MO FACE INVESTIGATION #97MO030
Farm Worker Struck-By Back-Hoe in Missouri
On March 21, 1997 a 48-year-old male farm worker was run over by a back-hoe. He was apparently preparing to move the back-hoe into a maintenance building on the farm. The victim was standing in front of the right rear tire of the back-hoe when he apparently started it while it was in gear. The back-hoe ran over him, then proceeded across the equipment lot before stopping against a trailer. The victim was a part-time intermittent farm worker. He had worked with the employer for many years and had a good knowledge of most the farm's equipment.
The MO FACE investigator concluded that in order to prevent similar occurrences, all employers should:
On March 26, 1997, the MO FACE Program was notified by the county coroner of a machinery-related fatality incident that occurred on March 21, 1998. A 48-year-old farm worker (victim) was killed when he started a back-hoe while it was in gear and it ran over the entire length of his body. The employer in this incident was a farmer who also owned a construction company. The employer operates his construction business out of his farm home. There he maintained his construction equipment including a road grader, two back-hoes, two dump trucks, and various other equipment. The employer also farmed mostly by himself for approximately 20 years and employed the victim for farm work on an as needed bases. The victim had worked for the farmer intermittently for five years and was familiar with the farm equipment located there. The employer did not have a written safety program and stated that he always told the people that worked for him to use common sense, and always make sure they are in the seat when starting any equipment.
The MO FACE investigator traveled to the incident site and conducted interviews with the employer, the county coroner, and the deputy sheriff who investigated the incident. The incident was unwitnessed but the employers wife was home at the time of the incident and assisted the victim and notified emergency personnel.
The victim arrived at the farm that morning and had several projects to work on including some fence repair and some repair to the back-hoe. These activities were not out of his capabilities, and he had performed them many times in the past. The back-hoe was an older (late 60's, early 70's) model Ford 3400. It was being started for the first time since winter. The incident was unwitnessed, but apparently the victim started the tractor while it was in gear. He was standing on the right side of the unit in front of right rear tire. After the tractor engine started and the transmission was in gear, the back-hoe began moving, striking the victim proceeding across a gravel parking lot. The unit traveled approximately 157 feet when the bucket of the loader came to rest after striking the rear of a flatbed, goose neck trailer.
The employer's wife heard the victim shouting for help, came out of the house and saw the back-hoe running against the trailer. She first attempted to shut the tractor off by turning the key off. When this did not work, she ran around to the right side of the back-hoe and pulled the kill switch. She then went to the aid of the victim and then called 911.
The deputy sheriff arrived at the scene first and was able to talk with the victim. The victim said "he was not sure what happened". The victim was life-flighted to a major medical center but did not survive the injuries.
CAUSE OF DEATH:
Crush injuries to the chest and abdomen and multiple fractures.
The following recommendations are intended to educate all employers and employees how similar occurrences can be avoided.
Recommendation #1: Back-hoes and heavy equipment should be started only when the operator is occupying the operator seat.
Discussion: The victim apparently started the back-hoe while standing in front of the right rear tire. Had he climbed into the seat to start the equipment, this incident would have been avoided. Employers should ensure that workers are trained in the hazards of working on and around heavy equipment, as well as the hazards of starting heavy equipment from the ground. According to some equipment manufacturers, many of the back-hoes manufactured since 1970 are equipped with safety interlocks to prevent this type of operator action. For example, these newer tractors cannot be started unless someone is sitting on the driver's seat, the clutch is depressed, and/or the tractor is in a particular starting gear.
Recommendation #2: Employers should ensure all safety switches are maintained and interlocks are operational.
Discussion: According to the employer a ignition safety switch may not have been connected. It may have been disconnected when the tractor had an ignition module replaced recently. Failure to reconnect safety interlocks can introduce hazardous situations. Following all maintenance procedures, ensure that safety interlocks are re-installed, operational and properly.
Recommendation #3: Employers should develop, implement and enforce a comprehensive safety program that includes, but is not limited to, training of employees in hazard recognition and avoidance, and safe work practices.
Discussion: The employer did not have a comprehensive safety training program, and it appears that the victim may not have fully understood the hazards of starting the back-hoe while not sitting in the operator's seat. Employers should incorporate their employees into the company's comprehensive safety and health plan and safety committees. This form of empowerment can increase worker participation and worker hazard recognition and avoidance. It may also invite more open positive feedback on how the facility could operate more safely and efficiently.
The Missouri Department of Health, in co-operation with the National Institute for Occupational Safety and Health (NIOSH), is conducting a research project on work-related fatalities in Missouri. The goal of this project, known as the Missouri Occupational Fatality Assessment and Control Evaluation Program (MO FACE), is to show a measurable reduction in traumatic occupational fatalities in the State of Missouri. This goal is being met by identifying causal and risk factors that contribute to work-related fatalities. Identifying these factors will enable more effective intervention strategies to be developed and implemented by employers and employees. This project does not determine fault or legal liability associated with a fatal incident or with current regulations. All MO FACE data will be reported to NIOSH for trend analysis on a national basis. This will help NIOSH provide employers with effective recommendations for injury prevention. All personal and company identifiers are removed from all reports sent to NIOSH to protect the confidentiality of those who voluntarily participate with the program.
Please use information listed on the Contact Sheet on the NIOSH FACE web site to contact In-house FACE program personnel regarding In-house FACE reports and to gain assistance when State-FACE program personnel cannot be reached.