DEPARTMENT OF LABOR
MINE SAFETY AND HEALTH ADMINISTRATION
District 6
ACCIDENT INVESTIGATION REPORT
PREPARATION PLANT
FATAL POWERED HAULAGE ACCIDENT
Sidewinder Mining Company
No. 1 Plant (I.D. No. 15-14468)
Virgie, Pike County, Kentucky
January 11, 1995
By
Carlos P. Smith
Coal Mine Safety and Health Inspector
And
Ronald Hayes
Coal Mine Safety and Health Inspector
Originating Office-Mine Safety and Health Administration
100 Ratliff Creek Road, Pikeville, Kentucky 41501
Carl E. Boone II, District Manager
GENERAL INFORMATION
The Sidewinder Mining Company, No. 1 Plant, is located approximately one mile off U.S. Highway 23 on Rob Fork near Virgie, Pike County, Kentucky. The principal officers at the mine are Todd Kiscaden, president, and Keith Vanhooser, secretary/treasurer. The No. 1 Plant, erected in the 1970's, was acquired by Sidewinder Mining Company in October 1993, and is normally operated six days a week on two processing and one maintenance shift per day. The shift worked by the loadout crew was dictated by the arrival and departure time of the rail cars. Coal is trucked to the plant from surrounding mines. The plant employs 30 persons to process approximately 10,000 tons of coal per day. After the cleaning cycle is completed, the coal is transferred via belt conveyors to a stockpile area or directly to a loadout facility where it is loaded into rail cars for transportation to customers. The loadout facility utilizes a car retarder that consists of a winch attached by a steel cable to a braking (dummy) car. Empty rail cars are positioned inby the loadout by the CSX Railroad Company. The rail cars are manually dropped to a point where they can be attached to the car retarder which controls them during loading. After the rail cars are loaded they are manually dropped below the loadout onto side tracks.
The last regular health and safety inspection was completed on June 8, 1994.
DESCRIPTION OF ACCIDENT
On Wednesday, January 11, 1995, between 3:00 p.m. and 4:00 p.m., the loadout crew, consisting of three car droppers and the loadout operator, arrived at the No. 1 Plant to begin their shift.
Loadout activities had been normal during the shift. The rail cars were loaded and dropped in units of five. John Justice, plant foreman, stated he had made several brief trips to the loadout area during the shift to check on the progress of the loading operations. While there, he also assisted the car droppers in closing the doors on the bottom of the empty cars that were to be loaded. Justice stated his last trip to the loadout area was around 9:45 p.m. At about 10:30 p.m., seventy cars had been loaded and dropped down track. Prior to the seventy-fifth car being fully loaded, Roger Dale Adkins, car dropper, left the loadout control room and walked toward the front cars where he normally rode to manually drop the cars. Floyd Tackett and Derek Hughes, car droppers, left the loadout shortly after Adkins and the two prepared to disconnect the loaded cars from the car retarder. At approximately 11:20 p.m., after the seventy-fifth car was loaded, Tackett signaled for Hughes to disconnect the five cars. Hughes then called for Donald Collins, loadout operator, to release slack in the cable on the car retarder. Collins activated the winch which controlled the movement of the railroad cars. The tension was released between the car retarder coupler and the coupler on the loaded railroad car which it was attached to. Derek Hughes, car dropper, then pulled the decoupling lever which released the car retarder from the five loaded railroad cars. Tackett was in the process of boarding the released trip between the seventy-fourth and seventy-fifth car when he looked forward and observed Adkins lying on his back and heard him yell. Tackett realized Adkins was injured and began applying brakes on the cars which had been released from the retarder and were now moving. The loaded cars traveled approximately 625 feet down the side track before coming to a stop. Tackett climbed off the car and began running back up the track to locate Adkins. He located him approximately 140 feet from the original location where Adkins was lying on his back. Adkins was conscious and his left leg had been severed. Tackett told Adkins he would get help and he then ran toward the loadout to summon assistance. Collins and Hughes were the first to hear Tackett's request for help and immediately went to assist Adkins. Tackett proceeded into the loadout control room, called the plant via company radio for more assistance and first aid supplies. John Justice, second shift plant foreman, heard the radio call and telephoned for an ambulance and then proceeded to the scene. Danny Casebolt, a mechanic at the plant, heard the call for help and went to the accident scene. Upon arriving at the scene, Casebolt checked Adkins for signs of life and none were found. Justice and Casebolt began CPR. An ambulance arrived with Emergency Medical Technicians who also attempted to revive Adkins without success. The Pike County Coroner's Office was notified and Russell Roberts, Jr., Deputy Coroner, arrived at the scene and Adkins was pronounced dead at 12:32 a.m. Mine management notified MSHA shortly thereafter.
PHYSICAL FACTORS INVOLVED
The investigation revealed the following factors relevant to the occurrence of the accident:
- There were no actual eyewitnesses to the occurrence.
- Floyd Tackett, car dropper, stated that he assumed that the
victim was in a safe position when he signaled both Collins
and Hughes to start dropping the loaded rail cars. Tackett
stated that when the rail cars started to roll after being
released, he observed Adkins lying on the ground between the
second and third rail cars and heard him call for help. The
other co-workers stated they could not see or hear Adkins.
- Tackett stated he was not in place on the cars when they
were released and had to get aboard them to begin braking.
- An examination of the accident scene revealed the five
loaded rail cars traveled approximately 625 feet down the
sidetrack on a 2 to 3 percent grade before being brought to
a complete stop by Tackett.
- The weather conditions on the night of the accident
consisted of precipitation in the form of rain that had
fallen steadily until approximately 10:00 p.m. The
temperature was above freezing.
- Miners present stated the tracks below the loadout were wet
and slick when the accident occurred. The access ladders on
the railroad cars were also wet. The ground surface in the
loadout area consisted of wet patches, gravel and mud.
- An examination of the accident scene and the loadout area
was conducted during night hours. The examination revealed
that illumination in the area was adequate. Lighting was
provided by floodlights located on the loadout structure and
along the inclined belt conveyors located both parallel to
and adjacent to the tracks. Dusk-to-dawn lamps were located
along the tracks. Illumination was also aided by reflection
of light off the rock highwall located on the opposite side
of the tracks.
- The distance between Car number GNFX91049 and the railroad
cars on the set of tracks that were being dropped was 17
inches at the closest location. There was no indication that
the victim came in contact with Car No. GNFX91049 during the
sequence of the accident. The close proximity of Car No.
GNFX91049 to the cars being dropped on the parallel set of
tracks in the radius curve may have impeded visibility of
the front railroad cars from the rear area of the trip.
- An examination of the five railroad cars and statements from
the co-workers revealed that there were no mechanical
defects with the cars or their braking system.
- The miners, who assisted the victim following the accident,
stated he was wearing a safety belt. The belt was examined
during the investigation and found to be operable, but was
not in use at the time of the accident. This was evident by
both latches on the safety line being attached to the belt.
- Statements from co-workers revealed that a hand-held radio
was provided to the victim for communicating with the
loadout operator when car dropping activities were in
progress. It was also revealed that Tackett and Hughes were
not provided with a radio. The investigation revealed that
the radio carried by the victim was not normally used.
- The investigation revealed that there was no written safety
procedures or method developed for safely dropping cars in
and around the loadout area. The miners stated that they had
received no instruction specific to the safe procedures for
performing these activities.
- The miners stated that Adkins normally proceeded to the
front of the front railroad car where he would ride and
brake once the cars were released. The second car dropper
normally brakes from between the fourth and fifth car in the
five car trip being released from the car retarder following
loading operations.
- The cause of death was listed as acute exsanguination due to or as a consequence of traumatic amputation of lower extremity due to or as a consequence of impact by coal car. The certificate of death states that death occurred within minutes of the occurrence.
CONCLUSION
The accident occurred when the railroad cars were released and began to move before Adkins had achieved a safe riding position. Adkins apparently fell onto the tracks in the path of the moving cars.
The accident occurred because car dropping activities were being carried out by miners who had not received proper instruction in safe procedures to be followed during these activities. Written procedures and precautions were not established and posted by the mine operator that would ensure that car droppers were in a safe position and were aware of each other's location prior to movement of the railroad cars.
VIOLATIONS
The following citations/orders were issued during or as a result of the investigation:
- 103(k) Order, Number 4011151, was issued to ensure the
safety of any person at the loadout facility until an
investigation could be completed.
- 104(a) Citation, Number 4511039, was issued for a violation
of Title 30 CFR, 77.1607(v). The five railroad cars were
not dropped in a manner that would assure the safety of all
workers involved. Roger Dale Adkins, car dropper, was
fatally injured after falling from the cars which began to
roll while he was walking on or around them.
- 104(a) Citation, Number 4497318, was issued for a violation
of Title 30 CFR, 77.1607(g). The operator of the crab hoist
did not make certain by signals or other means that all
persons were clear prior to moving the hoist and railroad
cars.
- 104(a) Citation, Number 4497319, was issued for a violation of Title 30 CFR, 77.1708. The operator failed to publish and distribute to each employee at the loadout a program of instructions with respect to the safety regulations and procedures to be followed at the loadout area.
Respectively submitted by:
Carlos Smith
Coal Mine Safety and Health Inspector
Ronald Hayes
Coal Mine Safety and Health Inspector
Approved by:
Carl E. Boone, II
District Manager
Related Fatal Alert Bulletin:
[FAB95C02]