Welcome to the June 2011 OH&S Newsletter
This month we examine the need to challenge what we think we know about our OHS risk especially when focussed on culture & statistics; psychology, lifeboats & booming industries; warning action, poor IT and monitoring; plant due diligence, forklifts & absenteeism; assumptions & cancer……....Enjoy!
Are our business leaders concentrating on the wrong areas in their safety leadership programs?
Last month we discussed the variations in the safety perceptions of CEO’s, senior executives &boards & others employed by companies. This last month we have been involved in a number of discussions with company leaders in relation to OHS & what is amazing is the perception of what matters in OHS leadership. The behavioural safety team have convinced most companies that the only challenge to OHS is managing safety culture & behaviours. What are being missed here are the behaviours of those making decisions about safety & the processes they are following. Much of this has to do with the skills our leaders & decision makers have to interrogate HS information particularly that relating to risk rather than incidents. Significant safety disasters including Fukushima nuclear plant, Pike River & Upper Big Branch mine explosions & Deepwater Horizon/Montara offshore fires/spills have all shown management systems failures (specifically design & maintenance processes) caused these & not the behaviour of those on the shop floor.
So much effort has focussed on the behaviours of personnel that little attention has been paid to our ability to actually systematically manage HS risks. The focus is on whether a contractor is exhibiting the right behaviour & following a JSA without actually checking if the JSA has identified appropriate risk management approaches. Has the structure been constructed properly by personnel exhibiting the right safety behaviours when we don’t even know if the designer had considered the risks of construction or worse still our design advice does not come in until have we have built critical parts of the facility. The question should not be are our behaviours & culture OK in isolation but what are our risks, how do we manage them, how do we know that works & does our culture support this approach at every level in our organisation. Does the CEO understand the risks on your shop floor & the barriers to managingg them effectively? What happens at your workplace?
Damn lies and statistics!
One area our senior managers need to be clear on is how their internal statistics are calculated & how those they are benchmarking against are collected. It would appear that we have had some difficulties in getting a good understanding of our injury statistics in Australia as many go unrecorded or are recorded in a different area often giving a false impression of improvement. For example, Safe Work Australia (SWA) has just revised its fatality statistics for 2008- 9 based on more data being incorporated to get a more reflective figure of fatality statistics. In its annual workplace death statistics, SWA initially reported that there were just 151 workplace deaths in that period. It says that the figure failed to take into account all deaths, including those travelling to & from work, to bystanders, as well as workers who were no longer employed but who died as a result of an injury or disease that arose from work.
When these workers were also taken into account, SWA revealed that of the 444 work-related traumatic injury fatalities in Australia during 2008–2009, 286 (65%) were directly injured at work (working fatalities); 117 (26%) while travelling to or from work (commuting fatalities) & 41 (9%) as a bystander to someone else’s work activity (bystander fatalities). It also revealed that this equated to 2.6 work-related deaths/100,000 workers. The figures showed that truck driving was easily the most dangerous occupation when it came to raw figures. One in five of those fatally injured while working in 2008–2009 worked as a truck driver (59 deaths) which is a fatality rate 14 times the all occupations rate. Meanwhile, more than half (54%) of those fatally injured while working in 2008–2009 were employed in four industries: construction (44 deaths); road freight transport (44); agriculture (41) & manufacturing (25). Men were far more likely to die as a result of work than women with 92% of all deceased workers being male & their death rate of 4.4/100,00 workers more than 5 times higher than that for their female counterparts (0.8%). However, females were far more likely to die as bystanders with 41 deaths recorded compared to 25 for men. Finally, SWA said that while 117 commuter deaths were reported, there were real limitation in the data & that it was a “known undercount”. This does make it difficult to make meaningful comparisons but should also make most senior executives question what OHS figures they are receiving actually mean and how well vehicle risks are managed?
The importance of thinking through psychological implications of tasks you ask personnel to do!
A recent case has highlighted the damage that was caused to a Queensland miner who liaised with the "shocked" families of workers killed in a major mine disaster. The Commission allowed the receipt of compensation for a psychological injury, after finding his employer failed to offer him training, direction or support for the difficult task.
In early 2008 the Anglo Coal employee, who worked through the Moura mining disasters of 1975, 1986 & 1994 heard rumours that the mine where the most recent disaster took place, entombing 11 workers, was going to be reopened. He made inquiries & found further mining had been proposed, & preliminary drilling near a supposed exclusion zone had already commenced. The miner, a union official, met with managers to express concerns about a potential community backlash. When someone suggested the community could be informed via a notice in the local newspaper, he offered to liaise with families directly. The offer was accepted. The worker said responsesfrom the families he spoke to included "shock, horror & anguish", & that many assumed he had known what was going on and approved of it.
His psychiatrist said that prior to the events of 2008, the worker was vulnerable because of the previous tragedies he experienced at the mine, but he had "coped with his symptoms by dedication to his work"until he heard rumours about the exclusion zone & began consulting with the community.
The miner was later diagnosed with major depression, and sought workers' compensation. Q-COMP rejected his claim, and he appealed. Before Industrial Relations Commissioner Thompson, the employer said it only planned to mine near the entombed miners, & that its initial decision to mine, & response to the worker's concerns, constituted reasonable management action. It said its failure to consult with the community earlier in the process was "simply a blemish".
Commissioner Thompson found the employer showed a complete disregard for the community's "obvious sensitivities" to its proposal, & it was the worker who "copped a backlash" from the families. They did not suggest that it would be appropriate for a member of staff to accompany him and made no offer to provide any assistance by way of training that may have been of benefit even though basic training is provided to staff who visit the family of a deceased person following a fatality at the mine. He also received no direction from his employer as to what to tell the families. How well do you prepare your employees for tasks with potential psychological impact even though those employees may be willing to do these?
Fredrick Hempseed AND Q-COMP (WC/2010/5)
Have we not learnt from the Titanic’s’ life boat debacle?
Last month saw a release of an alert by the Australian Offshore regulator of 9 enforcement actions in 4 months on facility operators regarding the general condition of some Totally Enclosed Motor Propelled Survival Craft (TEMPSC) currently in use offshore. This is of particular concern when this is one of the few industries booming in Australia. The actions focussed on the lack of effective routine maintenance and inspections being conducted. TEMPSC were identified with damaged or broken safety harnesses, unsecured and loose items, and illegible safety and operating instructions. A shortfall in the competencies of personnel assigned to essential lifeboat duties was also noted. There were also concerns that some facilities’ induction processes do not provide personnel with suitable familiarisation of assigned lifeboat locations & procedures. The expectations of & by personnel during preparation for the boarding process, for example, was also not always clearly illustrated in the induction.
For many facilities these devices are the primary means of evacuating the facility. Delays in the launching of TEMPSC due to a lack of familiarisation with location or procedures could be the difference between a successful controlled departure and an uncontrolled abandonment. The ability by personnel to understand and observe boarding arrangements, secure the craft for launch and progress the launching of the TEMPSC itself are all critical to an effective evacuation. These devices are designed to protect personnel during the evacuation process but can clearly not complete this function if they are not maintained and personnel do not known how to interact with them. How well are your personnel prepared to use your safety critical gear and has it been adequately maintained?
What happens when we combine a booming industry, high production pressures with huge plant & quick shift changeovers?
We have changeover personnel who do not take the time to complete thorough pre-start checks, cannot use normal options to ensure a safe working area, & do things in such a hurry they forget basic practices. Last month the QLDs Mining department produced an alert of 2 incidents involving hot seat changeovers where in the first an oncoming dump truck operator parked his light vehicle in the exclusion zone that was out of the line of site of the dump truck & then proceeded to run over this vehicle once instilled on the dump truck. An alarm from nearby plantprevented him being able to hear the proximity warning device on his own truck as he drove over the light vehicle. In another, an oncoming operator was unaware the dump truck was being refuelled & drove away with the fuel line still attached!
Do you act on warnings?
A NSW coal mine has been fined $180,000 for a safety incident that occurred just weeks after it was directed to redesign the "dangerous" task involved. In September 2008, three members of the mine's night shift crew were moving a 61-tonnne, track-mounted continuous mining machine back from the cutting face, when it accidentally slewed and crushed one of them against the rock wall.
The worker sustained serious injuries, and Gujarat NRE Coking Coal Ltd was charge with and pleaded guilty to a breach of the State OHS Act. In the Industrial Court, Justice Kavanagh heard the continuous miner was powered by an electrical cable that had to be manually loaded each time the machine advanced or retreated. It was common practice for two miners to wait against the wall of the mine while the operator used a remote control box to reverse the machine. When it stopped they threw the cable onto hooks on the machine's side and over its cutting head.
On the night of the incident, the operator began to reverse the machine with the remote control while walking backwards behind it, when he tripped and fell and the machine slewed to the right, trapping the injured worker between the cutting head and the wall. Justice Kavanagh heard that only 3 weeks previously a mine safety officer had watched the cable-loading practice taking place, & had notified the employer that all face crews needed to be told it was dangerous and that the procedure must be reviewed. No such review or communication took place. Justice Kavanagh also heard the employer had two "near misses" involving the practice in 2007.
She said that while the company had in place a remote control machinery plan that identified the need for a 2 m "no go" zone around the continuous miner, the plan failed to provide a safe work procedure for crews. Toolbox meetings had referred to "no go" zones, but they were not defined. Justice Kavanagh said this was "a most serious incident where basic site safety procedures were not in place before a very normal mining task was performed on a regular basis. The risk was known and unfortunately became a reality”. In handing down what was a large fine for a case that did not involve a fatality, Justice Kavanagh said "the mining industry requires extra vigilance and rigour from its employers in the performance of mining activities which are inherently dangerous tasks". Do you have effective procedures in place for your routine higher risk tasks? Does anyone follow these/ how would you know?
Regan v Gujarat NRE Coking Coal Limited [2011] NSWIRComm 71
Is poor IT affecting your monitoring? Are your insurers providing you with the service you want?
Generally workers compensation insurers provide their clients with good service however there is always a need for regulatory monitoring through efficient IT systems & this case is a good example where WorkSafe Victoria has committed to modernising its IT systems & holding its insurance agents to account. The state Ombudsman found agents had withheld payments from injured workers, stymied the return-to-work (RTW) process & rorted the scheme. One of their agents, CGU, had hidden about 10,000 invoices in a locked cupboard in order to obtain lucrative WorkSafe incentive payments. He also found that all of the agents had breached privacy rules, in sending medical reports to the wrong claimants or employers, & including personal information on file covers.
WorkSafe has 6 authorised claims agents: CGU, Allianz, Gallagher Bassett, GIO, QBE & Xchanging, which cover injured workers' weekly benefits, medical treatments, ambulance transport & personal & household help. WorkSafe paid the agents more than $212.5 million in fees in the 2009/10 financial year. In his report, the Ombudsman says he decided to investigate the record keeping & administrative practices of the agents, after complaints against them increased by 27% in 3 years. These included concerns about having to repeatedly submit the same documentation to the agents & delays in service that caused. In one case, an injured worker had to wait months to receive more than $20,000 in back pay, because Xchanging lost her documents & maintained only minimal records of her claim. In another case, a worker who required a kidney transplant because of a work-related illness, & was unable to walk to the bathroom, had to wait more than a year for Gallagher Bassett to act on a claim for the costs of home modifications.
Poor record keeping also allowed CGU to manipulate incentive measures for nearly a year before the ruse was detected, the Ombudsman says. CGU, in hiding thousands of accounts & processing them when convenient, benefited by $2.5 million in inappropriately obtaining incentives & avoiding penalties for failing to meet "timeliness targets". It has since been fined $2.8 million, & ordered to repay the money. Some CGU senior managers were found to be complicit being able to do this due to inadequate record keeping systems hindering WorkSafe's monitoring of CGU by "inadequate" & "antiquated" IT systems, including "ACCtion", which was developed in 1985.
It was found that despite having an annual audit program WorkSafe has failed to identify & therefore rectify or enforce some of the most basic record keeping issues. The report concluded a more transparent & accountable system by which WorkSafe can accurately measure the performance of their agents regarding the timeliness of payments is needed as a minimum!
How thorough is the due diligence we do on plant we purchase?
This case described by the Australian Transport Safety Bureau provides a good example. At about 0700 Western Standard Time on 16 August 2010, a Fairchild Industries Inc. SA226-TC (Metro II) aircraft, registered VH-NGX, departed Perth Airport on a charter flight to Fortnam Mine, Western Australia. On board the aircraft were the pilot and 10 passengers. The aircraft was climbing through flight level 205 when the right cockpit side window suddenly failed and the cabin rapidly depressurised. The pilot put on his oxygen mask, activated the passenger oxygen system and transmitted a distress call to air traffic control. He commenced an emergency descent to 9,000 ft & returned to Perth. There were no reported injuries to the aircraft occupants and the aircraft sustained minor airframe damage as a consequence of the window failure.
The investigation determined that the window failed as a result of cracks that had propagated laterally between the retainer holes along the upper edge of the window & significantly weakened its structural integrity. Inspection of the aircraft logbooks determined that the failed window was fitted as an outer window in 2006 by the previous aircraft owner. However, is was found that the window was manufactured & supplied as an inner window only, was of reduced material thickness, & was not designed to safely withstand cabin pressurisation loads. The work practices during the installation of the incorrect window & its reduced material thickness contributed to the window's deterioration & failure under pressurisation loads.
The investigation did not identify any organisational or systemic issues that might adversely affect the future safety of aviation operations. What do you know about plant that you purchase & how it was maintained, possibly modified or altered?
How well do you supervise what your forklift drivers do?
Well this employer will be paying much closer attention after having to pay a damages bill in excess of $700 000 to a worker who was seriously injured in an incident caused by a negligent, unlicensed forklift driver. The driver was moving an unsteady and unsecured load, when a 220kg pallet fell and hit the worker, crushing his right leg.
District Court Judge Levy heard that at the time of the June 2006 incident, the worker was helping unload a shipping container of spare parts at a warehouse operated by TVH Australasia Pty Ltd. His task was to guide the tines of the forklift, which had been fitted with metal extension slippers, into the correct position so they would not go further than the pallet to be lifted. He said he had never done the job before, had not been trained to do it, and had not been told that the driver was unlicensed. The worker contended that the loads on the pallets were tall and top-heavy and packed on plastic pallets that were "flimsy and unsuitable". The cartons were not tied together or tied down.
He said the load was resting on the tips of the extended tines, rather than against the loading board, when the forklift driver reversed down a ramp out of the shipping container. The bottom carton of the load collapsed and the boxes fell on him. When he looked at his leg, his right foot was hanging off to one side and broken bones were protruding through his skin.
Judge Levy found the incident would not have occurred if "common sense was applied" to secure the load and place it in a more stable position before moving the forklift. The worker should have been warned to stand clear. Having found the employer responsible for the negligence of the forklift driver, Judge Levy went on to find the injury compensable under the State Motor Accidents Compensation Act, because when the load toppled the "predominant action" was one of driving rather than loading.
The worker was cleared of any contributory negligence, as the duties given to him were only to guide the forklift driver. Judge Levy made it clear it was the responsibility of the forklift driver not to move the vehicle until he was sure the load was secure & that "bystanders would not be injured as a result of his driving". How do your forklift operators drive do they secure their loads well?
Chaseling v TVH Australasia Pty Ltd [2011] NSWDC 24
Good case for workplace health programs to reduce absenteeism !
US researchers have found that weight management & quit-smoking programs conducted at the workplace could significantly reduce the high cost of absences linked to musculoskeletal disorders (MSDs). They tracked the absence history of 6551 full-time employees at several Shell refinery and petrochemical facilities, using the company's health surveillance system aiming to identify risk factors for MSD absences that were not caused by workplace injury.
The study found 860 employees took sick leave of four days or longer because of non-occupational MSD during the four-year follow-up period. These MSDs were responsible for the most absences taken, and accounted for over a third of all work days lost. The analysis showed obesity was a major risk factor for low back and non-low back MSD absence, and that smokers had significantly increased low back MSD and were more likely to take longer off work. The risk of MSD absence was 3 times higher for employees who had had a previous absence due to MSD. Chronic illnesses, such as cardiovascular disease, were also a risk factor, as was mental illness.
So if organisations could focus on weight reduction, non-smoking, stress management & personal fitness this would impact not only on work & non-work-related MSD, but also on the prevention of metabolic syndrome & cardiovascular illness. How much is obesity & smoking affecting illnesss in your workplace Shan, T et al, Risk Factors for Illness Absence due to Musculoskeletal Disorders in a 4-Year Prospective Study of a Petroleum-Manufacturing Population. J Occ Env Med. 53 (4) 2011
Think about your workplace risks!
WorkSafe Victoria has called on employers to change the way they think about safety, after issuing a 2118 improvement notices & 24 prohibition notices as part of its 12 month Safe Towns, Safer Work Zones campaign. Inspectors visited 1546 small businesses or workplaces in 13 regional & suburban areas. Worksafe commented that considering the businesses were given notice & information on the campaign, the high number of businesses that failed to address health & safety risks was very disappointing.
Do you assume your workforce is following your systems of work?
A NSW employer has been fined $100 K after admitting it had not considered the possibility that its system of work would not be followed exactly, after a 457-visa worker was killed by a falling object. In August 2008, two Byrne Group Management Pty Ltd (BGM) employees were fitting out the top level of a trailer when a steel beam fell off their work platform, striking one worker below, & narrowly missing another. The injured worker, a Chinese 457-visa holder who was not wearing a helmet, was taken to hospital by ambulance, but later died. The employer was also charged with & pleaded guilty in failing to ensure the safety of employees.
In the Industrial Court, Justice Marks heard the employer failed to:
- ensure staff did not access the area below the platform while others were working above;
- address the risk of objects falling between the edge of the platform & the trailer; &
- ensure workers wore hardhats when constructing trailers
It also failed to engage a qualified interpreter to ensure employees with limited English understood instructions, or appoint a supervisor to ensure work was performed safely. However, safety & warning signs were displayed in Mandarin for Chinese workers, & the employer had engaged an independent, part-time interpreter for the induction process. That would not help this employee however understand how this specific task should be done BGM's director accepted responsibility for the incident, but said demarcation lines were in place to ensure the area below the work platform was kept clear, & that the deceased employee should have been working away from where the beam fell. The circumstances surrounding the incident were "just not contemplated" because the company was "blind to the possibility" its planned work sequence and system of work would not be followed, the director said. Justice Marks agreed that if the director's methodology had been followed, the worker would not have been in danger. He said the director expressed genuine and sincere remorse, and was "physically and emotionally affected by the incident", which generated significant media attention and adverse publicity. After the incident, BGM fitted flaps to eliminate the gap between the platform and the trailer; engaged the Department of Immigration and Citizenship to provide an accurate interpreting service; retrained staff; and expressly prohibited staff from working beneath the platform when work was in progress above. How well does your workforce understand your systems of work?
Inspector Maynard v Byrne Group Management Pty Ltd [2011] NSWIRComm 72
Is your neighbourhood giving you cancer or do you just live near your workplace?
A Canadian study could support claims of occupational breast cancer, with its finding that there is a slightly higher risk of breast cancer among women who live close to certain heavy industries. The study detected small increases in the risk of the potentially fatal disease among women living near steel mills, thermal power plants, petroleum refineries and pulp mills.
According to the researchers, breast cancer accounted for 28% of all new cancer cases among women and 15% of all cancer-related deaths among women in Canada in 2009. They said that while environmental pollutants had been suggested as being linked to breast cancer, studies on the issue were rare. In this study, the researchers questioned nearly 5000 women, including controls, on their health background and lifetime residential history. It found that of the 2343 women with breast cancer, 59% had lived within 3.2 km of a heavy industry at some time in the previous 30 years, compared to 52.6% the control group.
The researchers said there was an increased risk of breast cancer for premenopausal women living within 3.2 km of steel mills and thermal power plants, and an increased risk for postmenopausal women living in the same proximity to petroleum facilities and pulp mills. They noted, however, that proximity to an industrial plant did not necessarily mean that the person had been exposed to contaminants. There is obviously a need for greater research but the study did not seem to address what the women did for work which could have also increased their risk as they may have been more likely to live near their workplace.
Sai Yi, P et al: Breast Cancer Risk Associated With Residential Proximity to Industrial Plants in Canada. J Occ Env Med, 53 (5) 2011.
Written by Julie Armour