On June 29, 2004, a 34-year-old Hispanic flagger (the victim) died after being run over by a partially-filled dump truck. The victim was a member of a three-man crew filling drop-off areas along the shoulders of a secondary state road with a dirt/gravel mixture of unclassified stone, also known as UCL. The victim was flagging from a position on the passenger side of the ten-wheel dump truck, on the shoulder of the opposite side of the road. As the amount of UCL became insufficient to level the road shoulder, the driver-side worker motioned for the truck driver to stop the truck and raise the bed to allow more UCL to flow to the rear of the truck. When sufficient material to fill the low spots again began to flow, the worker motioned for the driver to pull forward. As the truck moved forward, the rear of the truck swayed and the driver-side worker again motioned the driver to stop. He then walked around the rear of the truck to the passenger side and discovered the victim underneath the two sets of rear tandem wheels. He called to the driver, who ran around the front of the truck to the passenger side and immediately called 911 from a cell phone. Emergency Medical Service (EMS) and fire personnel responded and used a jack to raise the rear axle of the truck and extricate the victim. Two emergency room physicians passing the scene stopped to assist the EMS personnel in treating the victim. The victim was transported by life flight helicopter to the hospital where he was pronounced dead by the attending physician. NIOSH investigators concluded that, to help prevent similar occurrences, employers should: 1. develop, implement and enforce a comprehensive safety and training program in language(s) and literacy level(s) of workers, which includes training in hazard recognition and the avoidance of unsafe conditions, including the identification of blind areas around construction vehicles; 2. ensure that roadway construction workers strictly adhere to the provisions on temporary traffic control set forth in the Manual on Uniform Traffic Control Devices (MUTCD); 3. consider the use of proximity warning devices such as radar and sonar based systems and/or rear view-camera systems to enable operators to detect when someone is near or approaching a vehicle or piece of machinery; 4. ensure that before each work shift begins, communications signals between machine operators and workers on foot are reviewed and confirmed; 5. consider instituting a progressive discipline program to reinforce the need for workers to follow established safe work procedures; and, 6. ensure that the nearest area office of the Occupational Safety and Health Administration is notified within 8 hours of a fatality or in-patient hospitalizations of three or more workers as a result of a work-related incident at their company.