Excerpt from the government of Ontario’s ‘Newsroom’
A worker was killed after jumping from a truck that was rolling backward and downhill at a culvert and bridge rehabilitation project north of Elliot Lake on Highway 639. The worker was employed by Teranorth Construction & Engineering Ltd. of Sudbury, Ontario; a business focusing on highway construction, municipal infrastructure and site development.
A water truck unit and a fuel truck unit, both with manual transmission, needed to be taken back to Sudbury. The driver selected for the task had a Class DZ license.
At the time, the worker was employed by Teranorth as a technician, and operating fuel or water trucks was not part of the worker’s regular duties.
On October 11, 2017, the worker picked up the fuel truck and drove it back to Sudbury. On October 13, 2017, the worker was asked to go back to Elliot Lake to pick up the manual transmission water truck. The worker arrived at the laydown site on Highway 639 and conducted the daily trip inspection report for the water truck.
The daily trip inspection report is a standard vehicle booklet that is used for multiple pieces of equipment and vehicles at Teranorth. The daily inspection of truck, tractors and trailers is guided by a checklist that is not specific to a particular type of truck, tractor or trailer. The checklist lists the hydraulic brake system as a component to be inspected on the vehicle. It does not specify how to inspect the hydraulic brake system. The inspection report identifies it as a major defect when the brake boost is not operative, requiring the driver not to drive the vehicle.
The water truck was a six-speed-plus-manual transmission cube-style truck equipped with a braking power assist system called a Hydro-Max Booster. A Hydro-Max Booster works by utilizing the hydraulic power steering pump to assist the driver by reducing the driver-applied force required at the brake pedal. The system has an electrically powered back-up pump which starts automatically in the event of a malfunction in the power steering pump or loss of engine power.
Driving a vehicle without an operating electrical back-up pump could result in loss of braking ability if the primary power source is lost. Prior to departure from the laydown site, the water truck’s lights and the lug nuts on the tires were checked; the back-up booster was not tested.
The gears in the water truck were closer together than the gears in the fuel truck that the worker had driven two days earlier. The worker took the truck around a corner and approached a big hill, approximately 1.5 km from the starting point. The hill stretched a long way and required downshifting through multiple gears in order to gain momentum to climb the hill.
A passerby was travelling from the opposite direction, northbound on Highway 639. The passerby crested the hill and observed the water truck rolling backwards and weaving. As the truck cab was passing the middle of the highway, the passerby observed the driver exiting the truck and hitting the ground, rolling a few times before coming to a rest next to the truck. The truck had rolled backwards into the bank and flipped on its left (driver’s) side.
The water truck’s driver was found unresponsive, transported to Elliot Lake Hospital and was pronounced dead from injuries suffered in the fall.
A Ministry of Labour engineer inspected the Hydro-Max braking assist system and concluded that the electric back-up pump of the system was not working. It had failed due to the corrosion within the motor that progressed until the rotor shaft of the motor became seized in the bushings of the end plate. The engineer concluded that the failed electric motor would have been detected if the operator’s manual, which explains how to test the electric back-up, had been followed.
No one had instructed the driver on how to test the functionality of the back-up booster; the operator’s manual, which had test instructions, was not available to the driver; no supervisor determined whether the driver was aware of how to do the test.
Section 25(2)(a) of the Occupational Health and Safety Act states that an employer is guilty of an offence for failing to provide information, instruction and supervision to a worker to protect the safety of the worker. In this case, the employer failed to provide information and/or instruction to a worker in the operation of a manual transmission vehicle on hilly terrain or on the testing of the Hydro-Max Booster back-up braking system as part of the daily vehicle inspection.
Teranorth Construction & Engineering Ltd. was convicted in 2013 for a fatality that took place in 2011. A worker was killed when the elevated work platform the worker was standing on overturned. The company was fined $115,000 in that incident.
(See blog post #496 for more details)
The law(s) in contravention:
Teranorth Construction was found guilty of a contravention of the Ontario Occupational Health and Safety Act (OHSA) section 25, subsection 2(a) which states,
“An employer shall,
(a) provide information, instruction and supervision to a worker to protect the health or safety of the worker.”
There has to be a set of written operating instructions, and the machine MUST be inspected per the manufacturer. One failure.
Where was the engineering side of this business? Does Teranorth even have a safety professional on staff? Considering their past record, one would wonder if that message was received and that Teranorth would make safety the overriding priority.
Maybe the next time!
HRS Group Inc. has a great team that can help you with all your health and safety needs including ‘Due Diligence’ and ‘Standard Operating Procedures’. Contact Deborah toll free at 1-877-907-7744 or locally at 705-749-1259.
Ensure your workplace is a safe place.
Remember – In Ontario, “ALL Accidents are Preventable”
‘Work’ and ‘Play’ safe.
Daniel L. Beal
CHSEP – Advanced Level
VP & Senior Trainer
HRS Group Inc.