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Fatality #1 - January 2, 2007

Accident Classification: Other
Location: Bayer Alumina Plant, Texas
Mine Controller: Alcoa Inc
Mine Type: Facility
Mined Material: Alumina
Incident Date/Time: January 2, 2007 01:40 pm

On January 2, 2007, John L. Dorton, instrumentation/electrical (IE) technician, age 37, was fatally injured when he opened a valve in the piping system of a vacuum monitoring line and hydrogen fluoride discharged onto his face. Dorton was not wearing a respirator or face shield when he opened the valve in preparation for unplugging the stem. 



The accident occurred because management failed to establish procedures to ensure that IE technicians could safely work on vacuum monitoring lines. The procedures provided to IE technicians did not require them to wear a respirator or face shield to protect them from hydrogen fluoride exposure. Additionally, the established procedures did not require the IE technicians to use the special wash out tool designed to seal around the clean out drill bit and prevent pressure or hydrogen fluoride from escaping during the clean out procedure.

FATALITY ALERT

METAL/NONMETAL MINE FATALITY - On January 2, 2007, a 37 year-old instrument technician, with 2½ years experience, was fatally injured at an alumina operation. The victim partially opened a ball valve in an access pipe in preparation for maintenance. Hydrogen fluoride discharged from the pipe onto his face. He was hospitalized and died several hours later. 

FINAL REPORT

UNITED STATES
DEPARTMENT OF LABOR
MINE SAFETY AND HEALTH ADMINISTRATION
Metal and Nonmetal Mine Safety and Health 

REPORT OF INVESTIGATION 

Surface Metal Mill
(Alumina) 

Fatal Other Accident
January 2, 2007 

Alcoa World Alumina Atlantic
Bayer Alumina Plant
Point Comfort, Calhoun County, Texas
Mine ID No. 41-00320 

Investigators 

Brian P. Goepfert
Supervisory Mine Safety and Health Inspector 

Emilio Perales
Mine Safety and Health Inspector