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Technician fatalities

Country: RUSSIA - Russia & Central Asia

Location: ONSHORE

Incident Date: 12 September 2021   Time: ---

Type of Activity: ---

Cause: Struck by

Function: ---

What happened?:

An IOGP Member has alerted us to two separate incidents, both with fatal outcomes and related to maintenance/changing of tyres on vehicles. The incidents represent opportunities to highlight risk areas that were insufficiently recognised in our industry.

On September 12, 2021 a contracted tyre technician was fatally struck by a heavy vehicle tyre and a tyre rim which ejected after a sudden failure. On December 23rd, 2021, an employee was fatally struck by a heavy vehicle tyre rim during maintenance.

Both incidents happened during routine activities in controlled logistics environments. The trucks involved were heavy and had been used in rough terrain. Tyre inflation pressures were as per manufacturers' recommendations, in the order of 130 psi.

In the first event, a new tyre was already mounted on the one-piece rim after having been previously inflated inside a safety cage, and it was resting outside the cage waiting installation on a truck. A maintenance technician noticed some air leaking from it and approached it. While the technician was inspecting/troubleshooting the tyre the wheel parted, releasing the rim which hit the technician on the head.

In the second event, a driver was loosening the lug nuts of a heavy vehicle wheel that had been reported defective by a previous shift driver, with the intention of replacing it with a spare. The rim catastrophically failed and cracked in two, releasing the tyre and part of the rim with explosive force and projecting the driver several metres away.

Following the incidents, prior damage was noted on the tyre rims in both cases. This may either have occurred through wear and tear during rough terrain driving or potentially through driving with a partially deflated tyre. Subsequent wider inspection of tyres and tyre rims revealed that such cases are not limited to the incident vehicles in isolation.

What Went Wrong?:

  • In both incidents, workers were in the Line of Fire from a pressure hazard and had not recognised this as a risk.
  • In both incidents, the tyres were not deflated prior to troubleshooting task commencing.
  • In one incident, substandard practice was noted, in that the wheel was removed from its cage without inspection of the rim seat area.
  • In both incidents, tyre rim damage had been sustained and not recognised. Subsequent inspection of other vehicles found cases of cracks and damage.
  • In first incident, OEM recommendations for tyre rim inspection had not been followed.
  • In the second incident, learnings from the first incident had been insufficiently embedded.

Corrective Actions and Recommendations:

  • Reinforce Line of Fire awareness with all personnel and the importance of avoiding body positioning in the of line of fire.
  • Procure and raise awareness of tools and methods that enable humans to perform any activities related to tyres, such as inflation and deflation, away from the Line of Fire.
  • Perform immediate tyre and tyre rim inspections across the fleet of vehicles and verify inclusion of both tyres and tyre rims in vehicle inspection programs.
  • Reinforce the hazard of tyres and tyre rim damage through reflective learning or similar activities.
  • Raise awareness of the need to deflate tyres before removal from the vehicle.
  • Raise awareness of the general risk of pressure release from tyres and different modalities where such release can occur.
  • Attain a deeper understanding of tyre rim construction, types and inspection requirements as per OEM recommendations.
  • Reinforce the requirement to monitor for weak signals with respect to tyre and tyre rim construction during driving. Stop the job in case anomalies are noted.
  • Reinforce the availability of Learnings from previous incidents.

Figure 1: September incident


Figure 2: December incident


Safety Alert number: 331
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