Warehouse Safety Fatality File

Forklift Operator Crushed by Full Pallet of Soft Drink Cans – Oregon

SUMMARY

On February 28th, 2020, a 47-year-old forklift operator was crushed by a loaded pallet of soft drink cans that weighed ~2000 pounds. The pallet was on the top layer of a pallet row. Pallet rows were oriented back-to-back. The warehouse inventory management system directed the operator to pull pallets from a row that didn’t contain any product. The operator pulled 4 pallets from the back of the adjoining row, destabilizing the top layer of pallets. While cleaning up some cases that fell off one of the pulled pallets, the top layer pallet fell onto operator (from a height of approximately 20 feet), causing massive internal injuries. The forklift operator worked swing shift full-time at the warehouse, as well as another job that started at 6am, working ~70 hours/week total.

CONTRIBUTING FACTORS

Key contributing factors identified in this investigation include:

  • Back-to-back pallet row orientation without physical barriers or visual cues makes it difficult to distinguish where one pallet row ends and the other begins.
  • Pallet retrieval procedures not followed while working under and/or adjacent to a live load.
  • Fatigue due to lack of sleep may have adversely affected employee’s judgment.

RECOMMENDATIONS

To help prevent similar occurrences, employers should:

  • Ensure warehouse layout and pallet stacking procedures incorporate sufficient engineering controls to prevent distracted employees from inadvertently destabilizing multi-layer pallet rows.
  • Ensure pallet stacking procedures are written and accessible to employees and include instructions on how to perform spot checks on pallet rows to assure they are safe. Ensure employees follow these procedures and provide retraining if an accident occurs.
  • Ensure employee training program includes training about the hazards of working around potentially unstable pallets, including awareness of potential pallet collapse areas while working on or below a live load.
  • Treat sleep deprivation as a workplace hazard, especially for swing and night shift employees.