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DEPARTMENT OF LABOR MINE SAFETY AND HEALTH ADMINISTRATION Accident Investigation Report Surface Nonmetal Mine Fatal Machinery Accident Capital City Aggregates Jaxon Enterprises Mound House, Lyon County, Nevada ID No. 26-02267 April 23, 1996 By Willie J. Davis Supervisory Mine Safety and Health Inspector James W. Ashton Mine Safety and Health Inspector Mine Safety and Health Administration Western District 3333 Vaca Valley Parkway, Suite 600 Vacaville, California 95688 Fred M. Hansen District Manager GENERAL INFORMATION John C. Reno, equipment manager, age 33, was fatally injured at about 2:00 p.m. on April 23, 1996, when the mobile crane that he was operating overturned. Reno had a total of 15 years mining experience, all with this company; the past six years as equipment manager. Reno had not received training in accordance with 30 CFR Part 48. MSHA was notified at 5:27 p.m. on the day of the accident by a telephone call from James Baker, plant foreman. An investigation was started the following day. Capital City Aggregates, a crushed stone operation, owned and operated by Jaxon Enterprises, was located at Mound House, Lyon County, Nevada. Principal operating officials were W. Jaxon Baker, president; Robert Towne, plant manager; and James Baker, plant foreman. The mine was normally operated one 8-hour shift a day, five days a week. A total of eight persons was employed. Rock was excavated by a bulldozer in the pit and pushed to a crusher. After crushing and sizing, the material was transported by belt conveyors to appropriate stockpiles. The finished product was sold primarily for construction aggregate. The last regular inspection of this operation was completed on January 18, 1996. Following the accident, another inspection was completed on June 14, 1996. PHYSICAL FACTORS The crane involved in the accident was a rubber-tired, 1984, Pettibone, Model 40 SCP, designed for rough terrain. Maximum boom extension was 92 feet and lifting capacity was 20 tons. At the time of the accident, the boom was secured in the travel position. An enclosed operator's cab was located on the left side of the vehicle. ROPS was not a part of the crane's cab design. Seat belts were not provided. An examination of the crane by the investigators and MSHA technical specialists disclosed that both brake fluid reservoirs were empty. There was no evidence that leakage had occurred following the accident. A support bracket for the rear brake reservoir had been broken some time prior to the accident. Brake shoes, brake drums, and planetaries showed very little wear. Mark Collier, hot plant operator, had used the crane about two hours prior to the accident. Collier stated that steering and parking brake components were working properly. He said that the service brakes were not as effective in stopping the vehicle as they should have been, and that second gear in the transmission could not be engaged. At the time of the investigation the transmission lever was noted to be in the forward position, between first and second gear. Because the crane was used at non-mining as well as mining operations, there was little information available that would indicate its maintenance and repair history. Also, the person responsible for, and knowledgable of, the crane's upkeep was the victim. The road where the crane overturned was recently constructed for access to a new crusher location. From the main access road, the new road curved to the left before extending up the hill on a 12 percent grade. The road was 300 feet long, 18 feet wide and was cut into the hillside. An axle high berm meeting MSHA requirements was provided along the outer edge. The surface was dry and well compacted. At the time of the accident, the weather was clear, cool, and dry. DESCRIPTION OF ACCIDENT On the day of the accident, John Reno (victim) arrived at the work site at about 7:00 a.m. As equipment manager, Reno worked discretionally at various company-owned operations. At this site, he was responsible for overseeing the relocation of the primary crusher and was also involved in construction of the project. Part of his duties included operating equipment used for site preparation and moving and reassembling the crusher components. At about 1:30 p.m., Reno went to the company-owned asphalt plant, a distance of about one-fourth mile, to get the crane. Thomas Gregory, a contract mechanic who was assisting Reno, stated that he observed Reno returning with the crane on the inclined roadway enroute to the new crusher location at about 2:00 p.m.. Gregory said that the crane traveled about 100 feet up the grade, stopped for a few seconds, and then began rolling back down the road. Since Reno was looking to the rear, with his head out the window, Gregory thought Reno was in control of the crane. Near the bottom of the grade the crane appeared to be gaining speed. At the curve, it continued in a straight line. The wheels on the right side ran onto a mound of compacted dirt off the roadway and the crane came to a stop. Gregory stated that Reno braced himself as the crane rocked from side to side and then overturned, crushing the operator's cab. Gregory ran to the crane and saw that Reno, who was still in the cab, was unresponsive and badly injured. After another employee arrived, Gregory ran to his service truck and called the local 911emergency number. Emergency Medical Technicians arrived a short time later, but were unable to revive Reno. He was pronounced dead at the scene. CONCLUSION The accident occurred because the service brake system on the crane had not been properly maintained. Consequently, the brakes were not capable of stopping or holding the vehicle on a grade. An effective maintenance program, which would have including pre-operational equipment inspections and prompt correction of safety defects, could have prevented this accident. CITATIONS/ORDERS Order No. 3910443 Issued on April 24, 1996, under provisions of Section 103(k) of the Mine Act. Citation No. 4140759 Issued on May 23, 1996, under the provisions of Section 104(a) of the Mine Act for violation of 30 CFR 56.14101(a)(3): Citation No. 7953816 Issued on September 17, 1996, under provisions of Section 104(a) of the Mine Act for violation of 30 CFR 56.14100(d): /s/ Willie J. Davis Supervisory Mine Inspector /s/ James W. Ashton Mine Safety and Health Inspector Approved by: Fred M. Hansen, Manager Western District Related Fatal Alert Bulletin:  [FAB96M14]
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