SAFETY FLASH PETCHEM/SF/2019/35

Learnings from Accident

TITLE: LTI _ Electrical chain hoist failed and man basket fell from 16m height
What Happened?
On 06th Nov’19 at 11:35 am two grinders were working at 16m height on man basket. Both of the grinders
were using rope grab fall arrestors which was connected to independent lifeline (secondary fall protection
as suggested by safety team). Chain link of electrical hoist failed due which man basket (Suspended work
platform) fell from 16m height. One of the grinder got suspended on vertical lifeline at a height of 16m and
was rescued safely. Other grinder got entangled with the wire rope connecting the man basket got
suspended at 5m height. Both the workers were taken to OHC and was latter referred to Bathinda for further
treatment.

Electrical chain hoist Man basket Failed chain Link

What went wrong?

× Selection of equipment & design:
o Electrical chain hoist was not designed for man basket operation.
o Man basket design: It become unbalanced due to oversize which led to failure of limit switch
actuator mechanism (collar just above the hook block got stuck) & failure of 3rd chain link.
× Healthiness of electrical hoist: Periodic inspection and maintenance schedule of electrical hoist was
not in place.
× Competency of Operator: Operator tried to lift the man basket beyond the maximum limit.

Key Learnings
 Selection of lifting equipment shall be done based on the job requirement. i.e. Lifting men/material.
Use gravity limit switch for electrical hoist to cut hook movement in up direction at least 400mm from
the hoist body.
 Man basket design: Man basket shall be designed taking into consideration safe sling angle (not be
more than 60Deg). Man basket design and approval shall comply with HMEL Addenda 9118-HSE-SI-
001– Safety instructions for Cranes & Rigging.
 Inspection check & preventive maintenance: Limit switch cut off and emergency switch cutoff
operations to be inspected as per checklist (provided by OEM) on daily basis before starting hoist
operations. Lubrication to done on weekly basis in all chain and shall be recorded.
 Operator Training: Operator for man/material handling should be trained for limit switch and
emergency switch operation.
 Severity of the incident got reduce due to
o Use of independent secondary fall arrest system (Independent lifeline with rope grab)
o Use of safety harness with shock absorber reduced the impact during the fall.