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What happened?
The turning brake on a crane was identified as faulty at the beginning of operations.
After a mechanic made adjustments to the system, an operational test was started to verify the effectiveness of the maintenance.
To test the turning brake, the crane needed to perform a turning motion.
To avoid the crane’s ball weight hitting anything during the turn, the crane operator elevated the crane’s ball by 1.5m (5ft).
The load drum rotated to pick up the lifting cable.
The mechanic was pulled by the system, and was trapped between the hoisting cable and the moving drum.
He suffered head and body injuries, dying at the scene.
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Why did it happen?
No permit to work (PTW) in place.
No specific step-by-step procedure for crane maintenance and safety measures.
The anchorage point for the harness was not defined.
No energy isolation plan in place.
Tolerance to deviations in crane maintenance activities execution.
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What did they learn?
Ensure procedures for crane maintenance activities are in place and followed.
Perform risk assessments to identify the risks and ensure safety measures are in place.
Enforce PTW requirements and audits.
Ensure PTW issuers are trained to use the systems and personnel request permits for their tasks.
Leadership plays an important role in the safety of the operations. Reinforce the importance of planning, risk analysis, procedures, and compliance.
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Ask yourself or your crew
What should they have done differently?
Do we have a step-by-step procedure for crane maintenance? What are the steps?
How do you confirm energy isolation during operational tests?
Do you understand the risks of the task you are performing today?
What safety measures do we have in place to prevent this from happening on our site? How can we improve?
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What happened?
The turning brake on a crane was identified as faulty at the beginning of operations.
After a mechanic made adjustments to the system, an operational test was started to verify the effectiveness of the maintenance.
To test the turning brake, the crane needed to perform a turning motion.
To avoid the crane’s ball weight hitting anything during the turn, the crane operator elevated the crane’s ball by 1.5m (5ft).
The load drum rotated to pick up the lifting cable.
The mechanic was pulled by the system, and was trapped between the hoisting cable and the moving drum.
He suffered head and body injuries, dying at the scene.
Why did it happen?
No permit to work (PTW) in place.
No specific step-by-step procedure for crane maintenance and safety measures.
The anchorage point for the harness was not defined.
No energy isolation plan in place.
Tolerance to deviations in crane maintenance activities execution.
What did they learn?
Ensure procedures for crane maintenance activities are in place and followed.
Perform risk assessments to identify the risks and ensure safety measures are in place.
Enforce PTW requirements and audits.
Ensure PTW issuers are trained to use the systems and personnel request permits for their tasks.
Leadership plays an important role in the safety of the operations. Reinforce the importance of planning, risk analysis, procedures, and compliance.
Ask yourself or your crew
What should they have done differently?
Do we have a step-by-step procedure for crane maintenance? What are the steps?
How do you confirm energy isolation during operational tests?
Do you understand the risks of the task you are performing today?
What safety measures do we have in place to prevent this from happening on our site? How can we improve?
A mechanic was fixing a crane’s turning brake. During testing, he was pulled by the system and trapped between the hoisting cable and the moving drum. His injuries were fatal.
