How a simple instruction manual could have prevented this costly injury

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After a worker’s arm was crushed while removing a decommissioned x-ray machine at Dunedin Hospital, Southern District Health Board and Fire and Mech Contracting Limited were fined heavily for failing to provide  the manufacturer’s instructions

The incident occurred in May 2017 when Fire and Mech Contracting Limited asked a worker assisting with removal of the x-ray to help cut a wire rope to clear away the machine. A spring loaded system struck the worker’s forearm, causing a serious injury including a broken radius and ulna.

WorkSafe’s investigation found the Southern District Health Board failed to provide a copy of manufacturer’s instructions, including steps on safe removal, to those involved.

It also found that Fire and Mech did not seek out the manufacturer’s instructions, and that although its workers did have some experience in decommissioning machinery, they did not have experience with the x-ray machinery.

Reading instruction manuals thoroughly before working with complex machinery is an easy way to avoid serious injury, WorkSafe says.

Fire and Mech was fined $247,500 and the Southern District Health Board was fined $225,000.

This signals the first Crown Entity prosecution to be completed following changes to the Crown Organisations (Criminal Liability) Act 2002. These changes allow public sector agencies such as the Southern District Health Board to be subject to the same fines as any other business under the Health and Safety at Work Act 2015.

WorkSafe’s Head of Specialist Interventions Simon Humphries says avoiding injury in this instance was as simple as carefully reading manufacturer’s instructions and carrying out a detailed risk assessment.

He says the incident was easily avoidable.

“Had the Southern District Health Board provided instructions to those involved in the decommissioning, a competent person may have been able to mitigate any risks around removing this kind of machinery.

“Fire and Mech should have undertaken a comprehensive risk analysis to ensure work was completed safely. Because the workers were not experienced with this machinery, a worker has ended up with serious injuries.

Southern District Health Board

  • Reparation of $25,000 was awarded.
  • A fine of $225,000 was imposed.
  • Southern District Health Board was charged under sections 36(1)(a), 48(1) and (2)(c) of the Health and Safety at Work Act 2015.
    • Being a PCBU, failed to ensure, so far as was reasonably practicable, the health and safety of workers who worked for the PCBU, while the workers were at work in the business or undertaking, namely removing an x-ray machine and that failure exposed any individual to a risk of death or serious injury arising from the sudden release of an aluminium plate which was part of a spring counter balance system.
  • The maximum penalty is a fine not exceeding $1,500,000.

Fire and Mech Contracting Limited

  • Reparation of $25,000 was awarded.
  • A fine of $247,500 was imposed.
  • Fire and Mech Contracting Limited was charged under sections 36(1) (a), 48(1) and (2)(c) of the Health and Safety at Work Act 2015.
    • Being a PCBU, failed to ensure, so far as was reasonably practicable, the health and safety of workers who worked for the PCBU, while the workers were at work in the business or undertaking, namely removing an x-ray machine and that failure exposed any individual to a risk of death or serious injury arising from the sudden release of an aluminium plate which was part of a spring counter balance system.
  • The maximum penalty is a fine not exceeding $1,500,000.
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