While installing mainline piping for residential development in Castle Pines, CO an employee fell onto bedding while descending a ladder into a trench box. The ladder was extended above the box 8 feet and not secured at the bottom; being only hooked over the trench box ladder hook on the left side facing the run. As he mounted the ladder on the trench side it pivoted, he lost his balance and fell into the trench. Fortunately, the injured person was not seriously hurt being able to complete the day’s work afterward.
Overnight he was sore requesting and received medical treatment the following day, given two doses of prescription pain medication by the physician. Due to an oversight, he was not D&A tested although per policy he was required to do so. The Foreman and Laborer were both given disciplinary warnings. The laborer stated he had a close call earlier with the ladder pivoting due to not being secured, but failed to act on it. This is an OSHA Recordable Injury Incident.
Procedure or Practice not Fully Developed: During the investigation it was determined that a Safe Work Practice (SWP) did not exist for the routine task of assembling and using the trench box and access. A SWP is needed so all persons understand what is expected of them to work safely.
Incomplete Training/Communication: Failure to Utilize STOP Work, See Something Say Something (SSSS) or Speak-Up Listen-Up (SULU) practices by the craftsman and his co-worker present to secure the ladder after having a close call earlier in the day. Trench ladder use is considered routine and was not addressed in the Daily Toolbox. Toolbox talks are to capture routine tasks as well as new ones.
Incomplete or Inadequate Inspection: The Trench and Excavation Inspection form was competed but not thoroughly. The section addressing on safe access was not adequately looked at for ladder securement, and a clear access transition onto/off of ladder adjacent to the trench box.
> Prepare a (1) Safety Alert and (2) Safe Work Practice to share with work crews via Tailgate Topics and onsite Awareness. Discuss implementing SWP at next Foreman’s Meeting. Require all ladders to be secured with a safe access landing.
> The fall was significant and should have resulted in immediate notification to supervision and the employee being evaluated by a doctor. The D&A policy requires testing when employees are seen by doctor. Review policy with employees, Foreman and Supts.
> Update the FSI Trench & Excavation Form to add detail to the access and trench box set up portion. Have ready for next Foreman’s Meeting.
> Supervisors and HSE staff to document review of T&E Inspection form and all ladder usage as part of the Routine Safety Site Safety Inspection.
> Look into alternate ladder attachments, ladder types, and available equipment for double stack trench box applications.