23-year-old laborer was overcome and drowned when he entered a 10,500-gallon molasses tank to reposition a drain pipe, Michigan
Michigan Case Report: 16MI071
A 23-year-old male laborer was overcome and drowned when he entered a 10,500-gallon molasses tank to reposition a drain pipe. The decedent and a coworker were in the process of draining an 11.8-foot wide by 13.9-foot high, 10,500-gallon tank which had held a mixture of molasses and water. Near the bottom of the tank was a pipe to drain the contents. The drain pipe had been turned “up” rather than “down”. The workers hooked up a gasoline-fueled pump to the bottom valve to pump the molasses/water mixture from the tank. When no more of the mixture could be removed, his coworker indicated that a sufficient quantity of the molasses/water mixture had been pumped from the tank. The coworker stepped away, and several minutes later, noticed the decedent preparing to enter the tank. At the top of the tank was a 15-inch hatch opening. After some discussion, the coworker, who told the decedent not to enter the tank, agreed to “spot” the decedent while he entered the tank to rotate the drain pipe to the “down” position in order to be able to pump more of the mixture from the tank. To enter the tank, the decedent placed a lift truck in front of the tank and raised the forks to a position so the forks were straddling the 15-inch opening. Suspended from the mast and the forks were two cargo tie-down straps. The decedent donned a pair of full-length waders and a full-face respirator equipped with ammonia cartridges and rappelled to the base of the tank to reposition the drain pipe. He pushed the drain pipe into position, and then attempted to climb out of the tank by holding the straps and placing his feet on the side of the tank and pulling/walking up. The decedent twice attempted to climb out of the tank. The coworker observed the decedent become unresponsive and attempted to pull him out of the tank, but was unsuccessful. The spotter then ran to the firm’s office and emergency response was summoned. Firm personnel used a circular saw to cut a 4-foot by 4-foot hole in the tank. Two employees entered the tank and found the decedent submerged in the mixture. They pulled the decedent from the tank and began CPR. Emergency response personnel arrived and the decedent was transported to a local hospital where he was declared dead.
MIFACE identified the following key and possibly contributing factors:
- The business did not have a permit-required confined space program in place, and consequently workers had no training in confined space hazards, entry, or rescue.
- The hatch door was not locked, which provided unrestricted entry into the molasses tank. The atmosphere of the tank was not tested prior to, or monitored throughout, entry.
- Employees were not empowered to prohibit the entry of coworkers into a confined space.