On the 25th January, 1979, Robert Nicholas Williams reported to work as usual at the
Ford Motor Company’s casting centre in Michigan.
Robert was twenty-five years old, and worked as an engineer at the plant, managing a massive,
custom-built robotic parts retrieval system.
The system was five storeys tall, and consisted of a series of powered carts and robotic arms
that could quickly retrieve parts from and return parts to a vast array of high-density
shelving units.
The robot could move parts that were heavier than any human worker could handle, and do
so at a pace that a human worker would be unable to match.
On this particular day, Robert was one of three engineers in charge of the system, but
an undiagnosed fault with the machine meant that it was operating significantly more slowly
than it normally would.
If it continued to operate slowly, production could be delayed, potentially costing the
company a huge amount of money.
This was, of course, a situation that the engineers wanted to avoid.
Robert was asked to speed up the process by climbing up into the high-density shelving
and retrieving some of the required parts by hand.
Robert duly did so, entering the shelves and climbing up to the third level to access the
parts that were needed.
As he did so, the robot retrieval system was still in operation: moving rapidly and silently
elsewhere in the maze of shelves.
It is likely that Robert had very little warning when it entered the same area of shelving
that he was working in.
As the machine sped past him, a protruding part on a heavy transfer cart smashed into
his head, killing him instantly.
Robert’s co-workers were, at first, unaware of the accident.
The machine continued to operate for 30 minutes, patiently and indifferently retrieving parts
from the shelves, before they discovered his body.
By the time Robert’s body was discovered, it was too late for medical intervention.
The machine, and the entire rest of the plant, was quickly closed down.
Robert’s body was retrieved, and the police were called to process the first ever incident
of a human having been killed by a robot.
In the aftermath of the accident, Robert’s family sued the manufacturer of the robot,
Litton Industries, alleging that they had designed a system that lacked adequate safety
measures to protect workers using it.
Litton was ultimately ordered to pay a sum of $15 million to the family of the deceased,
in a ruling that would go down in history as the first, but certainly not the last,
of its kind.
On the 23rd of December 2010, Alan Catterall reported for work as usual to a small factory
in the town of Runcorn in the UK.
The factory was owned by Pyranha Mouldings – a company that made moulded plastic kayaks.
Alan, 54 years old at the time, was a supervisor, and had worked at the factory for a number
of years.
One task he would be undertaking that day concerned the maintenance of a kiln, or industrial
oven.
This kiln was of a bespoke design, and was used to bake moulded plastic parts.
It had a number of design features to make it more efficient, including a design feature
that would automatically shut and lock the doors when the kiln was switched on.
The kiln used a huge amount of energy to reach temperatures of 280 degrees Celsius (or 536
degrees Fahrenheit), so ensuring that the doors were shut whenever it was switched on
saved a significant amount of electricity.
Cleaning up the kiln was a common day-to-day task within the factory.
Workers had to remove spilled blobs of melted plastic from the inside of the machine…
and it was a task that some workers were especially wary of.
There had been two previous incidents involving the kiln: one where a worker was inside cleaning
the oven when the doors began to close, and another when a worker was carrying out repairs
underneath the oven when it was switched on.
In both cases, the workers involved escaped without injury.
On this occasion, the kiln had been deactivated in order for maintenance to be carried out.
While this was done, Alan entered the kiln and began cleaning up blobs of spilled plastic.
As soon as the maintenance was completed, another worker – who happened to also be
Alan’s son-in-law – approached the control panel of the kiln.
From the control panel there was no clear line of sight to the kiln, and so this worker
could not see that Alan was inside.
He switched it on, causing the doors to shut and lock, sealing Alan inside.
Alan had with him a pry bar, which he used to attempt to break out of the oven.
This was to no avail.
The noise level on the factory floor around the oven was extremely high, and so nobody
present could hear his shouts for help.
Other workers only realised that something was amiss when smoke began pouring from the
oven.
By the time they had switched it off and opened the doors, Alan had suffered severe burns
and passed away.
The accident was followed by a lengthy court case, with Pyranha Mouldings accused of corporate
manslaughter.
The company was ultimately fined £200,000, and the company director was given a suspended
prison sentence.
The oven was modified with the addition of an escape hatch – an intervention that should
have been in place from the day it was installed.
On the 16th of August, 2012, temporary worker Lawrence “Day” Davis reported for work
at the Bacardi Bottling plant in Jacksonville, Florida.
It was the first day of his assignment, and he was delighted to have found some work through
a temporary worker agency, as he was keen to earn money and help out his family.
Temporary worker agencies supply workers to other companies on a temporary basis.
Typically this means that workers can be brought on to meet demand – working for a few hours
or days as needed.
The agency takes care of the administrative side of their employment, saving the company
they perform the work for time and money, and providing them with a more adaptable,
flexible labour force.
Lawrence reported to the Bacardi Bottling Plant, and was issued with a high-visibility
vest.
On arrival at the plant, he was given a fifteen minute training session.
After this brief introduction to the factory was completed, Lawrence was sent out on the
floor, initially to work on the bottling line.
After less than an hour in this role, however, Lawrence was sent across the factory floor
to help clean up after a machine malfunction.
A number of glass bottles had spilled from a palletizing machine and smashed on the concrete
floor below.
The broken glass now needed to be cleaned up, and Lawrence was asked to enter the area
below the machine and do so.
Keen to impress on his first day at work, Lawrence did so without question.
He began to pick up the glass… and was still doing so minutes later when, without warning,
the machine was switched back on.
The machine was designed to stack pallets with full bottles of rum.
A fully-loaded pallet could weigh as much as 900 kilograms (or 2,000 pounds).
As soon as the machine was switched back on, one such pallet descended on top of Lawrence
and crushed him against the floor.
Other workers heard Lawrence scream as the machine restarted… and though they immediately
triggered an emergency stop, they were not quick enough to avert the accident.
For several minutes, workers struggled to reverse the machine in the hope that it would
lift the pallet off Lawrence’s body.
They even resorted to using a handheld pry bar to try and move the pallet… but this
was no use, and by the time emergency services arrived on the scene Lawrence had passed away.
The fifteen minute training session he had been given at the start of his shift had not
covered hazardous work, such as working around or underneath machinery.
Given that it was his first day, and that he was a temporary worker, Lawrence had deferred
to the expertise of the permanent workers at the plant, and had died within 90 minutes
of beginning his shift as a result.
In each of these cases, multiple failings contributed to the death of a worker in horrendous
circumstances.
One particular safety measure might have prevented all three.
It is common for workers in industrial facilities to need to enter dangerous areas in order
to carry out maintenance or resolve problems with machines.
It is a long-established practise to “lock out” machines whenever this is necessary.
A range of devices can be used to lock out a machine.
The most simple is a padlock, which can be secured to the controls of the machine to
physically keep them in the “off” position.
If the worker entering the machine retains the only key to the padlock, the machine physically
cannot be switched on until they have exited the danger area and removed the padlock.
Systems have been developed to allow workers – even multiple workers – to lock out
almost any machine that they might have to work with in a given facility.
However, for one reason or another, the ability to lock out a machine is not always used.
Sometimes machines are not locked out to save time, sometimes because the worker does not
know or has not been trained to understand this process, or sometimes because it is believed
that it is not necessary to do so.
In each case, and in so many workplace accidents, a simple system of locks and tags could be
the difference between life and death for workers in dangerous situations.
But this simple system can only make a meaningful difference when and if it is actually used.