DEPARTMENT OF LABOR
MINE SAFETY AND HEALTH ADMINISTRATION
ACCIDENT INVESTIGATION REPORT
(SURFACE COAL MINE - CONTRACTOR)
FATAL POWERED HAULAGE ACCIDENT
CONTRACTOR I.D. NO. CA8
SALYERSVILLE, MAGOFFIN COUNTY, KENTUCKY
SHOP BRANCH MINE #2 (I.D. NO. 15-17939)
LODESTAR ENERGY, INC.
IVEL, FLOYD COUNTY, KENTUCKY
MAY 22, 1998
COAL MINE SAFETY AND HEALTH INSPECTOR (SURFACE)
HOBERT WEBB, JR.
COAL MINE SAFETY AND HEALTH INSPECTOR
JAMES L. ANGEL
Originating Office - Mine Safety and Health Administration
100 Ratliff Creek Road, Pikeville, Kentucky 41501
Carl E. Boone, II, District Manager
On Friday, May 22, 1998, Robert C. Cooper, employee of Smith Patrick, was operating a 1976 DM-800 Mack truck at the Shop Branch Mine #2, Lodestar Energy, Inc., located at Ivel, Floyd County, Kentucky. The truck, loaded with an estimated 30 tons of coal, was traveling on the mine haulroad. Cooper apparently attempted but failed to shift gears on a 10% downgrade and was unable to stop the truck due to inadequate service brakes. The truck traveled a short distance through a drainage ditch and then onto the upslope bank. Cooper either apparently attempted to jump or was thrown from the overturning truck and was fatally injured when he was caught between the truck and haul road. This accident occurred because the service braking system on the truck was not properly maintained. Additionally, it was not designed for use with the payload being hauled at the time of the accident. Failure to provide adequate training for the victim was also a contributing factor.
The Shop Branch Mine #2, Lodestar Energy, Inc., is located at Ivel, Floyd County, Kentucky. Coal is mined from nine seams of various heights using the mountain-top removal method. Lodestar Energy, Inc., has another active surface mine (Ivy Creek Mine, ID NO. 15-17661), located adjacent to the Shop Branch Mine #2. The haul road where the accident occurred is common to both mines.
The Shop Branch Mine #2 opened on June 10, 1997. Sixty-four persons are employed on two, 10-hour production shifts. The mine produces coal seven days a week, with four rotating crews.
Coal is transported from the pits by various independent contractor company trucks to the company-owned loading facility, located approximately six miles from the mine.
Smith Patrick, Contractor I.D. No. CA8, is one of the contractors hauling coal for the Lodestar Energy, Inc. In addition, Smith Patrick performs contract reclamation work at several locations throughout the region. Smith Patrick had five employees on the Lodestar mine property at the time of the accident. Smith Patrick's offices, shop and truck parking area, are located at Salyersville, Magoffin County, Kentucky. Trucks are driven each workday from the shop/truck parking area approximately 30 miles to the mine site. Trucks are returned to the shop/truck parking area at the end of each workday and parked at this location when not in use.
The last health and safety inspection of the Shop Branch Mine #2 by the Mine Safety and Health Administration was completed March 18, 1998.
DESCRIPTION OF ACCIDENT
On Friday, May 22, 1998, at approximately 11:30 a.m., Robert C. Cooper, coal truck driver for Smith Patrick, arrived at the mine site. He was operating a 1976, DM-800, Mack truck which he had picked up at the Smith Patrick truck lot located at Salyersville, Kentucky. Upon arrival at the mine, he was informed by co-workers that they were being loaded at the No. 3 Broas Rider coal pit. Cooper proceeded to the pit where his truck was loaded with coal. He hauled the coal to the coal company-owned preparation plant located approximately six miles away.
Cooper dumped his second load of coal at 2:53 p.m., (as indicated by the weigh tickets). Bobby Lowe, front-end loader operator, stated he loaded Cooper's truck for the third time at approximately 4:00 p.m. Cooper left the coal pit and had traveled 3.3 miles when he apparently lost control of the truck. The truck went across the drainage ditch, traveled up slope onto the right side embankment, and overturned onto the mine haul road. The victim apparently jumped or was thrown from the overturning truck and was crushed between the truck bed and haul road surface.
At approximately 4:30 p.m., Doug Trimble, night shift foreman at the Ivy Creek Mine, was traveling toward the mine site and came upon the accident scene. Trimble walked around the truck and checked the operator's cab. He assumed the driver had caught a ride with someone since he could not be located.
Trimble returned to his vehicle and proceeded to the mine site and contacted Burl Osborne, office clerk for the Ivy Creek Mine, and informed him of the overturned truck. Contacts were made with other employees via the telephone and C.B. radio. Cooper's whereabouts could not be established.
During this time, Dana Hamilton, blaster for the Ivy Creek Mine, was en route home when he came upon the accident scene. Jeff Bailey, truck driver, had also arrived at the accident scene by this time. A search by Hamilton revealed no evidence of Cooper. With the aid of a flashlight, Bailey and Hamilton located the victim's shoe underneath the truck bed. This information was relayed to Donald Holiday, foreman. The Floyd County Rescue Squad and the Kentucky State Police were contacted.
A front-end loader was used to assist in the recovery. The truck bed was raised slightly and blocked with wooden cribs. The victim was removed from beneath the truck bed and pronounced dead at the scene at 5:20 p.m. by Floyd County Coroner, Roger Nelson. The body was transported by the Floyd County Rescue Squad to the Nelson-Frazier Funeral Home.
Burl Osborne, employee of Lodestar Energy, Inc., called Donnie Johnson, Supervisory CMS&H Inspector, at 5:05 p.m., and notified him of the accident. Company personnel also contacted the Kentucky Department of Mines and Minerals.
INVESTIGATION OF THE ACCIDENT
MSHA personnel were dispatched to the mine upon notification of the occurrence. A 103(k) Order of Withdrawal was issued upon the arrival of MSHA personnel to ensure the health and safety of all persons at the mine until an investigation was conducted. A preliminary examination of the accident scene indicated that an extensive examination of the truck would be needed to help determine the cause(s) of the accident. A request was made to MSHA Technical Support for assistance concerning truck braking systems. James L. Angel, mechanical engineer, was dispatched to evaluate and test the braking system on the subject truck.
After photographs and measurements were obtained, permission was granted by MSHA to relocate the truck to facilitate further examinations. The truck was towed by wrecker to the Smith Patrick shop at Salyersville, Kentucky, for the examinations and tests. Smith Patrick provided two mechanics to assist with MSHA's investigation of the coal truck's braking system.
The investigation revealed the following relevant physical factors:
- There were no known eyewitnesses to the fatal accident.
- The coal truck (Unit No. 5) involved is a 1976 Mack, Model DM-800, vehicle identification
number DM 885SX-3416. The truck is a 10-wheel tandem provided with a coal haulage bed.
- The truck left the mine haul road, crossed the drainage ditch, and traveled up the embankment
- The mine haul road surface at the accident site consisted of dry, hard packed gravel, being well
constructed and maintained. The road is approximately 26 feet wide with a 10% grade. Based
on a topographical map supplied by Lodestar Energy, the haul road is relatively level for
approximately the first 2.8 miles from the pit and then descends at an average grade of 10% for
approximately 0.5 miles prior to reaching the location of the accident. The haul road makes a
sharp right turn approximately 500 feet prior to where the accident occurred. The haul road then
makes a sharp left curve approximately 700 feet down hill from the accident site. In addition,
MSHA personnel traveled the roadway to confirm this information and to observe the roadway
conditions, which the truck had traveled prior to the accident.
- An examination of the cab, after the truck was up righted, found both the direct and auxiliary
gear shifts were in the neutral position and the engine-brake switch was engaged. Down-shifting
gears along this area of the mine haul road is a common practice for the purpose of maintaining
control of the speed of the vehicle, as stated by other truck drivers interviewed. These truck
drivers indicated the average speed of loaded trucks in the accident area is 5 to 10 mph.
- The cab area of the truck sustained minimal damage. No cab glass was broken. The right
front-leaf spring's front shackle was broken off the frame and pushed back which caused
interference in the steering system. A valve attached to the right side fuel tank was broken off
and the fuel filter was dented and appeared to have a small hole in it. The left front tire was flat
but personnel from Smith Patrick reported that it did hold air pressure when later re-inflated.
This damage appeared to be the result of the accident.
- Traffic rules and speed limit signs are posted along the mine haul road. The posted speed limit
for the mine haul road is 15 miles per hour.
- The weather was overcast and dry at the time of the accident.
- These highway-type coal trucks are not provided with a rollover protective structure (ROPS),
but a seat belt in proper working condition was provided.
- The accident occurred during the victim's third trip from the coal pit to the preparation plant.
This was to be the last scheduled trip of the day. This was confirmed by the weigh tickets
obtained from the company and statements from both Lodestar and Smith Patrick personnel.
- The truck was overloaded at the time of the accident. It is estimated that the truck weighed as much as 101,420 lbs. based on the maximum weight of previous trips. The resulting estimated payload of the truck at the time of the accident is estimated at 63,800 lbs., or 244% of the manufacturer's specified maximum payload of 26,080 lbs. In addition to overloading the truck's tires and rims, springs, and axles, the estimated payload would have caused the design loads of the truck's brake system to be exceeded. Mack Truck, Inc. has specified that the truck's brakes are designed around its axle ratings. The truck's front axle and brakes are rated for 20,000 lbs. and each of the two rear axles and their brakes are rated for 32,500 lbs. for a combined brake design weight of 85,000 lbs. The brake system was not designed for an estimated payload that put the truck's GVW at 101,420 lbs., at the time of the accident.
- The brake system consists of an air applied service brake system, with brakes on each side ofthe front steering axle and the two rear driving axles. A spring-applied, pressure-released
parking brake, integral to the service brakes, is present on both sides of the two driving axles.
- The pushrod travel of all brake chambers was measured. Only the
left-rearward drive axle's
pushrod travel exceeded the maximum stroke at which brakes should be adjusted, (2 inches for
this type 30 brake chamber). The pushrod travel measured 2-3/16 inches at approximately 100
- The left-front brake-drum diameter exceeded the maximum wear allowance. Rust and built-up dirt were found on the wear surface of the brake linings and drum. No clean wear surfaces
were found indicating the linings were not effectively contacting the drum when the brakes were
applied. No significant braking force was generated by this brake.
- The right-front brake-drum diameter exceeded the maximum wear allowance. Rust was
found on the wear surface of the brake linings and drum. No clean wear surfaces were found
indicating the linings were not effectively contacting the drum when the brakes were applied.
There was no braking action on this wheel due to the air pressure being blocked to this brake
chamber by an apparent malfunction in the quick release valve, that serves both front wheel
brake chambers. No braking force was generated by this brake.
- The left forward-drive axle's brake linings and drum were rust covered over approximately
3/4 of their width. Three of the four lining segments were broken in several places with missing
portions that exposed a fastening device. The braking force generated by this brake was
- The left-rearward drive-axle's drum diameter exceeded the maximum wear allowance. Rust
and built up dirt were found on the wear surface of the brake linings and drum. No clean wear
surfaces were found indicating the linings were not effectively contacting the drum when the
brakes were applied. Two of the four brake lining segments were broken with missing portions
that exposed a fastening device. The "s" cam was riding on the side of the brake shoes and not
the rollers provided. No significant braking force was generated by this brake.
- Two of the right-rearward drive-axle's brake lining segments had entire cross sections broken
off from the fastening devices to the lining's edge.
- The right-forward drive-axle's brake chamber's air hose was worn through the outer wire
- The right-rearward drive-axle's brake chamber's air hose was worn through the outer wire
- During the air leakage test prescribed by Mack Trucks, Inc., with the engine off and the
services brakes fully applied, the air pressure drop was about 18.2 psi/min. The air pressure drop
should not have exceeded 3 psi/min.
- The engine brake operated when tests were conducted. However, according to Mack Trucks,
Inc., this truck was not equipped with an engine brake when manufactured. The engine brake
was added later. It was noted that if the transmission was in neutral and the accelerator released,
the engine would stall almost immediately. Although this is common with some engine brakes,
if the engine brake shuts the engine down, power assisted steering is lost and the brake system's
air reservoir is no longer replenished by the engine-driven compressor.
- Essentially only two of the truck's six service brakes were functioning to control an overloaded truck on a 10% grade. Further, the performance of one of these two brakes was partially compromised due to a missing section of lining. During application, these brakes would likely have overheated quickly causing the braking force to diminish.
- No steering defects, except for those apparently related to accident damage, were found on the truck during the tests and examinations.
- Smith Patrick operated and maintained a number of trucks at their central facility. Contractor
personnel stated that a service manual or other inspection criteria was not being used by Smith
Patrick during repair and/or inspection of the trucks.
- Smith Patrick maintained detailed maintenance and repair records for each truck.
- Smith Patrick maintenance records, for the truck on the day of the accident, indicated a new
air compressor, and rear brake chamber were installed, along with a brake adjustment.
- A driver's vehicle inspection report and truck log was turned in daily for the vehicle involved
in the accident by the victim.
- The victim's pre-operational vehicle inspection report for the No. 5 truck was completed on
the day of the accident. The report did not list any safety defects.
- The compressor appeared to be new but the new brake chamber could not be readily
- Robert Gilbert, mechanic, stated he talked to the victim during the shift. He stated the victim reported no mechanical problems with the truck.
- Roger Nelson, Floyd County Coroner, listed the cause of death as traumatic crushing injuries.
- The victim had approximately 1 year of experience as a truck driver and approximately 5
months on this job.
- The victim had received his commercial driver's license (CDL) on May 28, 1997, which
allowed him to operate a truck of this type on public roadways. A portion of the trip from the
coal pit to the preparation plant and return was on public roadways.
- Cooper's training consisted of Hazard training given on January 22, 1998, at Lodestar Energy, Inc., Shop Branch Mine # 2.
This accident occurred because the service braking system on the truck was not properly maintained and was not designed for use with the payload being hauled at the time of the accident. Failure to provide adequate training for the victim was also a contributing factor.
- A 103(k) order, Number 4515593, was issued on May 22, 1998, to Smith Patrick (contractor)
to ensure the safety of the miners working in the area.
- A 104(a) citation, Number 4491033, was issued on June 1, 1998, for a violation of 30 CFR,
Section 77.1605(b) to Smith Patrick (contractor). The 1976 Mack Truck, Model DM-800,
vehicle identification number DM 885SX-3416 was not provided with adequate service brakes
that would stop the truck in an emergency situation.
- A 104(a) citation, Number 4491034, was issued on June 16, 1998, for a violation of 30 CFR,
Section 77.1605(b) to Lodestar Energy, Inc. The 1976 Mack Truck, Model DM-800, vehicle
identification number DM 885SX-3416 was not provided with adequate service brakes that
would stop the truck in an emergency situation.
- A 104(a) citation, Number 4515600, was issued on June 1, 1998, to Smith Patrick (contractor)
because Robert C. Cooper (victim) had not been given newly-employed experience miner
training as required by 30 CFR before he was assigned to work duties, a violation of 30 CFR,
- A 104(a) citation, Number 4218641, was issued on June 1, 1998, to Lodestar Energy, Inc. because Robert C. Cooper (victim) had not been given newly-employed experience miner training as required by 30 CFR before he was assigned to work duties, a violation of 30 CFR, Section 48.26(a).
Coal Mine Safety and Health Inspector (Surface)
Hobert Webb, Jr.
Coal Mine Safety and Health Inspector
James L. Angel
Carl E. Boone, II
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