Dig a little deeper after a near-accident
There may be more to the story
If you can discover why an employee performed a job incorrectly, which caused a near-miss accident that could have been fatal to other workers, wouldn't this information be priceless to you?
Employee X was a general production worker performing duties of lifting a full beam of material with a manual overhead hoist, recalls Kathy Dayvault, RN, MPH, COHN-S/CM, an occupational health nurse at PureSafety in Franklin, TN. The beam weighed approximately 1200 pounds.
At this manufacturing site, general production workers were to be trained in at least three jobs. Lifting a beam required correct placement of straps on the floor, rolling the full beam off the loom, lowering the hoist and hooking the straps to the hoist, and lifting the roll with the power control.
On this particular day, a co-worker had observed employee X doff the roll onto the straps. He began to lift the roll with the hoist, while holding the hoist cable above the hook, and started raising the beam. The full beam began lifting from the floor with the employee holding onto the cable, who was being lifted as well.
"A different co-worker saw the employee being lifted. He yelled for him to stop the hoist and let go," she says.
The employee let go, but did not stop the hoist. Suddenly the full roll slipped out of the straps and fell to the floor from a height of approximately four feet.
"Fortunately, no one was injured," says Dayvault. "The second co-worker noticed the straps were placed incorrectly, as well as the employee being lifted from the floor."
Underlying reasons
Initially, it was felt the employee failed to perform his job safely, placing himself and others at risk for substantial harm including death. Upon questioning the employee, however, Dayvault learned some additional information.
"I learned that he spoke poor English, had not had training in greater than two years and had not done the job in at least three years," she says.
She also learned that a prior similar incident has occurred about four months earlier to a different worker, resulting in a fracture to his finger. At that time, company officials advised that all workers should be re-trained. However, only the workers who performed maintenance work had been re-trained.
"Employee X had just moved from a night shift position to a day shift position, and had been out of work for a substantial amount of time due to a workers' comp injury to his arm," she says.
A forklift physical completed after the incident revealed that the man suffered from poor vision. He wore glasses, but had not seen a physician for a vision exam in five years.
"We then found that other employees performing the job did not follow a standard procedure for doffing full rolls of material," says Dayvault. There was one loom where the correct procedure could not be used due to lack of physical room. Also, a general production worker might be needed on any job, but was only trained on three.
"All the above issues were addressed. Appropriate workers were trained, and the employee obtained stronger corrective lenses," she says.
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