Assistant Manager at Fertilizer Mixing Facility Dies When Pinned Under Overturned 1972 Tractor Without a ROPS

Michigan Case Report: 13MI009
Release Date: May 1, 2014

The following report is the product of our Cooperative State partner and is presented here in its original unedited form from the state. The findings and conclusions in this report are those of the individual Cooperative State partner and do not necessarily reflect the views or policy of the National Institute for Occupational Safety and Health.

SUMMARY

In the winter of 2013, a male fertilizer mixing facility assistant manager in his 30s died when his 1972 Case 580B Construction King tractor with a front end loader overturned after sliding down the walls of a drainage ditch. The tractor was not equipped with a roll over protection structure (ROPS) and seat belt. The decedent had unsuccessfully attempted to remove a 12-foot section of the rail of a railroad on the south side of the facility with the tractor bucket. The facility’s General Manager determined that another method should be used to remove the rail. The decedent was in the process of backing the tractor away so he could move it to another area. The tractor length, including the bucket was approximately 15 feet. The decedent backed the tractor approximately 20 feet. The ground was snow covered. The back wheels of the tractor slipped into an approximate nine-foot-deep ravine with an unmarked edge. As the tractor was sliding down the ditch, he attempted to drive the tractor forward, but the tractor continued to slide into the ravine. When the front wheels of the tractor reached the edge of the ravine, the tractor overturned to the rear. The decedent was pinned against the ravine bank by the tractor seat. A ROPS was an optional piece of equipment when the tractor was built in 1972.

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