Owner Of An Auto Dealership Dies Of Carbon Monoxide Poisoning While Doing Car Repairs In An Unventilated Garage

Wisconsin FACE 93WI181

SUMMARY:

A 50 year old male owner of a car dealership was overcome by carbon monoxide when he was apparently repairing an automobile with the engine running in an unventilated garage. According to the victim’s friend, he and the victim ate pizza and had a beer together late at night at the garage. He left the garage at midnight while the victim stayed on. Early the next morning, the friend returned to the garage and saw the victim down on the floor in a small garage normally used only to wash vehicles. An automobile was in the garage with the ignition on. The coroner was summoned and pronounced the victim dead at the scene at 7:24 AM, he estimated the time of injury at approximately 1:00 AM. The Wisconsin FACE investigator concluded that, in order to prevent similar occurrences, the employer should:

• Conduct a jobsite survey to evaluate equipment and work processes and remove or control safety hazards identified
• Develop and implement a written general safety program and train workers in recognizing and controlling hazards affecting themselves.

INTRODUCTION:

On April 10, 1993, the owner of an auto dealership died of carbon monoxide poisoning in a small garage attached to his office. The Wisconsin FACE investigator was notified by the Department of Industry Labor and Human Relations Workers Compensation Division on May 10, 1993. A visit was made to the site on May 20, 1993. A death certificate and a police report were obtained. The victim’s son only spoke with the FACE investigator very briefly as he had changed his mind regarding accepting the investigation. Photographs were not taken as the victim’s son refused. He did not want to discuss the situation, but said that the area where the death occurred was never used for car repair and therefore will not cause a risk to him and his 3 brothers that continue to run the business. He said that the garages used for repair are equipped with ventilation and that they are aware of the dangers of confined spaces and carbon monoxide poisoning. He declined to talk about safety policies and procedures.

INVESTIGATION:

The night prior to the incident, the owner of the auto dealership and a friend had been at the dealership office sharing pizza and beer. At around midnight the friend had gone home. There were no witnesses to the incident, but the victim’s son thought his father may have worked on a car that needed minor repairs in a garage normally used only to wash cars because it was late and the car was parked right outside this garage. All the windows were closed and the doors locked to the building with the exception of the door between the garage and the office. This door was closed but not locked. The ignition to the car was on the on position, there was approximately a quarter tank of gas in the car according to the gauge, and the car was not running when the victim was found in the morning. His friend had returned to the garage and saw the victim on the floor near the rear of the car on his side. The friend found another person who broke the window to gain entry, finding the victim without a pulse. They called for the coroner and the police. The son said that his father may have been in a hurry to finish minor repairs on the vehicle because the car was to be sold in an auction.

CAUSE OF DEATH:

Carbon monoxide poisoning. Blood samples for the victim was positive for carbon monoxide 79.5%.

RECOMMENDATIONS/DISCUSSION:

Recommendation #1: Employers should conduct a jobsite survey to evaluate equipment and work processes and remove or control safety hazards identified.

Discussion: a safety survey with regard to adequacy of ventilation in the garage may have identified insufficient ventilation. According to the son, this area is not used for repairs. However since cars do fit in this area, a ventilation system should be installed in the event it is used again. A warning should be placed on doors indicating the need for ventilation.

Recommendation #2: Employers should develop and implement a written general safety program and train workers in recognizing and controlling hazards affecting themselves.

Discussion: In this instance the owner did not recognize the garage as a confined space and followed no precautions. There was inadequate ventilation and all doors and windows were locked. Working alone late at night in itself is a hazard, this worker was either not trained to or did not attend to this hazard.

FATAL ASSESSMENT AND CONTROL EVALUATION (FACE) PROGRAM

Staff members of the FACE Project of the Wisconsin Division of Health, Bureau of Public Health, perform FACE investigations when there is a work-related fatal fall, electrocution, or enclosed/confined space death reported. The goal of these investigations 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.

To contact Wisconsin 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.