Queensland government has released a mine safety alert regarding a service truck incident that resulted from failures within a braking system.
Safety Alert | Failure to Lockout
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A service truck had been travelling down a ramp. At the beginning of the ramp the service truck has been placed in second gear to control the speed whilst travelling down the ramp. The service truck operator has gone to apply the brakes to further slow the vehicle down. When this has happened the brakes have been ineffective resulting in the brakes not applying. The service truck operator has then steered the truck into a pile of material to stop the truck movement.
How did it happen?
- A spring brake chamber diaphragm had failed in operation.
- The air compressor for the air brake system was performing well below specification, therefore unable to maintain air pressure within the brake system, causing the rear brakes to drag, subsequently overheating and becoming ineffective. (Brake Fade)
- The exhaust brake was not functioning.
- The transmission retarder was not functioning.
- System defects were not identified as safety critical (stand down) defects by the operators.
- Identified defect repairs were not being repaired or scheduled in a timely manner.
Recommendations
All SSEs should review the SHMS to ensure:
- All defects in speed retardation or braking systems on mobile plant are identified.
- All mobile plant with defects in speed retardation or braking systems are removed from service until repairs are completed.
- Maintenance strategies are enacted to ensure air compressors on mobile plant are adequately maintained and warning systems (light, buzzer) are functional and accurate to identify system inadequacies.
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When I was with the QLD inspectorate I investigated a fatality and two serious injury incidents all with similar causal factors.
It is an abomination that problems with brakes and retardation systems on service and water trucks continue to be treated with less than satisfactory regard.
These are critical safety systems for @&$! sake.