Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, FACE 83-008, 1983 Jan; :1-4
On July 12, 1983, an electrician was electrocuted while replacing a switch on a coal sampler at a coal fired powerplant. The victim was a class-A electrician with about 10 years of experience. The victim, who was working alone replacing a coal sampler limit switch, was found by other employees laying on the ground next to a pack of cigarettes. Based on physical evidence and the patterns of burns on the victim's hands it was theorized that after connecting two of the three wires in the limit switch the victim may have tried to pull the third wire, which was carrying about 220 volts, further out of the conduit and the bottom of his hand contacted the limit switch completing the circuit. The amount of voltage was not considered enough to kill the victim instantly; however, it was considered that a cardiac arrhythmia resulted making the victim uncomfortable and he decided to sit down and smoke a cigarette when he died. The cause of death was determined to be electrocution. It was concluded that the major etiologic factor for this fatal incident was the failure of the victim to follow standard procedure for lockout of electrical power. It was recommended that the importance of lockout procedures be emphasized and enforced.
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