Bear Canyon #1 (ID No. 42-01697) C.W. Mining Co. (Co-op
Mine) Huntington, Emery County, Utah
July 15,
1999
by
Fred L. Marietti Coal Mine Safety and Health Inspector,
Electrical
Carl H. Schmuck Coal Mine Safety and Health Mining
Engineer
Originating Office - Mine Safety and Health
Administration Coal Mine Safety and Health, District 9 P.O. Box 25367,
Denver, Colorado 80225-0367
John A. Kuzar, District Manager
GENERAL INFORMATION
Bear Canyon #1 mine is an underground
coal mine, located nine miles northwest of Huntington, Emery County, Utah,
adjacent to State Highway 31. The mine opened in 1982 and operated until it was
idled in 1995. Operations resumed in the 3rd West Bleeder Section in April,
1999. The mine is owned and operated by C.W. Mining Company.
Bear Canyon
#1 mine uses the room-and-pillar method to extract coal from the Blind Canyon
seam. The mine currently has one active development section that uses a
remote-controlled Joy 14CM15 continuous mining machine, Joy shuttle cars, a Lee
Norse TD1-43 single-boom roof bolting machine and belt haulage.
The mine
employs 64 underground miners and 23 surface employees, producing an average of
700 tons of coal per day. The mine operates seven days per week with two
ten-hour production shifts and one ten-hour maintenance shift per
day.
Mine ventilation is provided by a Jeffrey Aerodyne fan that exhausts
81,650 cfm of air at 0.8 inches water gage. Negligible amounts of methane are
liberated.
The Bear Canyon #1 mine is accessed through four entries
driven into the Blind Canyon coal seam, which ranges from 8 to 19 feet thick.
Typical mining height on the 3rd West Bleeder Section, where the fatal accident
occurred, ranged from 7 to 9 feet within the upper portion of the Blind Canyon
coal seam. Mine workings in the Tank coal seam above and the Hiawatha coal seam
below do not project into the area where the accident occurred.
The 3rd
West Bleeder entries were being mined to provide ventilation access to the
pillar retreat section where coal pillars would be extracted from the previously
developed 3rd West North entries. The 3rd West Bleeder Section is a three entry
system that is developed adjacent to and between a fault, locally referred to as
the Blind Canyon Fault, and the pillars that would be extracted during retreat
mining.
The last regular safety and health inspection at this mine was
completed by the Mine Safety and Health Administration on June 1,
1999.
The principal officials at the mine are:
Ken Defa...................................................Superintendent
Cyril Jackson..............................................Safety Director
DESCRIPTION OF ACCIDENT
On Thursday, July 15, 1999, Chris Peterson, section foreman, proceeded underground with his crew at approximately 3:00 p.m. to the 3rd West Bleeder Section (MMU 004) to begin mining coal. He
assigned his seven crew members to their tasks for the shift. The continuous
mining machine was in the No. 14 crosscut at the last row of bolts. He told
Alejandro Medina, continuous mining machine operator (victim), and Miguel
Sanchez Cruz, miner helper (injured), to clean up the crosscut and then move to
the No. 2 Bleeder entry face.
Peterson went to the No. 2 Bleeder entry to
see what had to be done to start there. Coal had to be pushed in the face and he
assigned Melecio Castro Castro, scoop operator, to push the coal on the roadway
into the bolted face according to the cleanup plan, which required cleanup after
the place was bolted.
Peterson came back to No. 14 crosscut where the
continuous mining machine crew, Medina and Cruz, had cleaned up and cut 15 feet
past the unsupported intersection, creating a hazard. He sent Medina and Cruz
with the continuous mining machine to No. 2 Bleeder entry to mine. Peterson then
instructed the roof bolter operator to install roof bolts in the No. 3 Bleeder
entry to the No. 14 crosscut to abate the violation.
Medina and Cruz,
started mining in the No. 2 Bleeder entry and had advanced the cut about 30 feet
when the roof and ribs started to work. The roof failed and fell to the mine
floor. They stopped mining further into the entry and ran outby. Peterson told
them to clean up the fallen material and then go to No. 13 crosscut in No. 3
Bleeder entry. Cruz said they did not cleanup, but moved to No. 13 crosscut in
No. 3 Bleeder entry to mine where the fatal accident later
occurred.
Medina and Cruz started mining in the No. 13 crosscut in No. 3
Bleeder entry. Peterson went to work on a shuttle car that had broken down
nearby and was pulled into No. 12 crosscut to clear the roadway. The other
shuttle car ran over an electrical cable laying in the No. 3 Bleeder entry,
which provided power to the roof bolting machine. This tripped the circuit
breaker and power to the roof bolting machine. Peterson said someone told him
about the damaged cable. He told them to pull the damaged part of the cable
outby, out of the way. Peterson then left the section in the truck to go check
the belt scale outby.
At approximately 11:00 p.m., Medina and Cruz
finished advancing the cut on the left side of No. 13 crosscut and were backing
the machine out to move over to the right side for the clean-up pass. Cruz was
pulling the cable back out of the machine's way while Medina operated the
continuous mining machine with the remote control. Cruz was six feet outby
Medina with his back to the right rib. Abel Olivas Payan, roof bolting machine
operator, came up behind Cruz to help with the miner cable. Victor Zavagoza
Cabrera, an additional miner helper, was around the corner in No. 3 Bleeder
entry. Valentin Acosta Lozoya was operating the standard-side shuttle car, which
was still operational. At about 11:05 p.m., Lozoya drove into No. 3 Bleeder
entry and around the corner into the No. 13 crosscut. The shuttle car cab was on
the right side which allowed Lozoya to see the rib fail and roll out onto Medina
and Cruz.
Lozoya, Cruz, and Cabrera said there was no warning before the
rib failed. A large piece of coal rib about 13 feet long, 5 feet high, and 3
feet thick hit Medina in the back, pushing him to the floor and completely
covering him causing fatal injuries. A piece of the rib about 22 inches long, 40
inches high and 21 inches thick hit Cruz in the back knocking him to the floor
and into Payan. Payan was also knocked to the floor, but was not injured.
Payan, Cabrera and Lozoya pulled the coal off Cruz's back and lower
legs, and then administered first aid. They called to Medina but there was no
response. They tried to pull the coal off Medina but could not move it. Lozoya
ran to the phone in the kitchen at the feeder breaker to call outside for help.
He passed Alberto Duran, shuttle car operator, and Castro. He told them to find
Rodrigo Rodriquez, graveyard foreman. Rodriquez had come into the mine with his
crew of five miners at about 10:00 p.m. and was working outby on stoppings in
the belt entry. Lozoya called outside and reported the accident. Duran and
Castro encountered Rodriquez. Rodriquez told Castro to bring the scoop to the
accident site and then went with Duran to the accident site. Rodriquez told
Payan, who was at the site, to get the rest of his crew from the belt
entry.
Peterson, who was outby near the portal, heard a page for him as
he passed a phone. He was notified of the accident and returned to the
section.
Castro placed the scoop bucket under the coal laying on top of
Medina and lifted it. Rodriquez, Duran, and Cabrera pulled Medina out from under
the coal. Peterson, an EMT, checked Medina for vital signs and stated that there
were none.
Rodriquez, Duran, and Cabrera took Cruz to the kitchen, put
him in a truck, and transported him outside where he was taken by an ambulance
crew to Castleview Hospital in Price, Utah, examined and released. The doctor's
work release stated that Cruz had contusions and could return to modified work
on July 25, 1999, with restrictions of not more than six hours per
day.
Shane Stoddard, production foreman, arrived at the section kitchen
as Medina was being brought out. Medina was transported outside in Stoddard's
truck. An ambulance and EMT's arrived at the mine at 11:43 p.m. and ran a
defibrilator test on Medina, which showed no signs of life. Medina was placed in
an ambulance and transported to Castleview Hospital, arriving at 1:05 a.m., July
16, 1999. Medina was then taken to the mortuary where he was pronounced dead by
the County Coroner at 2:25 a.m.
INVESTIGATION OF THE ACCIDENT
The accident investigation
began on July 16, 1999, when Robert Baker (MSHA Coal Mine Safety & Health
Inspector - Castle Dale Field Office) issued 103(k) Order No. 7633274 to ensure
the safety of the miners until an investigation could be conducted. Fred L.
Marietti (Coal Mine Safety & Health Inspector, Electrical - Price Field
Office) was appointed team leader. Marietti and John R. Turner (Education &
Training Specialist, Castle Dale, UT) went underground to the accident site on
July 16, 1999. Turner provided Spanish language translation support. After
visiting the accident site, Marietti and Turner scheduled interviews for the
next day when the complete investigation team would be available.
The
MSHA accident investigation team was on site the morning of July 17, 1999, after
traveling from various locations across the country. The team consisted of: Fred
L. Marietti, William M. Taylor (Supervisory CMI, Price, UT), John R. Turner,
Carl H. Schmuck (Mining Engineer, Roof Control Group, District 9), William
Crocco (Senior Mining Engineer, Division of Safety), Joseph A. Cybulski
(Supervisory Mining Engineer, Technical Support, Pittsburgh, PA), and William J.
Gray (Mining Engineer, Technical Support, Triadlephia, WV).
A briefing
for the MSHA investigation team was conducted by Marietti and Taylor at the MSHA
Field Office in Price, UT, prior to visiting the mine on July 17, 1999. The team
arrived at the mine office at approximately 9:00 am. After a short conference
with mine personnel, the team divided into two groups. Fred Marietti and John
Turner conducted interviews of the mining crew members in the presence of Ron
Tucker, the miner's representative. The other group, Taylor, Gray, Schmuck,
Crocco and Cybulski went underground to the accident site with Ken Defa, Randy
Defa, and Allen Weaver from the company.
The underground group examined
the accident site, and other work sites that were active on the shift when the
accident occurred and the shift prior to the accident. In addition, an
examination of the working section where the accident occurred was initiated.
The interview group conducted interviews with most of the miners on the crew and
scheduled interviews with crew supervisors and the remaining miners for Monday,
July 19, 1999.
The investigation team met at the Price Field Office, on
July 18, 1999, to review what had been accomplished and to coordinate further
activities to complete the investigation. The team returned to the mine site on
July 19, 1999, and again divided into two groups. One group returned to the
underground accident site. The other group completed the interviews.
PHYSICAL FACTORS
Geologic Factors
The
Blind Canyon coal seam can be up to 19 feet thick with a thin shale layer in the
upper portion of the seam. The overburden above the seam has a maximum depth of
2000 feet, as reported in the approved roof control plan of December 8, 1998.
The immediate roof above the coal usually consists of ½-foot of mudstone, shale
and/or clay. A sandstone layer, with a thickness of 80 to 120 feet lies above
the immediate roof. The immediate floor beneath the coal also consists of ½-foot
of shale or clay. A sandstone layer, with thickness of 60 to 90 feet, lies below
the immediate floor.
Geologic conditions in the 3rd West Bleeder Section
consisted of an overburden depth of approximately 1200 feet. The typical mining
height on the section was 7 to 9 feet within the upper portion of the Blind
Canyon coal seam. The immediate roof above the coal in the section was observed
to be thicker than average. Observations of roof fall material and brow
separation in the 2nd and 3rd Bleeder entries indicated that the immediate roof
was 18 to 36 inches thick.
A thin shale layer, noted in the typical
columnar section of mine strata in the roof control plan, was present in the
coal ribs in the 3rd West Bleeder entries, including the fatal accident site. As
observed during the accident investigation, this shale layer did impact the
condition of the ribs. The location of this layer within the mining horizon
contributed to the type and severity of rib deterioration. Rib deterioration
appeared to initiate and become more severe near the shale layer. When the shale
layer was near the middle of the mining horizon, the ribline usually appeared
more fractured, often resulting in an overhanging rib condition. A shale layer
nearer the floor usually resulted in taller slabs or sheets of loose rib
material. The location of the shale layer changed in the section and even
divided to form two layers at some points. The shale layer was located about 42
inches from the mine floor and was several inches thick at the accident
site.
A fault, locally referred to as the Blind Canyon Fault, forms the
western limit of mining for the Bear Canyon #1 mine. The No. 1 Bleeder entry of
the 3rd West Bleeder Section is in close proximity to this fault. Water was
observed dripping from the roof and bolt holes in this entry from crosscut Nos.
10 to 11. This was the only area on the section where water was observed
dripping from the roof.
Mining Factors
Pillar sizes
ranged from 60 by 60 feet to 170 by 100 feet in the 3rd West Bleeder Section and
in the 3rd West North Mains, located adjacent to the 3rd West Bleeder Section.
The maximum entry, room, and crosscut width listed in the approved roof control
plan was 20 feet. Three locations on the 3rd West Bleeder Section were observed
to have mined widths in excess of 21 feet for a distance of 17, 45, and 48 feet
respectively.
Primary roof support installed on the 3rd West Bleeder
Section consisted of 6-foot long, 3/4-inch diameter, grade 60, fully-grouted
rebar and 6-inch by 6-inch bearing plates. The typical bolt pattern observed on
the section consisted of four bolts in each row across the entry with a row of
bolts every five feet or less along an entry or crosscut. The minimum roof
bolting pattern listed in the approved roof control plan allows a maximum
spacing of five feet between bolt rows, five feet between bolts in the same row,
and five feet from bolt to rib. The maximum bolt-to-rib spacing was exceeded in
three locations on the 3rd West Bleeder Section for a distance of 12, 38 and 48
feet respectively.
Title 30, Code of Federal Regulations, Section
75.202(a) requires that ribs where persons work or travel shall be supported or
otherwise controlled to protect persons from hazards. Loose ribs were scaled at
several locations on the 3rd West Bleeder Section during the course of the
accident investigation. An overhanging rib was observed along the right rib from
the accident site outby to the pillar corner. No installed rib support was
observed on the section.
The overhanging rib condition at No. 13 crosscut
had a depth of 1 to 2 feet. The overhanging rib appeared to be due in part to
uneven mining of the ribline. Marks from the continuous mining machine cutting
drum were visible on the lower portion of the rib and created a stepped profile
as more of the rib was mined as the cutting drum was lowered. Rock dust was
present on the lower portion of the rib indicating that this condition existed
prior to the accident.
A Lee Norse TD1-43, single-boom, roof bolting
machine was used to install roof bolts on the 3rd West Bleeder Section. The
typical spacing between bolt rows on the section was 54 inches. A roof fall,
experienced while mining in No. 2 Bleeder entry prior to the accident, had
fallen up to the last row of installed support.
Other
Factors
1. Training on hazard recognition and the requirements of
the roof control plan were inadequate. This was determined through interviews
with miners and supervisors. Inadequate preshift and onshift examinations, which
did not record obvious roof and other hazards, also indicate a lack of training
in these areas.
2. A communication problem existed between Spanish and
English speaking supervisors and miners at the mine. This language barrier
caused safety problems in completely understanding work assignments and the
associated hazards for the Spanish speaking Hispanic miners. One English
speaking section foreman stated that he did not speak very good Spanish, but
that he got his points across. The miner helper injured in the accident spoke no
English. The additional miner helper and one shuttle car operator on this crew
also spoke no English.
CONCLUSION
Loose, hazardous rib conditions, that were not
taken down (barred down) or supported at the accident site, were the direct
cause of the fatal accident on July 15, 1999. The following conditions were
directly related to the rib failure:
1. Geologic conditions in the area
contributed to the deterioration of the ribs. Rib deterioration from stress was
observed at the accident site and throughout the section. Stress resulted from
the depth of cover (1200 feet) and the proximity of a fault.
The rock
(shale) layer present in the coal appeared to intensify the loose rib
conditions. Rib deterioration was observed to become more severe near the shale
layer. This shale layer was located about 42 inches from the mine floor at the
accident site, which contributed to an overhanging rib condition.
2.
Mining practices at the accident site contributed to the overhanging rib
condition. Uneven mining of the rib was evident from marks made by the
continuous mining machine cutting drum on the lower portion of the right rib. A
stepped profile was mined as the cutting drum was lowered.
The ribs on
the mining section were also being undercut by the scoop bucket being pushed
into the ribs, as loose coal was cleaned up after mining.
3. Inadequate
examinations of the work areas contributed to the fatal accident. Records of the
pre-shift and on-shift examinations for the 3rd West Bleeder Section, including
the accident site, did not indicate the existence of hazards that were evident
throughout the section.
A review of the pre-shift and on-shift
examination records from March 30 through July 15, 1999, found that very few
hazards were entered in the record. None of the hazardous conditions observed
during the accident investigation were noted in the records. An adequate
examination of the work area and proper record keeping would allow hazards to be
recognized and corrected.
4. Interviews with miners and supervisors
indicated that there was inadequate training on hazard recognition and the
requirements of the roof control plan.
5. Communication issues, such as
communication problems between English and Spanish speaking miners and a lack of
mining experience for some employees, appeared to affect complete understanding
of work assignments and the associated hazards.
ENFORCEMENT ACTIONS
1. Section 103(k) Order No. 7633274,
dated July 16, 1999, was issued to ensure the safety of the miners until an
investigation could be conducted.
2. Section 104(d)(1) Order No. 7611452,
dated July 16, 1999, was issued for a violation of 30 CFR 75.202(a). The rib
that caused the fatal injury was not being supported or otherwise controlled to
prevent this fatal accident.
3. Section 104(d)(1) Order No. 7611456,
dated July 16, 1999, was issued for a violation of 30 CFR 75.360(a)(1). Adequate
pre-shift examinations were not being conducted to address the rib conditions
and other hazards in the section.
4. Section 104(d)(1) Order No.7611457,
dated July 16, 1999, was issued for a violation of 75.362(a)(1). Adequate
on-shift examinations were not being conducted to address rib conditions and
other hazards in the section.
5. Section 104(d)(1) Order No. 7611462,
dated July 19,1999, was issued for a violation of 75.203(a). Poor mining
practices in the section created conditions that increased the likelihood that
the ribs would fail and cause this fatal injury.
Submitted by:
Fred L. Marietti - Coal Mine Safety and Health Inspector, Electrical
Carl H. Schmuck - Mining Engineer
Approved by:
Irvin T. Hooker Assistant District Manager for
Enforcement Programs
The investigation was conducted by the Mine Safety
and Health Administration and those persons furnishing information and/or
present during the investigation were:
Ken
Defa.........................................................................Superintendent
Randy Defa......................................................................Maintenance
Foreman
Shane Stoddard................................................................Production
Foreman
Chris Peterson..................................................................Section
Foreman
Rodney Anderson.............................................................Section Foreman
Valentin Acosta Lozoya....................................................Standard Shuttle Car Operator
Melecio Castro Castro .....................................................Scoop Operator
Abel Olivas
Payan.............................................................Roof Bolter Operator Victor Zavagoza
Cabrera..................................................Miner Helper Miguel
Sanchez Cruz.........................................................Miner
Helper Jared
Stephens..................................................................Mechanic
Electrician Joel A.
Strid......................................................................NSA
Engineering Inc, Consultant
International Association of United Workers
Ron
Tucker......................................................................Miners'
Representative Utah State Labor Commission
Ron
Parkin.......................................................................Representative Mine Safety &
Health Administration Fred L.
Marietti...............................................................Coal
Mine Safety & Health Inspector, Electrical John
R.Turner..................................................................Education & Training
Specialist Carl H.
Schmuck.............................................................Mining Engineer
William M.
Taylor............................................................Supervisory Coal Mine Safety
& Health Inspector William
Crocco...............................................................Division of Safety, Senior Mining
Engineer Joseph A.
Cybulski.........................................................Technical Support,
Supervisory Mining Engineer,
Roof Control Division William J.
Gray...............................................................Technical Support, Mining Engineer,
Roof
Control Division
FAB99C18 
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