death was attributed to injuries received as a result of severe head trauma.
MSHA was notified of the accident at 2:55 p.m. on December 4, 2001, by a telephone call from Jim Watson, corporate safety manager for J. A. Jones of the Carolinas, to Steve J. Kirkland, supervisory mine safety and health inspector. An investigation was started that day. An order was issued under the provisions of Section 103(k) of the Act to ensure the safety of miners. MSHA's accident investigators traveled to the mine, made a physical inspection of the accident scene, interviewed employees, and reviewed conditions and work procedures at the time of the accident. MSHA conducted the investigation with the assistance of both mine and contractor management and employees. The miners did not request nor have representation during the investigation.
The accident occurred in building number 16 on the tripper floor level, 46 feet above the kiln floor level.
The victim was walking an inclined H-beam to the next higher floor to feed torch hoses down so they could be rolled up and transported to the next work site.
The H-beam was 9-1/8 inches wide, approximately 25 feet long, and installed on a 17 percent incline. An electrical control and monitor was secured approximately half way up the H-beam that the victim would have had to go around. It was at this point that he fell. Also, the beam Nance was walking on converged with an overhead horizontal beam that would have restricted walking height. The overhead beam where the victim was positioned when he fell, was 42 inches above the inclined beam on which he was walking.
A walkway and stairway provided access to the floor level where the torch hoses were located.
The victim was wearing a safety harness equipped with two lifelines but the lifelines were not attached to a secure point.
Power Plant Maintenance had a tie-off policy that required employees to be tied off any time they were working in elevated areas. Employees interviewed confirmed that they had been instructed to tie off while working from elevated positions six feet and higher.
On the day of the accident, the victim had not worked in an area where he would have been required to have been tied off prior to walking on the H-beam.
The decision to use the H-beam to access the higher level instead of the stairway was the root cause of the accident. Failure to secure the lifelines prior to walking on the elevated beam contributed to the severity of the injuries.
Order No. 6126179 was issued on December 4, 2001, under the provisions of Section 103(k) of the Mine Act:
A fatal accident occurred at this operation on December 4, 2001, when an steel worker fell from the tipper level to the kiln level in building number 16 of the plant, a distance of approximately 40 feet. This order is issued to assure the safety of persons at this operation until the mine or affected areas can be returned to normal operations as determined by an authorized representative of the Secretary. The mine operator shall obtain approval from an authorized representative of the Secretary for all actions to recover equipment, and/or return affected areas of the mine to normal.This order was terminated on December 7, 2001. Conditions that contributed to the accident have been corrected and normal mining operations can resume.
Citation No.6090057 was issued on December 12, 2001, under the provisions of 104(a) of the Mine Act for violation of 30 CFR 56.15005.
A fatal accident occurred at this operation on December 4, 2001, when a contract steel worker fell approximately 46 feet from the tripper level to the kiln level in building number 16. The victim was walking on an elevated inclined H-beam about 9-1/8 inches wide. He was wearing a safety harness but the two lifelines were not fastened.This citation was terminated on December 18, 2001. Safety meetings have been conducted with employees at this operation, and the requirements of their fall protection plan have again been stressed to each employee.
Related Fatal Alert Bulletin:
FAB01M28
APPENDIX A
Persons Participating in the Investigation
3M
Jim Zieylmeier ............... construction managerJ. A. Jones of the Carolinas
Bob Smith ............... general superintendentPower Plant Maintenance
Jim Watson ............... corporate safety manager
Walter McDaniel ............... division safety manager
Frank Szilvay ............... safety manager
Brian Peterson ............... safety manager
Randy Gardner ............... structural superintendentNorth Carolina Mine and Quarry Bureau
Bob Phillips ............... safety manager
Jimmie Rouse ............... supervisor
William Gerringer ............... assistant bureau chiefMine Safety and Health Administration
James C. Pate ............... mine safety and health representative
Joel B. Richardson ............... mine safety and health inspector
Steve J. Kirkland ............... supervisory mine safety and health inspector
APPENDIX B
Persons interviewed during the investigation
Power Plant Maintenance
Jimmie Rouse ............... supervisor
Mike Schesneider ............... steel worker
Jamie Cruz ............... steel worker
Richard Kinder ............... crane operator
Steve Buckllew ............... electrician
Darrell Wheeler ............... electrician