Level I Accident Investigation Report - Employee Fatality on the Bandon-Rogue No. 1 115kV Line

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Publisher:  U. S. Department of Energy - Bonneville Power Administration, Portland, OR

Published As:  Public


Topics:  Electrical, Contracts and Procurement, Operations, Construction/Project Management, Quality Assurance, Training and Qualification

On July 30, 2013, a Crew Foreman climbed up to the top of switch stand to attach lift slings suspended from a crane. Once the lift slings were placed and pulled up snug, the foreman positioned himself to assist in the removal of the blade end sectionalizing jumper and made contact with a difference of potential across the blade end insulator stack.

The on-site crew heard the foreman yell, and the Equipment Operator saw an arc and noticed that foreman had fallen back into his work positioning belt and harness. While 911 was called, other crew members began to initiate rescue operations. Using a bucket truck, the foreman was lowered to the ground, and positioned for cardiopulmonary resuscitation. He was then transported by ambulance and pronounced dead at Curry General Hospital in Gold Beach, Oregon.

The Board concluded that the root cause of the accident was the crews failure to establish an equipotential zone prior to performing work.

Lessons Learned While the job briefing and Task Hazards Analysis (THA) completed on the day of the accident met the requirements of Company Safety Manual, the Hazard Control Measures were not performed by the Crew at the worksite. THAs reviewed for the month of July had instances of incompleteness and lacked the rigor expected for the line work being performed. A difference of opinion was not elevated for resolution which contributed to inadequate grounding and bonding to establish an equipotential zone.

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