Date of incident: May 2021
Notice of incident number: 2021186430009
Employer: Wire manufacturer

Incident summary
At a wire manufacturing facility, a young worker walking in a rod yard was struck by an articulating forklift truck that was carrying spools of wire. The worker sustained fatal injuries.

Investigation conclusions

Cause

• Worker struck by forklift while in operator’s blind spot. The worker was walking through the rod yard when struck by the forklift. The forklift operator did not see the worker and it is not known why the worker did not or could not avoid the forklift.

Contributing factors

• No separation between pedestrians and mobile equipment. There were no designated pedestrian walkways in and around the incident location. The employer’s hazard assessments and safe work procedures stated that pedestrians must stay within the designated walkways, stay alert at all times within the plant, and make eye contact and communicate with the operator of mobile equipment before walking into high-traffic areas. The lack of designated pedestrian walkways in the rod yard resulted in pedestrians and mobile equipment working in close proximity to each other, and greatly increased the risk of a worker being struck by mobile equipment, as occurred in this incident.
• Inadequate health and safety program. At the time of the incident, the employer’s health and safety program was not fully implemented. Worksite inspections of the rod yard were not carried out, safety meetings were not regularly conducted, and the hazards of operating mobile equipment, in particular the hazard of collisions between pedestrians and mobile equipment, were not adequately controlled. The hazard identification and risk assessment conducted for the rod yard did not result in appropriate steps to mitigate the hazard of mobile equipment and pedestrians. Instead, the employer relied on administrative procedures (e.g., making eye contact and communicating with the operators of mobile equipment) and PPE (e.g., wearing personal protective equipment such as high-visibility vests), which are not the most effective types of controls in the hierarchy of controls. An adequate health and safety program would not only have identified these hazards in its written materials but also would have recognized those hazards in its work areas and work practices and would have eliminated or controlled them.

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