Coordination and communication absent in fatalityTue 28 Sep, 2010
www.shponline.co.uk | 27th September 2010
The death of a worker, who was overcome by poisonous gas fumes during the delivery of chemicals to a well-known food manufacturer, has culminated in fines totalling £350,000.
Leicester Crown Court heard that Walkers Snack Foods Ltd had commissioned a new starch reclamation unit, which converts waste starch into food-grade material used in the manufacture of snack foods. Chemical distributor Omnichem Ltd had already made several deliveries to the new plant, which was based at Walkers’ site in Beaumont Leys, Leicester, before the incident occurred on 19 July 2006.
Omnichem employee, John Marriott, 59, was driving a lorry containing four steel tanks, two with sodium chlorite and two containing hydrochloric acid. While transferring the two chemicals from his vehicle to the reclamation plant, Mr Marriott inadvertently mixed up the hoses on the tanks, resulting in the formation of green fumes of chlorine dioxide.
When he realised his mistake, Mr Marriott halted the transfer and started to hose the area down. No one from Walkers was on site to supervise the operation and Mr Marriott remained in the area for about half an hour as the gas cloud dispersed, breathing in the poisonous fumes. He was eventually taken to Leicester Royal Infirmary, along with an employee from Walkers who had tried to help him clean the area.
The Walkers’ employee suffered breathing difficulties and was in hospital for 30 hours before he recovered. But Mr Marriott’s condition gradually deteriorated; he died from the effects of the gas a month later on 17 August.
Principal Inspector Sue Thompson told SHP that the delivery arrangements were marked by a failure by the two companies to communicate and coordinate effectively with each other.
No one from Walkers was responsible for receiving the delivery and taking charge of the transfer operation, said the inspector, and the company was not informed about the chemicals being delivered, or of the risks involved.
She remarked: “Employees who had tried to help Mr Marriott did not know the type of operation that was being carried out, nor the nature of the gas being released. They had no appropriate training and they had no idea what to do.”
Walkers also had no plans on how to evacuate in the event of a chemical emergency. This meant that employees were present in the area for about an hour after the gas cloud had formed before they were evacuated.
Omnichem also failed to coordinate with Walkers about the nature of the delivery and the risks involved. It failed to undertake a site-specific risk assessment and its systems and procedures should have ensured that someone from Walkers was on the site to supervise and sign off the delivery.
Added PI Thompson: “There were insufficient written procedures for deliveries of chemicals and for the receipt of chemicals, and the tanks were also insufficiently labelled.”
Walkers Snack Foods Ltd was fined £200,000, with costs of £38,971, after pleading guilty to breaching sections 2(1) and 3(1) of the HSWA 1974. Omnichem Ltd admitted the same charges and received a £150,000 penalty, along with costs of £29,229.
Following the incident, Walkers put in place emergency procedures to deal with chemical incidents. It also eliminated the potential for the tank hoses to be mixed up by introducing a system so that only one chemical is delivered at one time. Omnichem audited its procedures and has since made them more robust, as well as committing to undertake site-specific risk assessments when delivering chemicals.
Summing up the case, PI Thompson said: “This incident was entirely preventable. Basic risk assessments and clear procedures could have avoided Mr Marriott’s tragic death but, as it was, there was a catalogue of serious failings.”
Underlining the importance of coordination and cooperation during deliveries of this nature, she warned companies to make sure they know who is coming on to their sites and what work-related risks are involved.
The October 2010 issue of SHP will carry a feature by legal experts at Pannone on communication between transport and logistics firms.