|Industry: Apple orchards||
Release Date: March 4, 2014
|Task: Operating tractor towing water tank||Incident Date: October 14, 2008|
|Occupation: Orchard laborer||Case No.: 08WA05301|
|Type of Incident: Tractor-related/Run over||SHARP Report No.: 71-128-2014|
A 43-year-old apple orchard tractor operator died when he was run over by the wheels of a water tank trailer.
On the day of the incident during the harvest, he was performing one of his normal job tasks. This task involved the operation of a tractor pulling a trailer-mounted, stainless steel 1,000 gallon capacity water tank to dampen the orchard’s compacted dirt and gravel roads to suppress dust while the apple pickers were working.
The orchard was located on a gradually sloping hill. The victim was driving the tractor with the attached nearly full water tank trailer downhill on an orchard road. The orchard road was constructed of dirt and gravel; it was straight, dry, and smooth with an approximate 1% slope. He was not watering down the road at this time. Investigators determined that what happened next was the result of the victim operating the tractor downhill in a gear ratio that was too high. This allowed the tractor to gather excessive speed. Due to the tractor’s speed and the weight of the trailer, the tractor brakes were not able to slow the tractor. The victim attempted to shift to a lower gear ratio, but the gearshift became stuck in the neutral position. This allowed for an uncontrolled descent. The victim then fell, jumped, or was knocked from the operator’s seat. After landing on the ground he was run over by the trailer wheels. He died at the scene.
Investigators found the water tank trailer separated from the tractor. A piece of broken wire was found in place of the required safety bolt on the trailer’s coupler. This wire broke either just before or after the victim came off the tractor, allowing the separation of the trailer from the tractor’s hitch. Also, the tractor did not have a rollover protective structure (ROPS) or a seat belt. It is possible that the victim could have survived if the tractor had a ROPS and he was wearing a seat belt.
Train tractor operators to understand and recognize the hazards associated with operating tractors while traveling downhill towing trailers, implements, and equipment such as water tanks and sprayers. This training should include how to safely operate the tractor and emphasize the importance of reducing speed and downshifting to the appropriate gear for the slope and terrain.
Statewide Statistics: This was number 54 of 72 work-related fatalities in Washington State during 2008, and was number 6 of 7 agriculture-related fatalities.
This bulletin was developed to alert employers and employees of a tragic loss of life of a worker in Washington State and is based on preliminary data ONLY and does not represent final determinations regarding the nature of the incident or conclusions regarding the cause of the fatality.
Developed by Washington State Fatality Assessment and Control Evaluation (FACE) Program and the Division of Occupational Safety and Health (DOSH), Washington State Dept. of Labor & Industries. The FACE Program is supported in part by a grant from the National Institute for Occupational Safety and Health (NIOSH grant# 5 U60 OH008487-09). For more information, contact the Safety and Health Assessment and Research for Prevention (SHARP) Program, 1-888-667-4277.
Publication #: 71-128-2014| March 4, 2014
Disclaimer and Reproduction Information: Information in NASD does not represent NIOSH policy. Information included in NASD appears by permission of the author and/or copyright holder. More