| Case Name |
A construction worker and his president became anoxia in the refuse pit, when picking up an object which had fallen when doing scaffold assembly work. |
| Pictograph |
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| Location |
The site of repairing concrete oblique wall in the trash slot of the waste treatment plant. |
| Overview |
Since a construction worker who intended to pick up an object of scaffold material fell in the refuse pit of the waste treatment field collapsed and did not move, his president found him and went down there to try to help him. But his president could not move either. A Staff who was responsible for the waste treatment field called the ambulance, and then the two were rescued by the rescue team. But the worker died, and the president was hospitalized for anoxia. Causes of the accident were that they worked without sufficient oxygen, and that they did not measure the environment over whether it was proper for work or not. |
| Incident |
At the site of repairing a concrete oblique wall in the trash slot of the waste treatment plant, a construction worker who went down into a refuge pit to pick up an object dropped by mistake, fell down and stopped moving. His president, seeing him fall down, went down into the pit to help him, and could not move either. It was the disaster because the worker died, and the president was hospitalized for anoxia. |
| Sequence |
The repairing work was scheduled to be carried out, because the concrete oblique walls of 2 out of
16 trash slots in the waste treatment plant were remarkably damaged. The operational procedure was,
1. Install the scaffold at the trash slots.
2. Cut off the reinforced steel which was bare out of the concrete oblique wall, and replace it with new reinforced steel.
But, the disaster occurred when doing the first procedure, installing the scaffold. The order of scaffold installation was,
1. Drive two 20cm-long anchor bolts in both ends of the concrete wall in the refuse pit.
2. Install the 5m length metallic beam in the anchor bolt, using transportable crane.
3. Build a stage plank on the beam from the slot side.
4. Repeat the same operation above the previous stage along with the concrete oblique wall, and, in the last result, construct the scaffold
to the 6m depth from the slot.
The measurement of the oxygen density on that day was done by staffs of the waste treatment plant
around 9:30 a.m.; the measurement was done at 1 point near the each entrance of two trash slots.
To repair the slope of 2 slots, setting a load type truck crane in front of the slots, the three,
president and worker A and B, had started installing the scaffold, and finished building the scaffold
on one of the two slots .The president operated the crane to build a scaffold on the other slot.
Worker A dropped the beam in the refuse pit, when he was getting on the swing installed on the crane to fix the beam.
The president lowered the swing to the top of the refuse in which the beam had fallen,
and worker A stepped down onto the refuse, but when he tried to put the hook of the crane on the beam,
he pitch forward and did not move. First the president called out to A, but he did not reply.
Then he connected the end of the rope beside him with the crane, and went down along with the rope.
Although he tried to hold A up, he also fell down and could not move.
A staff that was responsible for waste treatment plant noticed this accident, and called the ambulance,
and then the two were rescued by the rescue team. But, as a result, A died, and the president was hospitalized for anoxia.
The measurement of the oxygen density done by staffs of the waste treatment plant
before the work start was done at only 1 point near each entrance of the two trash slots,
and both of the measured values were 20%. |
| Cause |
1. They worked without sufficient oxygen.
2. The proper work environment measurement was not done.
3. The accident prevention was not sufficiently examined in work planning.
4. The safety and health education was not carried out. |
| Response |
A staff of the waste treatment plant called the ambulance, and the two were rescued by the rescue team. But, as a result, A died, and the president was hospitalized for anoxia. |
| Countermeasures |
* We need to offer the accurate information in the ordering stage.
* We should definitely conduct the oxygen density.
* We have to use ventilators or self-contained compressed air breathing apparatus.
* We should use the machine suitable for the work.
* Someone responsible for oxygen deficiency dangerous operations is required when carrying the work.
* We should carry out the special education on safety and health. |
| Knowledge Comment |
* The oxygen is insufficient inside the refuse pit.
* We have to ventilate the air before helping casualies, when a casualty falls down for lack of oxygen or gas poisoning.
* Sufficient investigation and knowledge of the work environment before starting work are required.
* Humans cannot live without oxygen |
| Background |
* Lack of knowledge on the work environment.
* Lack of knowledge on anoxia. |
| Scenario |
| Primary Scenario
|
Ignorance, Insufficient Knowledge, Insufficient Analysis or Research, Insufficient Environment Study, Poor Response to Change in Environment, Change in Environment, Poor Concept, Poor Strategy or Concept, Poor Value Perception, Poor Safety Awareness, Organizational Problems, Poor Staff, Regular Movement, Dangerous Movement, Non-Regular Action, Emergency Action, Bodily Harm, Death, Loss to Organization, Social Loss
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| Number of Deaths |
1 |
| Number of Injuries |
1 |
| Field |
Civil Engineering
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| Author |
IKAI, Seiji (ICHITEC CORPORATION)
BABA, Kanji (ICHITEC CORPORATION)
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