Description of Incident
During daily site tour, the site operator, contractor and sub-contractors’ attendees were inspecting the auxiliary transformer area for work progress (site is under construction). The IP stopped on top of the cable pit, which was temporarily covered with a plywood board.
The IP was unhappy due to the delay in work progress, the day before he had asked to install the permanent cover slabs. Consequently, he stomped his feet on the plywood cover. The plywood broke and IP fell into the pit/cable trench from a height of 3.1 meters, on the cables installed. Following the incident the plywood cover was replaced with a cover compliant with scaffolding standard with safety sign.
Why it happened?:
The area was hard barricaded (scaffolding) to restrict the access of unauthorised personnel. On the day before the accident, during the daily tour, IP instructed contractor & Subcontractor to remove all scaffolding barricades, and to install the permanent cover slabs (Concrete slabs) on the same day. On the day of the accident, they noticed that the hard barricade had been removed but the slabs had not been installed. There are no standards recognised by contractor for plywood design as a cover neither method statement, risk analysis or work at height procedure. At the time of accident, one single plywood cover was installed, with wooden support alongside the nib.
The single plywood had the caution/hazard sign “Floor Opening”, did not have tags with unique number. At the time of removing the hard barricade, no inspection was performed. There is no specific checklist for checking temporary floor covers, no tracking with tags. There is no management of change procedure at time of scaffolding/barrier removal, no inspection performed to check safe area.
There is “clean room hand over check list” between the civil and electrical subcontractor, in which there is no mention about temporary covers, or suitable covers installed. It is mentioned references about the design safety (fire extinguisher, safety signs, final grating). Regarding the emergency management, tripod is available but could not be installed due to hole size. There is no stretcher approved for work at height rescue. Confined space measures were not taken into account for rescue. IP's spine was not immobilised before transfer on the stretcher.
Good Practice Guidance
- No standards for plywood design as cover identified.
- No management of change procedure available for removal of engineering controls / collective protection.
- No regular inspection performed on cover.
- Existing practice not detailed into risk assessment or method statement.
- Hand over between civil and electrical does not mention/identify covers or temporary equipment.
- Safety and behaviour refreshing training to improve risk perception, safe work supervision and constructive follow up.