Worker fatally injured while connecting shunt truck to trailer
Date of incident: May 2020
Notice of incident number: 2020177720011
Employer: General trucking company
Incident summary
At a trucking yard, a worker was operating a shunt truck (a semi-tractor intended to move trailers short distances) with a fifth wheel (a coupling assembly used for towing a trailer). The worker reversed the shunt truck toward a trailer to connect and move the trailer. With the shunt truck stopped but still in reverse gear, the worker exited the rear of the shunt truck onto the fifth wheel assembly, to connect the electrical and air lines. While the worker was standing on the assembly, the shunt truck inadvertently reversed into the trailer, crushing the worker. The worker sustained fatal injuries.
Investigation conclusions
Cause
- Fifth wheel missed kingpin connection due to insufficient elevation. The worker reversed the shunt truck to the trailer for connection. The fifth wheel was not sufficiently elevated on the shunt truck’s movable boom to come into full contact with the trailer’s skid plate (under the trailer, near the front). As a result, the kingpin (in the centre of the skid plate) missed the wedge-shaped opening on the fifth wheel and did not connect. When the worker was between the shunt truck and the trailer, the shunt truck continued to reverse and the kingpin began sliding along the fifth wheel. The worker became caught between the shunt truck and the trailer and sustained fatal injuries.
Contributing factors
- Shunt truck not adequately maintained. The shunt truck had several deficiencies and was not adequately maintained. The gear shifter was difficult to move to change gears. This may be why the shunt truck’s gear was left in reverse when the worker exited the rear of the truck to connect the electrical and air lines.
- Lack of work procedures. The employer did not have written procedures directing workers how to safely operate a shunt truck or connect trailers and did not instruct the worker not to leave the shunt truck in reverse when connecting the electrical and air lines.
- Inadequate supervision. The employer did not ensure that the worker was adequately supervised. How the work should be carried out was not communicated, and the worker’s competence with mobile equipment was not assessed to ensure it complied with the Occupational Health and Safety Regulation. In addition, the worker was not provided with a new worker orientation and a worksite orientation.
- Inadequate management of workplace health and safety. The employer did not have an occupational health and safety program and did not hold monthly health and safety meetings. Hazards and unsafe conditions, such as the maintenance of the shunt truck and lack of work procedures for operating the shunt truck, were not identified. These deficiencies, as well as the circumstances of the incident, demonstrate that the employer’s workplace health and safety management was inadequate.