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Maintenance mechanic died after falling approximately 30 feet from an elevated forklift platform in California.
Public Health Institute
Morgantown, WV: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, FACE 95CA001, 1995 Jun; :1-4
A 44-year-old, male maintenance mechanic (the victim) died after falling approximately 30 feet from an elevated platform (crow's nest) that was being lifted by a forklift. The crow's nest was 48" x 26", was equipped with a 36" protective rail, and was attached to the top of a 15' pole. The victim had requested that a coworker, who had not been trained in forklift operations, lift him so that the victim could inspect a lighting fixture. The coworker stated that when the victim finished his observation, he (the coworker) began to lower the forks. However, the fork carriage traveled up out of the inner rails, allowing the carriage to tilt forward at a 45 degree angle. Neither the victim nor the crow's nest were secured or tied off. The victim fell 30 feet to a table below, and the crow's nest fell on top of him. Coworkers summoned paramedics to the scene and the victim was taken to the hospital where he died approximately two weeks later on February 11, 1995 at 1:05 p.m. Examination of the forklift after the incident revealed that both stops that prevent the carriage from traveling up out of the inner rail were missing. One stop broke at the time of the incident. The other stop had been missing from the forklift for at least one year. No evaluation of the controls was performed after the incident so it is unknown if they were functioning properly. The victim had been employed with this company for three months. The employer had no provision within their Injury and Illness Prevention Program (IIPP) to ensure safe work practices. The CA/FACE investigator concluded that in order to prevent similar future occurrences, employers should: 1. have machinery and equipment such as forklifts inspected and serviced on a regular basis. 2. ensure safe work practices among employees by use of recognition, training, or discipline. 3. have a standard operating procedure (SOP) for the proper use of a crow's nest. 4. require that employees be adequately guarded or restrained when being elevated by a forklift.
Region-9; Accident-analysis; Accident-prevention; Accidents; Injuries; Injury-prevention; Traumatic-injuries; Work-operations; Work-analysis; Work-areas; Work-performance; Work-practices; Safety-education; Safety-equipment; Safety-measures; Safety-monitoring; Protective-equipment; Protective-measures; Maintenance-workers; Training; Personal-protection; Personal-protective-equipment
Field Studies; Fatality Assessment and Control Evaluation
NTIS Accession No.
National Institute for Occupational Safety and Health
Public Health Institute
Page last reviewed: May 5, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division