FACE Investigation #93-NJ-106-01
School Maintenance Worker Dies After Falling 20 Feet From A Ladder While Servicing An Outdoor Athletic Field Light
DATE: March 29, 1994
On November 16, 1993, a 54 year-old male school maintenance/custodial worker died after falling 20 feet from a ladder. The incident occurred when the victim climbed the ladder to replace a light on a pole at a high school football field. After raising the ladder from the bed of his pickup truck to the light pole, the crossarm broke, causing the ladder to fall against a fence and throwing the victim to the ground. NJDOH FACE investigators concluded that, in order to prevent similar incidents in the future, these safety guidelines should be followed:
On October 16, 1993, NJDOH FACE investigators were notified by the NJ Department of Labor (NJDOL) Public Employees Occupational Safety and Health (PEOSH) Program of a death resulting from a work-related fall. The following day, NJDOH FACE investigators conducted a site visit to interview the employer and photograph the incident site. Additional information was gathered from the PEOSH compliance officer and the police and medical examiner's reports.
The employer was a municipal school district that has been in operation for 75 years and employs 123 workers divided among three schools. The district does not have a formal health and safety program. The victim was a 54-year old male maintenance/custodial worker who had worked for the district for over 12 years. He worked as a custodian for over eight years and had maintenance work (i.e., light repair) for the entire school district added to his custodial duties four years ago.
The day of the incident was a clear Tuesday with mild temperatures. As usual, the victim arrived for work at 7 a.m. and opened one of the schools. He worked at his usual custodial duties until 10 a.m. when he switched over to working on maintenance. During the morning he was called to the school administrator's office and told that a light was not working properly in the high school football field. After being given some replacement bulbs for the high intensity halogen light, the victim said that he would get a truck for the job. According to the school superintendent, the victim (who was a member of the local fire department) usually borrowed a ladder truck from the fire department and used it to work at heights.
Shortly before 1 p.m., the victim drove out to the football field in the school district maintenance pickup truck and parked near the defective light pole. This pole was approximately 25 feet high and had two high intensity lights mounted on metal pipe crossarms. The pole was adjacent to a fence and was approximately seven feet away from the brick wall of a neighboring building. Working alone, the victim set up a two-section aluminum extension ladder to reach the light. Instead of placing the ladder on the ground, he placed in on the bed of the pickup truck and raised it to rest on the crossarm of the light. He then climbed up the ladder to the lights.
No one witnessed the incident. At about 1:08 p.m., the crossarm of the light broke where it connected to the pole, causing the ladder to fall forward against a nearby fence and building. Two neighbors heard the ladder fall and ran to find the victim lying on a blacktop walk near the fence. One neighbor called for help while the other stayed with the victim. The police and paramedics quickly arrived and started CPR. The victim was transported to the local medical center where he died of his injuries at 1:55 p.m.
CAUSE OF DEATH
The county medical examiner attributed the cause of death to multiple injuries.
Recommendation #1: Employers should ensure that employees receive the proper equipment and training before performing a job task.
Discussion: In this case, the employer may not have had the proper equipment for servicing the lights. In the past, the employer depended on the victim's access to a fire department ladder truck for reaching high places. A second factor may have been the victim's improvising by placing the ladder on the pickup truck to reach the light. To prevent future incidents, we recommend that the employer and employees should decide if the available equipment and training is adequate for the task. If not, the employer should purchase the appropriate equipment (such as a lift truck or platform lift) and train the employees in its use. In situations where the task is not routine or if the equipment and training is too expensive, the employer should hire a qualified contractor to perform the job.
Recommendation #2: Employers should conduct a job hazard analysis of all work activities with the participation of the workers.
Discussion: The victim was a self-supervised worker who was responsible for a variety of maintenance tasks. To prevent incidents such as this, we recommend that employers conduct a job hazard analysis of all work areas and job tasks with the employee(s). A job hazard analysis should begin by reviewing of the types of work activities that the employee is responsible for and the equipment that is needed. Each of task is further examined for fall, electrical, chemical, or other hazards the worker may encounter. The results of the analysis can also be used to design or modify a written employee job description.
Recommendation #3: Employers should develop and implement a comprehensive safety program with the assistance of a joint labor/management safety committee.
Discussion: It is recommended that all employers emphasize worker safety by developing and implementing a comprehensive safety program to reduce or eliminate hazardous situations. This program, as developed with the assistance of a joint labor/management safety committee, should include the recognition and avoidance of hazards identified by the job hazard analysis and include appropriate worker safety training. Records should be kept of any training conducted.
Job Hazard Analysis. OSHA 3071, US Department of Labor, Occupational Safety and Health Administration, Washington DC. 1988.
Information Bulletin: Joint Labor/Management Safety & Health Committees. NJ Department of Health, Public Employees Occupational Safety and Health Program, Trenton NJ.
To contact New Jersey State FACE program personnel regarding State-based FACE reports, please use information listed on the Contact Sheet on the NIOSH FACE web site. Please contact In-house FACE program personnel regarding In-house FACE reports and to gain assistance when State-FACE program personnel cannot be reached.