FACE 88-02


Painter is Electrocuted in South Carolina


Introduction:

The National Institute for Occupational Safety and Health (NIOSH), Division of Safety Research (DSR), performs Fatal Accident Circumstances and Epidemiology (FACE) investigations when a participating state reports an occupational fatality and requests technical assistance. The goal of these evaluations is to prevent fatal work injuries in the future by studying: the working environment, the worker, the task the worker was performing, the tools the worker was using, the energy exchange resulting in fatal injury, and the role of management in controlling how these factors interact.

On September 9, 1987, a 49-year-old male painter was electrocuted when he contacted a fluorescent light fixture.

 

Contacts/Activities:

Officials of the Occupational Safety and Health Program for the State of South Carolina notified the National Institute for Occupational Safety and Health (NIOSH), Division of Safety Research (DSR) of this fatality and requested technical assistance. During the week of November 16, 1987, a DSR research team visited and photographed the incident site, and interviewed company personnel and co-workers.

 

Overview of Employer's Safety Program:

The victim was employed by a large, multi-state textile company which employs 10,000 people. The company has been in existence for 92 years and has been under the present management for the past 3 years. The company has a formal safety program with training provided to all employees. Job safety analyses are performed for all positions, and are reviewed twice per year. A review of the OSHA 200 reports filed by the plant for the past several years showed few serious injuries. The company has not had any similar fatalities. The victim had been employed by the company for the last 20 years, and had been working as a painter for the 5 months prior to this incident.

 

Synopsis of Events:

On the day of the incident, the victim and a co-worker were painting steel "I" beams located approximately 12 feet above the plant floor. Numerous pipes, conduits, and 110-volt fluorescent light fixtures were in the area. The painters had been working around these obstacles while painting the beams. The room where the incident occurred was extremely warm (approximately 100 F).

In order to reach the beam, the victim was standing at approximately the 8-foot level of a 10-foot wooden ladder. He was leaning across a conduit and one of the fluorescent light fixtures suspended from the ceiling, while touching other pipes and conduits with his right arm. The cable that supplied power for the fluorescent light was not secured with a box connection at the point where the cable entered the light fixture; accordingly, any stress applied to the cable was transmitted directly to the connections within the fixture. As the victim leaned across the light fixture an energized conductor within the fixture contacted and energized the housing. Electrical current traveled from the energized housing through the victim's chest and out through the victim's right arm, which was in contact with pipes and conduits at ground potential.

The victim's co-worker stated that he heard a "scraping" noise and observed the victim lying across the light fixture. When he called to the victim and received no reply, he approached to see what was wrong. When he touched the victim he received an electrical shock. He then went for help and returned with two supervisors who disconnected power to the light and helped lower the victim to the floor. Cardiopulmonary resuscitation (CPR) was begun within a few minutes by plant medical personnel. CPR was continued by ambulance personnel who transported the victim to the local hospital where he was pronounced dead after resuscitation efforts failed.

Examination of the light fixture revealed that the ground wire was disconnected. It is presumed that the ground wire had not been reconnected when the ballast was last replaced. It was also noted that numerous burn marks existed within the light fixture at the points where the conductors were connected to the ballast.

 

Cause of Death:

The coroner's office ruled the cause of death to be accidental electrocution.

 

Recommendations/Discussion

Recommendation #1: Electrical equipment should be installed and maintained in accordance with the applicable requirements of the National Electrical Code (NEC).

Discussion: At sometime in the past, a new light ballast had been installed in the light fixture. The ground wire for this ballast had been clipped off and a proper ground connection was not completed as required by NEC 410-18. In addition, the power supply cord was neither secured nor protected at the point where it entered the fixture, a violation of NEC 410-28. Therefore, any stresses put on the cord were transmitted directly to the wiring connections within the fixture. Also, the conductor insulation became abraded due to rubbing against the metal housing at the point where the conductor entered the fixture. These factors led to the energization of the fixture housing.

Recommendation #2: Employees responsible for electrical work should be trained in the requirements of the National Electrical Code.

Discussion: The fact that this fixture was improperly wired is evidence that a training/retraining program is needed for employees performing electrical work within the plant. In addition, the performance of employees should be periodically monitored to identify those individuals in need of refresher training, and to verify that hazards are not being created through human error.

Recommendation #3: Periodic re-evaluations of job safety analysis (JSA) for each position should be accomplished to ensure that hazards and potential hazards for each task are addressed.

Discussion: While the plant conducts JSA for all positions and reviews them twice per year, it appears that these reviews do not address changes in work which may result in other than normal exposure to various hazards. In this case the victim, a painter, apparently was not aware of the hazards posed by the electrical equipment in his work environment. In addition, the improper wiring of the light fixture would seem to indicate that the employee who had repaired this fixture was unaware of the hazard being created by failure to properly wire and ground the unit.

Recommendation #4: A general safety training program should be developed for all employees whose work activities expose them to the potential hazards of electrical energy. This training should address the identification of electrical hazards and measures for controlling them.

Discussion: The victim was leaning with his weight across an energized piece of electrical equipment (light fixture), subjecting the light fixture to stresses beyond its capacity. The victim created the potential for electrocution by providing a "path to ground" through contact with the fixture and overhead pipes. This ground path involved vital human organs which are adversely affected by electrical energy. If the employee had understood the hazards of electrical energy and the methods of controlling the release of this energy, this incident may have been avoided. For instance, wet skin can have a resistance as low as 1000 ohms, although the resistance of dry skin to electrical current may be as high as 100,000 ohms. Reduced resistance (ohms) results in increased current (amps), which can make the difference between a barely perceptible shock and electrically induced cardiac arrest. If the victim had realized that his resistance to electrical energy was probably lowered significantly by perspiration (due to the warm working conditions) he may not have leaned on the fixture. A safety training program should include such basic electrical safety training for all employees.

 

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