safe by choice ….not by chance - morrison utility services · grinder when it snagged and kicked...

Safe by choice ….not by chance 02380 742222 [email protected] www.dyerandbutler.co.uk


Introduction from Mark Foster – Airports Director

Why do we come to work? For most of us it’s a necessity.

Why do we work for Dyer & Butler and not another contractor? Is it the pay and benefits? Possibly… or is that Dyer & Butler is a ‘safe’ company to work for?

Every year people working for us are injured at work even though we believe that our safety record is good. Our record is better than the other organisations, but there is still room for improvement.

At Dyer & Butler, we believe that the success of our company should not be measured merely by increasing turnover and reducing costs for improved profits. A good measure of how Dyer & Butler is performing is to look at our safety figures.

Bringing our injury rates down is all about behaviour. We need each individual to devote themselves to creating a habit of excellence, and to feel a part of something important. Safety will be the indicator that tells us when we are improving our behaviours across the entire company. That’s how we should be judged.

No job is so important that safety should suffer.

Of paramount importance to us is the belief that everyone should get home safe, every day. You also need to remember that the culture that you adopt at work spills over into your home life and benefits you and your families.

Please make sure you do your part every day to work safely and help us ensure that safety is at the heart of everything we do.

Mark Foster Divisional Director - Airports

Safety performance – January

Accident Frequency Rate – 0.190

Reportable Accidents or Incidents Whilst breaking out concrete around a manhole, a lump of concrete flew up and struck an operative on the hand whilst it was resting against the body of the vehicle. The resulting impact caused a fracture to a bone in the hand and tendon damage. The injured person required an operation to correct the damage.

Unchartered Services Report During January there were 27 reports of unchartered services being encountered on site which were not damaged.

Minor Accidents and Near Misses

3/1/17 – Leytonstone - LOGOB – An operative knelt on a bolt causing pain to their knee

9/1/17 – Larkhill Garrison – A cable was struck and damaged during excavation work. It was later found to be redundant.

9/1/17 – Southbourne Grove – A fibre optic cable was damaged during excavation works. The cables were located at a shallow depth.

11/1/17 – Bulford Camp – A dumper rolled forwards into a parked vehicle due to a fault where too much slack was present in the cable.

13/1/17 – Fareham Station – A stonemason was struck in the face by the handle of the grinder when it snagged and kicked up.

17/1/17 – Heathrow Yard – A car was damaged by a reversing vehicle as it reversed out of the yard. A banksman was in place at the time.

19/1/17 – Hotel Cul-de-Sac – Protecting cones were removed without authorisation at the end of the works leaving the worksite unprotected.

20/1/17 – T3 Valve Chamber – A 4” grinder being used to cut reinforcement mesh started to smoke due to over-use. It was dowsed with a powder extinguisher and taken out of service.

23/1/17 – Leytonstone - LOGOB – An operative scuffed their thumb against an adjacent wall whilst removing items from the platform.

23/1/17 – Western Minor works – A portaloo was stolen from site over the weekend.


23/1/17 – Fareham Station – An operative was changing into their workwear in the toilet when they tripped, fell and struck their head against the toilet partition. This caused a head injury and concussion which required hospital treatment.

24/1/17 – Gospel Oak - LOGOB – Whilst using a drill to install a handrail, the drill bit snapped and the end of the drill made contact with the operative’s hand causing a cut that required hospital treatment.

26/1/17 – Lisson Green – An electrician was seen drilling into a live electrical cabinet that contained live electrical terminals. The works were stopped and re-planned.

27/1/17 – Larkhill Garrison – A road sweeper driver lost control of his vehicle due to a medical episode whereby it crashed into a building.

30/1/17 – Larkhill Garrison – The main pin on the boom of an excavator worked loose and fell out. No immediate defects were noted.

30/1/17 – Nursling – An office employee trapped their hand whilst securing the compound gates causing pain and bruising.

31/1/17 – Bulford Camp – A metal band that had been used to secure wire ropes sprung open when released and the clip struck the operative on the top of the foot causing pain and bruising.

Please note…Accidents and incidents must be reported by phone to the SHEQ Advisor and then be followed up with a report on Workspace. Close calls may be reported using the email address shown on the posters, the close call reporting cards, or the QR Code App.

New penalties for using technology whilst driving

New rules on using technology such as a mobile phone in a vehicle comes into force on 1st March 2017 and as a result tougher new penalties will also be issued in terms of increased fines and penalty points.

Once the new rules come into force, anyone found to be using a mobile phone in a vehicle whilst the engine is on will be liable to receive a six points and a £200 fine.

Depending on how many points are already accumulated on the person’s license, it could mean that any offenders are automatically banned from driving or may have to take a re-test before being permitted to get behind a wheel again. More experienced drivers also risk going to court if they offend twice, with a possible fine of up to £1,000 and a driving ban of at least six months.

Many road accident surveys highlight how people are being distracted by technology while driving, this can include phone calls, texts, changing the radio and programming a sat-nav. Drivers must restrict the use of all in-car devices while driving. Dyer & Butler’s policy is clear and can be found in the Company Drivers Handbook section 8. This states that…

Whilst driving it is considered to be a breach of company policy (and an offence) for a driver to carry out any of the following…

Speak or listen to a phone call either by using a hand held phone or via a hands free device, even if this device is fitted within the vehicle.

The use or holding of any hand held device to send or receive text messages, images or access data, including the internet.

As the driver of the vehicle, it is your responsibility to ensure that you comply with these requirements for the safety of not just yourself and your passengers, but also for other road users and pedestrians as well.

No call is that important. Don’t be tempted to use your phone whilst driving – Turn it off

Wales and West safety award

Shane Margeson has been nominated to receive a safety award for diligently finding and reporting an unchartered cable prior to the commencement of excavation works on site.


The service ran over a plate girder bridge which Dyer & Butler were infilling to effectively remove it from the road network as its now redundant and weakened due to degradation of the steel.

Due to the overhead lines in the area and the steel bridge structure using the CAT and Genny was severely hampered as a lot of erroneous readings were being encountered.

However Shane spent a good amount of time scanning different parts of the area in different directions to effectively locate the service, which turned out to be an old, but still live, private service to a nearby residence.

Congratulations Shane, your careful approach prevented a potential service strike. A £25 voucher is on its way to you.

Tag Evac system in use

The airports team are now using a new system which can be used in the event of a building evacuation. The Tag-Evac system is easy to use and highly visible and provides a quick and easy means of confirming that a building has been properly evacuated should a fire or other emergency occur. It is hoped that this system will be rolled out to other offices in due course. If you would like more information, please contact the Senior SHEQ Advisor at the Airports, Geoff Fox.

Weather warnings

At the tail end of February, the UK received a battering from storm Doris. Over the course of the storm we received numerous reports of weather related incidents, near misses and close calls. These reports ranged from people being struck by windblown debris to more specific issues such as FOD (Foreign Object Debris) hazards within the airports environment.

There are currently 3 types of weather warning which are classified as follows…

When a weather warning is issued, you must ensure that you review your current work plans and put in place the relevant controls to minimise any risk that may be caused by extreme weather conditions.

Whilst Dyer & Butler will always try and communicate any weather warning that we receive, but from time to time operational constraints, regional variations and warning times might mean that you don’t receive prior warnings of any extreme weather events.

Therefore, please ensure that you keep an eye on the local weather for your area on a daily basis to ensure that you are capable of changing your plans should the weather dictate it.

Unknown services at Thetford

Dyer & Butler are currently undertaking works at a fuel farm in Thetford which is a top tier COMAH (Control of Major Accident Hazards) site. The works involve the installation of new drainage systems and the upgrading of the internal road network.

Prior to commencing works, the site team consisting of Tim Tyte, Niall Power and Muhammad Khawaja conducted a full underground service identification exercise which involved the location, exposure and confirmation of all known services on site.


This work was carried out in a controlled, professional manner and without causing any damage to the services that were uncovered.

In addition to the identification of the known services that were present on site, the site team also uncovered over 20 other unchartered services as part of the excavation works. One of these services was identified to be a live high voltage cable that even the electrical supply company had no knowledge of.

The team on site should be commended for their responsible approach to finding and protecting underground services throughout the early phases of the project. We will see you on the next safety award winner’s day.

Towing safety issues raised again

Once again two issues have been raised in the past month in relation to safe towing.

In one incident, the jockey wheel connector that was fitted to a cable trailer was found to be so badly worn that it would have been at risk of falling out whilst the trailer was under tow.

This could have posed a serious risk to other road users.

The second incident related to a towing bracket on the back of a dumper that appears to have spread apart meaning that the locating pin was not fully located in the bracket. As the dumper was towing a bowser across the site, the bowser became detached from the dumper. Luckily no-one was injured and nothing was damaged as a result of this incident, but the potential for a more serious incident to occur was definitely a possibility.

All employees are reminded that as the operator of the vehicle, it is you who are responsible for the safety of any towing operation and as such, the equipment related to towing safely should be checked as part of your daily inspection routine.

Heathrow safety award winner

During January, Darren O Connor, an operative from Groundwork Southern operating at Heathrow Airport was nominated for a safety award because he successfully located an uncharted, untraceable 125mm plastic water service whilst excavating for a new drainage run within a congested area of the airport. The service had previously been installed during construction work that was completed by another contractor, but the service location had not been added to the service clearance drawings.

Well done Darren, a £25 voucher will be with you soon.


DABBS awareness and leadership training - Update

Since the beginning of last year Dyer and Butler has been on a journey to deliver the DABBS course for operatives along with the 2 day safety leadership course.

We are still currently delivering both courses and are hoping to complete the training by the end of April 2017.

The feedback and participation has been greatly received, and this is currently under review with a view to provide a response.

For those who have completed the 2 day Safety Leadership Course here is the aid memoir to assist you with the process…

Stop and observe the work situation. Introduce yourself and put the person or

people at ease. Explain what you are doing and why. Ask them to describe the stages of the job that

they are doing. Praise any safe aspects of their behaviour. Ask what are the most serious or likely

accidents that could happen, and what the consequences would be.

If they are working unsafely, question them as to why they feel the need to work that way

Ask what corrective actions need to be undertaken to rectify any unsafe acts.

Achieve a commitment to act and establish who needs to do what, and by when.

Remember, if you invest the time to do your DABBS observations correctly, you may be preventing an accident or incident from occurring.

Please also remember that our current DABBS target is one DABBS observation for every 500 man hours.

A summary of the DABBS information that has been collected every month is provided in the Monthly SHEQ Report and Safety Matters.

CMS upgrade is imminent

Many of us within the business work to procedures and standards. Some of these procedures are client driven such as drawings and specifications but others are driven by Dyer & Butler requirements. Our procedures are created to meet Dyer & Butler, Client and ISO International standards. ISO International Standards give clients the comfort that the organisations that they are doing business with have a formal structure to provide products and services that are safe, reliable and of good quality. Covering almost every industry, from construction, technology and food safety, to agriculture and healthcare, the application of these standards and our own internal procedures are instrumental in facilitating trade between different organisations.

Compliance with the clauses of 9001 (Quality), 14001 (Environmental), and the 18001 (Safety) standards are a basic requirement and without holding these standards Dyer & Butler would not be able to tender for projects or frameworks with many of our key clients.

Maintaining and updating our management systems and processes are key to maintaining the development of Dyer & Butler.

Currently the company management system (CMS) is undergoing a major review and upgrade because the ISO9001 and ISO14001 standards have been updated by the International Standards organisation.

By completing the upgrade of the CMS we have also taken the opportunity to streamline our management systems and in doing so we have reduced the number of procedures within the business from 74 down to 37. In addition, operational teams will only have 4 core procedures to focus on, covering the Estimating, Pre construction, construction and post construction phases of the project.


Supporting procedures such as temporary works, design control and HAVS management (for example) will support the core operational procedures.

New guidance notes are also being provided to reflect the business requirements in areas such as inspection and testing, drawing control and noise.

We are currently anticipating that the revised CMS will be brought into use during the summer of 2017. A full package of training will support the roll out of the new system. Once implemented, the new CMS will be put forwards for recertification in October this year.

So all in all, you can expect a busy year in relation to the CMS requirements of the business. If you have any questions in relation to the contents of the new CMS or the implementation timescales, please contact the Quality Manager, Steve Holmes.

Coldbrook Flood Scheme – Safety Improvements

It is fair to say that the Coldbrook Flood Alleviation Scheme in Barry, South Wales has had its challenges, but recent news from site has really shown that the team on site have taken up the safety challenge and that some good practice is taking place as a result.

The works are taking place in a highly visible environment that is very close to public areas (i.e. roads, pavements, driveways and gardens).

Much of the work also involves deep drainage and excavation works in and around live services, some of which are encased in concrete which has to be removed carefully by hand.

Recently, one of the works gangs consisting of Sean Mannion, Jason Lock and Clive Morgan were carrying out works to install pre-cast box culvert sections within a particularly restricted residential area.

This work was completed without any accidents, incidents or complaints from members of the public and full compliance with the method statements and risk assessments connected with the works was also achieved.

On another part of the project, Jamie Morris and James Wheeler had been involved in laying new drainage pipes and constructing new gulley connections

As is common on this site, live services were carefully exposed and excavated beneath. A further uncharted concrete surround was also encountered and this was carefully removed by hand in full compliance with the safety plans for the works and company procedures.

All of the staff involved in these works should be commended for their actions and for maintaining the safety of the worksites in such a demanding environment. We will see you all on the next safety award winner’s day

Double safety awards and a safety milestone for DBE

At the time of typing this edition of “Safety Matters” Dyer & Butler Electrical Ltd have just ticked past the 500’000 hours worked without a reportable accident mark.

This is a truly remarkable achievement for the team and our congratulations go out to them on achieving this significant safety milestone


One of the reasons for DBE’s success is their constant drive to improve and make their operations safer and as such two separate nominations for a safety award have been received.

The first goes to Luke Harrison, who reported a close call whereby he assisted a passenger who had attempted to travel back through a security point to retrieve his luggage. Luke spotted the situation and took it upon himself to help escort the passenger to a security guard who could assist rather than allow the passenger to breach security protocols at Gatwick Airport.

The second goes to Kevin Ryan for maintaining exemplary site standards of safety. This was identified during a recent Achilles site audit and the auditor commented on not only the standard of the site set up but also commended Kevin’s professional approach during the audit.

Both Luke and Kevin will receive a £25 voucher for their involvement in maintaining DBE’s safety culture.

Close call – Safe vehicle loading

Recently, a delivery lorry that had been collecting spare packets of slabs from a Dyer & Butler site arrived at the Nursling office to offload.

On arrival at the office, it was very clear that an incident had occurred whilst the vehicle had been in transit and as a result, the load had shifted considerably. For

This was logged as a close call and the matter is currently under investigation by the delivery company, Lynch.

Initial investigations have shown that the vehicle had to perform an emergency stop on route from site to the office and in doing so, the load shifted uncontrollably.

Further consideration in relation to the way in which the packets of slabs were loaded have identified that this activity was unplanned and that the packets were incorrectly placed on the bed of the lorry and that they measures used to secure the packets of slabs for transit were ineffective (i.e. a single ratchet strap on each line of slabs).

Many of you will remember a recent safety bulletin that was released by Network Rail relating to an accident where a hydraulic unit fell from a van whilst in transit. The unit struck and killed a pedestrian that was out walking their dog along an adjacent footpath. This incident has all of the same hallmarks… If one of the pallets had fallen from the vehicle as a result of the emergency braking and struck a pedestrian, the outcome could have been a lot more serious.

Please note, that the drivers of all vehicles are responsible for the safety of their load whilst in transit.

A suitable means to secure the load should always be provided (i.e. straps, netting, etc).

Loads should not be placed onto a vehicle in an unstable configuration (i.e. high center of gravity or stacked)

Should an incident occur which destabilises the load during transit, then the vehicle must stop and should not continue its journey until the load has been fully secured.

A safe system of work should be in place to manage the loading and off-loading of any materials. Personnel are not permitted to climb onto the backs of vehicles without any fall protection measures in place.

Further information will be made available on this close call in due course.


100% intelligence – Zain Rehman

For those of you who have attended the 2 day Behavioural Leadership Training course, you will know that the intelligence test that is used on the course is particularly difficult to pass (no spoilers please).

On a recent course that was delivered in January, Zain Rehman, a Dyer & Butler Engineer from the Central Region, managed to achieve a 100% pass mark during the test.

This is the first time that anyone attending the course has achieved 100% during the test and by using the latest interrogation techniques, we are certain that Zain did not receive any help or assistance to pass the test.

Congratulations go to Zain for achieving this accolade… Is there anyone else out there that can equal this result.

Changes to the CSCS card scheme

The Construction Skills Certification Scheme (CSCS) is reminding its industry partners to be prepared for the withdrawal of the Construction Related Occupation (CRO) card. CSCS will stop issuing CRO cards from 31st March 2017 and all CRO cards issued since October 2015 will expire on 30th September 2017.

CRO cardholders must take further steps to replace their CRO cards before they expire.

The CRO card is no longer fit for purpose and CSCS has consulted with industry to determine the best way to address this issue.

Please note, all CRO cards issued from 1st October 2015 will expire on 30th September 2017 and are not renewable. You will be expected to register for a nationally recognised construction related qualification before the card expires. Only one occupation will be displayed on your CRO card from 1st October 2015. CSCS will stop issuing CRO cards from 31st March 2017.

Please note existing CRO cards issued before 1st October 2015 that expire after 30th September 2017 will remain valid until their expiry date.

If you hold a CRO card you will be expected to register for the appropriate qualification for your occupation before the CRO card expires. On completion of your qualification you will be able to apply for a skilled CSCS card.

If you do not register for the construction related qualification for your occupation before your CRO card expires you will be unable to obtain a CSCS card.

CSCS is aware there are existing construction related occupations without nationally recognised qualifications. Where appropriate, work is already underway to develop new nationally recognised qualifications for these occupations. For more information, please speak to the Dyer & Butler Training Manager, Andrea Parker.

Kevin Harding does the “Triple” On February 23rd Dyer & Butler had another very successful night at the “Heathrow Business Partner Health and Safety Awards”. The awards are set up to recognise both individuals and business partners who go above and beyond the area of health & safety.

Dyer & Butler Heathrow had submitted entries for all four categories.


• Working Together to improve Health and Safety

• Health and Well initiative of the Year • Innovation of the Year • Health and Safety Colleague of the Year

The outcome was that Dyer & Butler were shortlisted for two awards. These were Health and Safety initiative of the Year for the development and use of our QR code close call reporting all and also the Health and Safety Colleague of the Year.

Of the shortlisted categories Dyer & Butler had one winner which was chosen by the Heathrow Airport Ltd Development Team. The category that we won was Kevin Harding for the “H&S Colleague of the Year’’

This award follows up Kevin’s success at previous awards where he has won supervisor of the year followed by trainer of the year. This award shows Kevin’s unstoppable desire to ensure people are not hurt in their day to day duties for Dyer and Butler at Heathrow and his determination to assist Heathrow Airport in achieving their vision of “Everyone home or to their destination safe and well”

Abel Luger, Dyer & Butler Operations Manager, said “I would like to take the opportunity to congratulate Kevin with this massive achievement but also extend our congratulations to the entire team at Heathrow – WELL DONE! Thank you for another brilliant year especially for achieving this straight after our recent award in November – Health and Safety Partner of the Year. This definitely proves that we don’t only talk the talk but walk the walk”.

Stop Press – RISQS audit results

As this month’s edition is being typed, we have just completed the 2017 RISQS Audit which is the audit that checks our levels of compliance to be able to offer our services to the rail industry.

It is a pleasure to report that Dyer & Butler have completed the audit with…

No Major Non Conformances No Minor Non Conformance 5 Observations and… 4 Best Practice Comments

This is an excellent result for the company and it now means that our compliance rating has increased from 4 stars to a 5 star rating. Thanks to everyone that helped with the audit. If you need any more information about the audit protocol, please contact the Dyer & Butler Assurance Manager, Allan Guy.

Stop Press – 019 standard update

For those of us who work in the rail industry, the way in which we plan, deliver and manage safety critical work on the railway is changing. A series of briefings have been arranged and will be delivered throughout March and April. Full compliance with the updated standard is 3rd July 2017 so there is no need to concern yourself just yet.


DABBS Feedback

Your behavioural observations are continuing to be recorded and as such, we will continue to provide you with feedback on what the biggest issues are.

During January, PPE was identified as the most common cause of unsafe acts. Once again failure to wear the correct eye protection and hand protection were the main cause of unsafe acts. To repeat the point that was made last month… If you don’t have the correct PPE on to do your job safely, then you don’t work. Site teams must take a zero tolerance on this issue.

Work at Height issues were identified as our biggest cause of unsafe acts. Failure to plan and manage operations such as working on scaffold towers and the backs of vehicles were common. We need to ensure that a serious incident involving a fall from height does not happen as there is no safe height to fall from. The SHEQ Team are working on a number of initiatives to move the control and effectiveness of work at height issues up the agenda.

The winter weather also appears to have played a part in the increase of unsafe acts relating to Access and Egress hazards. Cold frosty weather and a lack of planning relating to making preparations for this type of hazard are mainly to blame for the increase in this category. The current focus on HAVS control and the use of the Reactec HAVS monitoring system have also led to an increase in the reporting of unsafe acts in this area.

During January, 294 DABBS observations took place, (the target of 313 was not achieved) 464 acts were observed – 54 of which were unsafe meaning that the percentage of unsafe acts = 11.63%

Close Call Feedback

Close calls are continuing to be monitored and during January 157 close calls were reported from across the company. This is the highest monthly total for close calls that have ever been reported. All divisions and regions showed an increase in reporting levels and the Central region topped the table with 61 close call reports during the month.

The rate of reporting continues to increase and this is a trend that should be promoted. All personnel must be encouraged to keep reporting close calls as part of their everyday activities The close call reporting figures as of January 2016 are as follows…

16

31

40

7

41

64

6

21

16

62

1

62

26

23

6

15

0 0 0

7

0

5

22

1 0

5

1 0

3 3 2 1

4

0% 0% 0%

15%

0%

11%

26%

14%

0%

24%

2%

0%

5%

10%

8%

14%

21%

0%

5%

10%

15%

20%

25%

30%

0

10

20

30

40

50

60

70

Monthly Safe & Unsafe Acts

SAFE UNSAFE PERCENTAGE OF ACTS UNSAFE


Amongst the close calls that have been raised during January, these are some of the best examples...

What Was The Close Call What Could Have Happened What Were You Able To Do About It..?

Discovered potential contaminated water in the excavation

Environmental incident involving contamination to nearby

watercourses

Notify the client and agree a safe course of action

The opening on top of shaft had only been demarcated with tape that was set back from the hole. This was too close to allow safe work to proceed in the vicinity.

If an operative had gone to work in the area there was a risk that, they

could have fallen through the opening to the crash deck below

circa. 1m

Scaffolders were immediately relocated to form a solid compliant edge protection to allow work to

safely proceed.

On completing the morning site check, damage was discovered to one of the stone parapet walls on the bridge. Large tractors and farm machinery is known to use the

bridge regularly with overhanging loads and may have caught it.

The damaged masonry could be wobbled by hand. This lump could

have fallen into the road and blocked it, or fallen down into our site below the bridge, causing

damage or injury.

Two RB22 water barriers were mobilised to make the parapet safe from the road. The loose masonry was then taken down carefully so that it could be re‐built. It was reported to the client who have asked for a quote to re‐build.

It’s your close calls that are making the difference… Keep them coming in…!

0

20

40

60

80

100

120

140

160

180

Feb‐16 Mar‐16 Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17

No of Close Calls

Month

Feb‐16 Mar‐16 Apr‐16 May‐16 Jun‐16 Jul‐16 Aug‐16 Sep‐16 Oct‐16 Nov‐16 Dec‐16 Jan‐17

Wales and West Close Calls 44 42 52 48 19 32 27 27 17 11 20 49

Southern Close Calls 10 8 12 10 10 6 8 11 20 12 20 41

Central Close Calls 5 32 56 56 46 40 20 27 10 43 19 61

Airport Close Calls 8 5 15 28 12 12 22 18 13 41 8 6

Close Calls by Region

Airport Close Calls Central Close Calls Southern Close Calls Wales and West Close Calls

Insh Marshes (RSPB Reserve): Category 1 Environmental Incident Issued to: All Network Rail line managers,

SHE professionals and RISQS registered contractors

Ref: NRL 17/02

Date of issue: 13/02/2017

Location: Insh Marshes, Kingussie

Contact: Keira McLuskey, Environment Specialist

Overview Insh Marshes is a nature reserve owned and managed by RSPB Scotland which is of local, regional, national and international conservation importance. It holds six national or international environmental designations. Following a track washout that left debris on RSPB's land a site visit was arranged and RSPB agreed in principle that culvert repairs and the installation of a 30m ditch could be undertaken. Method statements and drawings to confirm the proposals were requested and that all debris from the washout and any arisings from the ditch operations be disposed of offsite and that the works be completed before bird nesting season. RSPB made it clear to the project team that any work in the Insh Marshes Reserve would require RSPB to obtain consent from Scottish Natural Heritage due to its protected status. This would be done in collaboration with the project team using method statements and drawings.

The remedial work was contracted out and a 70m ditch was excavated. The work occurred without RSPB agreement and they were informed of the works after being seen by their Senior Ecologist from a passing train The work occurred without legally required consent from Scottish Natural Heritage. Most of the washed out debris was removed from the site however arisings from the excavation were spread over the RSPB reserve. The new ditch also blocked access to a private fishery. This incident was a "Category 1" (most serious category) Environmental Incident and whilst enforcement action against Network Rail has not been considered necessary, the incident damaged previously good relations with key environmental stakeholders.

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Underlying causes Documentation: project and specification documents were not adequate, were not internally or externally approved and suggested mitigation was not implemented. Communication: Confusion over the process for gaining consent for working in a third party owned protected site was evident; both Network Rail and the contractor assumed the other party would apply for and manage the consent.

Competence: Lack of Delivery Unit staff procurement experience (due to historically not having had to manage works of this nature) and low levels of environmental expertise within the DU meant that the importance of the consent was overlooked, against a perceived urgency to complete the works.

Key message

Any work in an environmentally protected area should not proceed without consultation and where appropriate, consent from the appropriate regulator.

Any work on third party land should have written permission from the land owner before work commences.

All staff should be aware of the importance of environmentally protected sites, how to operate in or adjacent to them and the consequences should this not happen.

Copies of Shared Learning documents are available on Safety Central

Part of our group of Safety Bulletins

This message was sent to [email protected] by Network Rail. Follow this link to Manage Preferences or Unsubscribe

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__________________________________________________________________

HSE Bulletin 04 in 2017 Best practice reminder – Cutting, Drilling & Fixing

Date of issue: 26 January 2017 ______________________________________________________________________

Background

Following a recent series of near miss drilling incidents the purpose of this HSE Bulletin is to remind all employees and contractors of the risks associated with cutting, drilling and fixing, and the correct installation process that must be adhered to at all times: The principal issues are buried services, hidden services and surface mounted services - located on both sides of a wall/structure.

Instruction

Design out the risk at Cutting, Drilling, Fixing (CDF) production stage - ensuring that fixings, depth of fixings, thickness of structure and services are considered.

A Safe System of Work (SSoW) shall be in place that details the potential risks and relevant control measures (including any residual risks detailed on the CDF).

Consult CDF Log.

Visually check the opposite side of the wall/structure, if not detailed in the ‘Asset Register’.

Scan surface of the wall/structure for hidden services. Set drill depth gauge to match the recommended depth for fixing the approved

design.

Ensure the CDF reflects the installation location.

Ensure that the ‘SSoW’ reflects the design and installation activity.

Please communicate this Bulletin to your teams, projects and suppliers as appropriate.

For more information contact: Gary Hicks, HSE Senior Manager

Approved by (HSE Snr Manager): James Terry, Head of Safety, CPD

Gloucester Road IMR (Internal) – Hole Above Cable Run

Gloucester Road IMR (Internal) – Hole above transmitter

Gloucester Road IMR (External) – Cable Bracket

HSE Bulletin 05 in 2017 Items falling from open office windows

Date of issue: 26 January 2017 ______________________________________________________________________

Background HSE Bulletin 5 is being issued following a recent incident at one of our Head Office Buildings when during the opening of a window an extension lead was accidentally dropped out of the window, narrowly missing a member of the public.

Instruction Section 7 of the Health and Safety at Work Act states that employees must take reasonable care for the health and safety of themselves and others affected by their acts or omissions. When opening windows or working near open windows, you must consider the risk of objects falling onto somebody or something below.

Do not store items on window ledges where they may fall out.

When undertaking work near open windows, be mindful and either close the window or ensure there is sufficient space so that items cannot be accidentally dropped.

Any hand-held equipment such as drills or saws can be dropped or knocked out of a window or over the edge of a platform or walkway. Materials such as nails, pieces of wood and debris can also represent a significant hazard.

Platforms should be made so that materials or objects can't fall and cause injury to anyone or anything below.


For more information contact Joanne Parker, HSE Manager

Approved by (HSE Snr Manager): Gary Edwards, HSE Senior Manager

______________________________________________________________________

______________________________________________________________________

HSE Bulletin 06 in 2017 Manual application of Herbicide

Date of issue: 06 February 2017

Background

All staff and contractors who work on the track and other open areas, including depots and sidings, are reminded that the annual application of herbicides will take place between February and September 2017.

Instruction

As part of our commitment to maintaining a safe working environment, the annual application of herbicide will be carried out at locations not intended to bare vegetation. When you see the “Caution herbicide application in progress” sign or similar (above) you must report to the Site Person in Charge (SPC). They have and will provide you with information on what product is in use and if any precautions or additional PPE are required to pass through the worksite. Details of all herbicide application station to station will be advertised in the Traffic Circular and herbicide application during track and depot possessions will be briefed at the start of the shift.

All staff must follow good hygiene and ensure they wash their hands and face before eating.

Please communicate this alert to your teams, projects and suppliers as appropriate

For more information contact: Gary Russell, Head of Track & Civils, SSL

Approved by (HSE Snr Manager): Steve Judd, HSE Senior Manager - Environment

HSE Bulletin 08 in 2017 Noxious Substance Attacks

Date of issue: 13 February 2017 ______________________________________________________________________

Background HSE Bulletin 8 is being issued following information we have received from the British Transport Police regarding acid attacks which have occurred on our stations. The incidents are rare and have been related to gang violence and not staff. Please note that there is no specific risk identified for our staff. The substances used are usually either “one shot” drain cleaner or a strong alkali type laboratory strength ammonia and the substances are usually decanted into a squeeze sports bottle, e.g. Lucozade. This is to enable offenders to easily spray the substance into victim’s faces.

Instruction In the unlikely event that you are involved in a noxious substance attack, please follow the following: • Call for an Ambulance. • Call BTP or Metropolitan Police to assist. • Are the Fire Brigade required? Yes if multiple casualties. • Contain the scene to prevent further casualties. • Start First Aid (unless the chemical can be identified it should be treated as a chemical

burn). • Do NOT try to do a sniff test and inhale the substance. • Ask casualties to disrobe – cut clothes off rather than remove overhead if able, remove

jewellery. • Irrigate effected area for AT LEAST 10 minutes (eyes) and 20 minutes (rest of body) with

water/non-hazardous liquid. • When irrigating ensure the water does not run down the body or under the casualty

causing further injury. Be careful that the chemical does not splash on the rescuer. • Do NOT use gauze – this can stick to the wounds. • Do NOT use any ointment.


For more information contact Joanne Parker, HSE Manager

Approved by (HSE Snr Manager): Simon Peacock, HSE Senior Manager

______________________________________________________________________

HSE Bulletin 09 in 2017 Restriction on access to a specific area at High Street Kensington Station

Date of issue: 15 February 2017 ______________________________________________________________________

Background Following HSE Alert 09/03, originally issued in February 2003, this HSE Bulletin is being issued for the attention of all Staff and Contractors who undertake work or may require access to the following area of High Street Kensington station: Disused Workshop 2/414 – accessed through room 2/661 at the north end (Notting Hill Gate) of Platform 1. A full management survey of this room took place in April 2015 and the report confirms the presence of ACMs. This survey is on the LU asbestos register document reference R481626: http://onespace.tfl.gov.uk/lu_/luar/default.aspx - Everyone with a OneLondon account and our maintenance contractors have access to the register. This asbestos will not be disturbed by normal train or staff/customer movement and poses no risk to the normal operation of the railway. Arrangements have been instigated to monitor the site on a regular basis.

Instruction Access to this room is prohibited until a full environmental clean takes place. To ensure compliance with the Control of Asbestos Regulations 2012, we have secured the room and placed a copy of this notice on the door. This room has been secured since the original Alert in 2003 so it is doubtful that emergency access will be required. The only emergency which may occur is if someone removes the panel which has been secured to the door without first contacting ACU. The APD control centre phone number for SSL is 020 7027 1913 or auto 51913. For general enquiries please contact: [email protected].


For more information contact Phil Flint, HSE Manager

Approved by (HSE Snr Manager): Sonja Hedgecock, HSE Senior Manager

______________________________________________________________________

http://onespace.tfl.gov.uk/lu_/luar/default.aspx

mailto:[email protected]

HSE Bulletin 10 in 2017 Accessing the track environment safely

Date of issue: 17 February 2017 Date of expiry: 17 August 2017

______________________________________________________________________

Background A member of the LU Signals Response team had a serious injury recently whilst accessing the track via a platform ramp. The injured person tried to access the track from a narrow ramp and stepped onto the track from partway down the ramp. The injured person fell over and sustained a broken pelvis. An investigation is under way. At this stage, a number of factors, which potentially could have contributed to this incident, have been identified. The injured person may not have been able to access to track from the bottom of

the ramp or track level due to the position of a train that was being used as protection.

As previously stated the ramp was narrow. The ramp may have been wet and hence slippery. The lighting may have been poor in the area.

Instruction Care should be taken accessing the track and the factors above should be

considered when accessing the track, including the general condition of the area of access.

All staff that use platform ramps to access the track must walk to the bottom of the ramp.

Report any damage or other concerns in relation to track access points via the appropriate channels.

Please communicate this alert to your teams, projects and suppliers as appropriate

Incident reference IRF000819532 / 13856

For more information contact Simon Milburn

Approved by (HSE Snr Manager): Marian Kelly

______________________________________________________________________

LU maintenance LU Stations and Trains CPD

HSE Bulletin 11 in 2017 Dust exposure on the Underground

Date of issue: 17 February 2017 Date of expiry 17 August 2017

______________________________________________________________________

Background

Surrey University recently published research into dust on the Underground. This bulletin is being issued in response to questions from staff to provide reassurance that the levels and content of dust in the underground sections of London Underground’s infrastructure do not pose a significant risk to your health. Independent monitoring Sources of dust in the Underground environment include metals, particularly iron from track wear, dust from outside which is often bought in by people in the form of foot trodden dirt, shed skin and hair, and surface air pollutants from motor vehicles. LU has an active programme of monitoring air quality and dust across the LU network. This is carried out independently and includes specific dust monitoring around work operations that generate dust such as construction and maintenance as well as general dusts that staff are exposed to as part of their general duties. The levels are then compared against Health and Safety Executive’s Workplace Exposure Limits (http://www.hse.gov.uk/pubns/priced/eh40.pdf). LU specifically monitors the following:

1. Respirable Dusts which are particles of a small enough size to penetrate deep into the breathing zone of the lungs.

2. Crystalline Silica comes from concretes and ballasts and can cause a disease known as silicosis. 3. Iron, which predominates Underground dust, and primarily comes from track and wheel wear and,

to a lesser extent, wear from braking systems. 4. Other metals, including chromium, nickel, manganese, copper and zinc which are metals used in

steel track and wheel construction. The results of the monitoring provides evidence that the levels of dust/air pollutants in the LU underground environment are all lower than the levels recommended by the Health & Safety Executive.

1. Respirable Dusts: results show that levels on the Underground were at least half of the HSE exposure levels, and in most cases, 70-80% below the recommended levels.

2. Crystalline Silica: results show that the highest exposure on the Underground was over 95% lower than the recommended HSE exposure levels.

3. Iron: results show that the highest exposure on the Underground was 97% lower than the recommended HSE exposure levels.

4. Other metals: all other metals monitored were below the limit of detection. While these figures show that air pollution and dust levels on the Underground are significantly below the HSE exposure levels, LU continues to look for ways of further reducing exposures to dust or air pollution. Further information Short film about dust on the Tube: https://www.youtube.com/watch?v=B98G-GR5zOE

For more information contact Olivia Carlton, Head of Occupational Health

Nick Wilson, LU Occupational Hygienist

Approved by (HSE Snr Manager): Marian Kelly

______________________________________________________________________

LU maintenance LU Stations and Trains CPD

http://www.hse.gov.uk/pubns/priced/eh40.pdf

https://www.youtube.com/watch?v=B98G-GR5zOE

Date issued: 17th February 2017 Issued by: Steve Hewings Author: Mark Dixon Safety Alert No: SA 17 01

RIDDOR Reportable Over 7-day Injury

Burns to Leg

What Happened? An MPFS yard operative was undertaking routine tasks which involved the removal of decals (labels) from company vehicles. The task involved the use of a chemical solution (Glue and Tar Remover) to remove the residual glue that remains after the decals have been removed. The operative used a spray form of the solution and proceeded to spray it onto the van, unaware that the solution had coated his boot. On completion of the task the operative stood in front of a guarded diesel space heater to warm up. After a few seconds the operative noticed that his right leg and boot were hot, he looked down and realised that his boot had caught fire. Quite rapidly, flames went up the inside of the operative’s trouser leg requiring him to quickly remove his trousers to extinguish the flames. After the flames were extinguished the IP received on-site first aid to dress his wounds, he was then taken to hospital. The incident resulted in the operative suffering burns to the shin and lower leg; he was off work for over 7 days.

Safety Alert

Immediate Cause

• Unsafe Act - standing directly in front of a space heater. • Unsafe Condition – using flammable chemical solution which soiled PPE.

Learning’s for the Group

• When using any chemical solution, ensure you undertake a COSHH Risk Assessment. • You must read and understood the COSHH data information sheet and the information on the

product itself before using it. • Where any spills occur, they must be cleaned immediately. • If any chemical solution soils clothing or PPE, clean it off or change the clothing and/or PPE.

Since the incident, Morrison Plant & Fleet Services has sourced an alternative (non-flammable) solution which will be used for this work activity going forward.

Remember, nothing we do is so important that we cannot take the time to do it safely!

Date issued: 17th February 2017 Issued by: Steve Hewings

Author: Lewis Binfield Safety Alert No: SA 17 02

Near Miss Electrical Flashover

If in any doubt – contact your Line Manager

Remember Nothing we do is so important that we cannot take the time to do it safely

Incident Overview On the 7th February 2017 two electrical low voltage jointing teams were dispatched to complete a Four Way Link Box replacement. The scope of the works included installing a new four way link box adjacent to the existing four way link box. Owing to vulnerable customers being on the section of the network where work was being undertaken, there was a requirement to maintain the supply. This could only be achieved by situating the new link box next to the old link box and transferring networks over. The team commenced the low voltage jointing activity by temporarily ‘pot ending’ the tails from the new link box. Under supervision, the jointer proceeded to complete the first crutch joint, making the new four way link box live. The team then started and completed the second crutch joint. Whilst completing the third breech joint and at the point of connecting the third phase, an Electrical Flashover occurred as the jointer was tightening the left hand connector bolt with a ratchet spanner. The force caused the right hand connector bolt to pierce through the second phase insulation.

Safety Alert

Learning Points

Always adhere to the Distribution Safety Rules (DSR) and Operation Manuals at all times.

If you are in a role where you are providing ‘Personal Supervision’ (as defined in the DSR to operatives ‘Under Personal Supervision’ (UPS) it is YOUR duty to provide continuous observation during the course of the works (or testing). You have been afforded the competence to intervene.

Remember to appropriately select and use approved tools whilst undertaking electrical jointing activities.

The use of further core protection/shrouding should be implemented as necessary.

2nd

Phase - Black

3rd

Phase - Grey

Safety Alerts should not be thought of as an accident investigation report. However, they are issued to raise awareness of accidents that occur and to highlight the safe work practices required to avoid them being repeated.

For Anglian Water employees and contractors No. SA000587 Date: 17th Feb 2017

High Voltage Cable Strike

What happened: During the installation of storage bays on site at Cotton Valley WRC a partner contractor struck two 11kv electricity cables with an excavator mounted auger. This caused a loss of power to a significant part of site. Luckily there were no injuries, flash over or fire as a result of the damage. The area was CAT scanned and the cables identified/marked however safe digging procedures were not fully followed which resulted in the cable strike. What do you need to do:

• Full CDM procedures must be followed on all construction projects, including:- o Appointments should be made in writing o PCI information issued o CPP information received o Pre start meetings to be held and minutes taken

• Survey drawings should be requested in advance of the job commencing. • All personnel involved in CDM projects should be competent and can seek additional

support from the AW CDM Team if required. • Always make sure there is a contract user checklist in place when issuing a

site/asset access authorisation (SAAA). • Site personnel must be trained and competent to carry out the task and use the

equipment, there should also be adequate supervision on site. • Personnel should always use a Genny with the CAT scanner. • ‘No Plans No Dig’ unless guidance has been sought. • Safe digging procedures including checklist must always be followed. • Do not use mechanical tools in the close proximity to services in line with AW

procedures. • Always wear FR/ARC resistant PPE as per your risk assessment when breaking

ground.

Nothing is so important we cannot take the time to do it safely

Sample Picture

SHE Bulletin No. RF-LFI-ALL-034 FO-SHE-010-005 v1.04

Page 1 of 1

FOR ISSUE TO ALL SSE

SHE ALERT REPORTABLE INCIDENT – FATALITY

A worker was fatally injured when a load toppled onto him whilst he was unpacking a crate

What happened?

In December 2016 an employee of an external offshore oil and gas company was injured on an offshore gas platform when equipment from a packing crate he was unloading fell onto him. Sadly the employee died from the injuries sustained during the incident. It was found that the equipment within the crate had become unstable during lifting, unpacking or in transit. The incident is under official investigation by the authorities.

What action is required within SSE?

When unpacking crates, boxes, etc., care must be taken to check the centre of gravity/balance and checkfor unexpected abnormalities.

Complete a risk assessment prior to interacting with potentially unstableequipment or equipment with the potential to cause serious injury or death.

Following your assessment determine how the crate/box is going to be openedensuring that persons remain ‘out of the line of fire’ and/or suitably protected in

case something unforeseen does happen when the crate/box is opened. Check withthe manufacturer/supplier if any specific unpacking procedures are required.

If possible, and ensuring that the load is secure, create a small opening in thecrate/box sufficient to look in and enable a further assessment of the situation andtake appropriate action thereafter.

Always ask – what’s the worst that could happen?

Never put yourself or others ‘in the line of fire’.

At SSE – if it’s not safe, we don’t do it.

See Perenco Safety Alert attached for further information.

All SSE Managers must ensure that this information is shared with the employees and contractors workingon their behalf.

Engage with Procurement/equipment suppliers/transport companies to ensure that transport andunpacking risks are eliminated/minimised.

Communication by () LSG Notice board Tool-box talk Team brief

Communication complete by () 1 week 2 weeks 1-month 2-months

Issued by: Alan Drake, Exploration & Production SHE Manager, Wholesale Date Issued: 25.01.2017

SAFETY ALERT

Potentially Unstable Equipment (Rev 1)

WHAT HAPPENED?

An incident occurred recently on our Inde 49/23A installation fatally injuring one of our employees whilst unpacking a tall

and heavy item of equipment. The item of equipment may have become unstable during lifting, unpacking or in transit.

INITIAL FINDINGS & SAFEGUARDS

The investigation into the incident is in its very early stages. Perenco are cooperating fully with the authorities to

understand the cause(s), such that we can make any necessary improvements to our safe systems of work to better

identify and prevent such risks. Whilst the formal investigation continues it is essential that we put in place some

immediate additional safeguards to protect our workforce.

1) Equipment with potential to cause serious injury / death

• Any equipment that is taller than you and heavier than you should be considered as a having the potential to

cause you risk of serious injury / death.

2) Potentially unstable equipment

• Any equipment that meets the following criteria should be considered potentially unstable:

• It has a centre of gravity (CoG) at a point above 50% of its height

• It has an off-set centre of gravity (CoG)

• Its size/shape means that its stability could be affected by environmental factors (i.e. wind/snow/ice loading)

• It has signs of damage which could have changed the CoG or result in sudden collapse

• It is located on uneven / unstable ground

ACTIONS

The following actions have been agreed and may be refined in due course.

1) All persons to ensure that if they are about to interact with equipment that meets the criteria above then they

shall undertake a formal risk assessment.

2) OIM/Site Manager shall ensure Safe Systems of Work (permits, procedures, formal risk assessments and

toolbox talks) identify risks associated with potentially unstable equipment and clearly define control measures

to reduce risks to ALARP. OIM/Site Manager shall authorise work of this type.

3) OIM/Site Manager/QSHE/Area Authorities shall engage with persons at the worksite to ensure risks have

been suitably assessed and control measures are being effectively implemented.

4) All persons interacting with potentially unstable equipment shall ensure they have an escape route identified

in the unlikely event that the equipment should become unstable and move or fall suddenly.

5) All persons shall STOP THE JOB if they consider the risk of potentially unstable equipment has not been

suitably risk assessed, the control measures are inadequate or are not being effectively implemented.

Originator: D Farrow (ext.1294)

Reviewer: J Rusin

Reference: PUK/SA/070

Centre of Gravity Marking Symbol

Centre of Gravity Marking Symbol

Date issued: 10th February 2017 Issued by: Steve Hewings

Author: Julian Williams Safety Bulletin No: SB 17 01

Significant Near Miss Grab Damages Concrete Lamp Post

Remember Nothing we do is so important that we cannot take the time to do it safely

What Happened? On 17th January 2017, a grab operator was clearing spoil from an MUS site. The Grab Operator lowered the grab to the ground to scoop the last of the spoil directly into the clam shell bucket and prepared to step down from the control platform. As he stepped off the platform, the coat he was wearing caught a control which caused the bucket to uncontrollably swing across the footpath and strike the concrete lamp post. The impact resulted in the lamp post breaking at the base and falling to the ground. Had there been any individuals near-by, there could have been significant and devastating injuries.

Safety Bulletin

Consider the hazards and injuries that may arise from the use of work equipment:

Entrapment - where parts of the body could be caught in parts of equipment.

Impact - where the body could be crushed by moving parts.

Contact - where the body could touch sharp edges, hot surfaces or abrasive surfaces.

Entanglement - where clothing or jewellery could get caught in parts of a machine.

Ejection - where parts of equipment or materials being worked on could fly off and hit the body.

Learning Points for the Group:

Loose clothing must be secured using drawstrings and/or velcro as necessary. You must ensure time is taken to secure any loose clothing/items before stepping away from controls that may be caught.

Ensure that you have assessed all potential hazards and risks in your site specific risk assessment.

Ensure all barriers and traffic management remains in place whilst operating grabs or other plant on site.

Rail Accident Investigation Branch Safety digest 03/2017: Stowe Hill Tunnel

Collision between a train and an engineering trolley, Stowe Hill Tunnel, 7 December 2016

1. Important safety messages

This incident demonstrates the importance of:

Track workers and managers being aware that the air flows generated within tunnels and pressure relief shafts (where provided) can be significant when trains pass, and are capable of lifting or moving heavy items of equipment unless robustly secured.

Complying with the rules for securely storing equipment by the line-side (eg using chains and padlocks), not only to stop theft or vandalism, but also, in the case of tunnels, to prevent equipment being swept onto the track by strong air flows. If there is no suitable means of securing the equipment, the safest approach is to not store equipment in a tunnel.

Including full consideration of where, and how, equipment should be stored during the task planning process and associated risk assessments and not deviating from agreed methods of securing equipment, particularly if storage in tunnels (which leads to increased risk of high aerodynamic forces) is unavoidable.

2. Summary of the incident

At 10:03 hrs on Wednesday 7 December 2016, a class 390 ‘Pendolino’ train operated by Virgin Trains collided with an engineering trolley in Stowe Hill Tunnel, without causing derailment or injury. The train was operating service 1A14, the 08:35 hrs Manchester Piccadilly to London Euston. It passed through the tunnel at a speed of around 120 mph (193 km/h) at the same time as a northbound class 390 service, 9G11, the 09:23 London Euston to Birmingham New Street.

A member of staff on board train 1A14 heard a loud bang and subsequently saw that one of the train’s windows had a broken outer pane. The staff member arranged for the driver to be informed by the train manager, and in accordance with operating procedures for Class 390 trains, the driver then reduced the speed to 100 mph (161 km/h). Virgin Trains reported the incident to Network Rail at approximately 10:10 hrs, but an exact location of the collision was not known at that time.


The train was examined that night at Longsight depot, Manchester, where further damage was found to underframe and bogie-mounted equipment. The discovery of this damage was reported by Virgin Trains to Network Rail at 08:05 hrs on Thursday 8 December 2016. Subsequently, damage to the body side of train 9G11 was also found, but it cannot be confirmed that this damage was also caused by the collision with a trolley in the tunnel.

The engineering trolley found between the Up Main line and the Down Main line

Following the report of 8 December 2016 from Virgin Trains, Network Rail instigated checks of the general area where the damage was reported to have occurred. However, before any such checks could be carried out, the driver of another train reported seeing an unknown object lying by the track in Stowe Hill Tunnel.

Stowe Hill Tunnel is located on a twin-track section of the West Coast Main Line between Rugby and Milton Keynes, approximately 68 miles (109 km) to the north of London Euston. The tunnel is 449 metres long, and comprises a single bore containing two railway tracks. The tracks are designated Up Main line (normally conveying traffic south towards London) and the Down Main line (conveying traffic away from London).

The tunnel has four pressure relief shafts which are vented to the surface. Their purpose is to help reduce the pressure pulses experienced by passengers when trains run in the tunnel. Shaft No.1 is at the southern end of the tunnel and shaft No.4 is at the northern end. Shafts 1, 2 and 3 are located at recesses on the Up side of the main tunnel bore. Shaft 4 is located on the Down side. Each pressure relief shaft has a metal grille to protect the railway from objects being dropped down the shafts.


Cross section through the tunnel showing pressure relief shaft and location of trolley stowage (schematic). The edge of the trolley is 1.77 metres from the Up Main line.

Network Rail staff were sent to Stowe Hill Tunnel on 8 December 2016 in response to the incident reports and discovered four hand pushed trolleys, each weighing 57 kg, within the tunnel in the following states:

one trolley was between the tunnel wall and the Up Main line and had been completely destroyed;

a second trolley was located between the Up Main and Down Main lines and had damage consistent with having been struck by passing trains;

a third trolley was in the recess of pressure relief shaft No.1 and was undamaged; and

a fourth trolley in the recess at pressure relief shaft No.2, also undamaged.

The two trolleys which had remained in the recesses were reported to be unsecured. However, broken cable ties were subsequently found in the vicinity of the trolleys.


Undamaged trolley as found within the pressure relief shaft No. 1 recess in Stowe Hill Tunnel. The metal grille at the bottom of the shaft can be seen in the background (photo courtesy Network Rail)

3. Cause of the accident

The accident occurred because the trolleys had been stored in the tunnel recesses without being adequately secured and the airflow generated within the pressure relief shafts was large enough to lift and move the trolleys onto the track. On the night of Sunday 4th December 2016 into Monday 5 December 2016, employees of AMCO Rail had been undertaking brickwork repairs within Stowe Hill tunnel. The AMCO staff used the engineering trolleys to move tools and materials to and from the access point.

The task planning process for this work had originally envisaged using an access point at Weedon, to the north of the tunnel, which was suitable for placing trolleys on the line. The intention was that the trolleys would be removed from the railway after each night’s work and therefore no consideration had been given to any means of storing the trolleys adjacent to the lineside. However, due to an error in the planning process, the access point shown on the Safe System of Work documentation issued to the AMCO staff was shown as Stowe Hill Tunnel. The Stowe Hill Tunnel access point is adjacent to and above the southern tunnel portal. The route from this access point to the lineside requires staff to descend more than 80 steps carrying tools and equipment as required.


During the night of 4/5 December, temperatures dropped and concerns were raised by the AMCO staff working on site that the steps to climb from the lineside back to the access point had become icy, and that therefore it was unsafe to remove the trolleys from the lineside using that route. It was therefore agreed between AMCO and Network Rail staff on site that the trolleys could be left in the recesses within the tunnel. Network Rail staff stated that the trolleys must be secured to ‘something solid’ using chains and padlocks.

However, at the end of the planned work, and after the Network Rail staff had left site, the AMCO staff realised that they did not have any chains or padlocks available. They reported that the four trolleys were placed and secured in the recesses at No.1 and No.2 shafts, two per recess. In each recess, one trolley was placed on top of the second, and they were secured to the grille using cable ties.

On 7 December 2016, trains 1A14 and 9G11 passed within the tunnel in the vicinity of No.1 and No.2 shafts. The forces acting on the trolleys due to the airflow produced in the pressure relief ducts when the two trains passed, caused the upper trolleys in each recess to be lifted by the airflow. One of the trolleys became airborne to the extent that it was able to clear the Up Main line and land in the area between the two railway lines in the tunnel.

The railway rulebook (GE/RT8000), Handbook 1, Section 7.1 states that ‘Tools & equipment must not be placed any closer than 2 metres from a line on which a train could pass, unless you are absolutely sure that they will not be hit by a passing train or be moved by the slipstream of passing trains’. In this case the trolleys were less than two metres from the Up Main line, and had not been adequately secured.

4. Previous Similar Incidents

RAIB report 03/2008 covers the derailment of a train on LUL’s Central Line at Mile End. The train became derailed on a roll of material which had been stored in a cross-passage between tunnels and was dislodged by the air flows generated by passing trains.

RAIB report 13/2013 covers the partial collapse of a structure within Balcombe Tunnel. The forces on this structure were generated by the air flows produced by trains passing at speed through the tunnel.

Network Rail have issued a Safety Bulletin which can be found here, covering the incident at Stowe Hill amongst others.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/411829/080131_R032008_Mile_End.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/410728/130815_R132013_Balcombe_Tunnel.pdf

https://safety.networkrail.co.uk/wp-content/uploads/2016/12/Safety-Bulletin-NRB-16_22-Plant-and-equipment-stored-in-tunnels.pdf

February 2017

In the early hours of Saturday the 14th January 2017, a Dyer & Butler operative sustained a significant hand injury when a small piece of concrete was ejected from concrete breaking activities at high speed.

The work being carried out at the time involved the breaking out of a concrete surround around a pit cover on an airfield cargo road. Due to its location on the airfield, the concrete was very hard and contained a lot of aggregate and flint. For this reason a 3 tonne machine with a hydraulic breaker was used to complete the works.

At the time of the accident breaking out operations had ceased to allow for the debris to be collected. The injured party had collected some debris and had made his way to the works vehicle which was parked approximately two meters away.

After depositing the debris onto the flatbed of the works vehicle, the injured party decided to push the debris a bit further onto the vehicle to make room for the next load. In doing so, he placed his hand onto the side of the vehicle.

At the same time, the breaking out activities started up again and this caused a small piece of concrete to be ejected away from the works area at speed.

The injured party immediately felt something hit the back of their hand which caused a significant amount of pain and on inspecting the hand, it was clearly apparent that a serious injury had occurred. The injured party was immediately taken to hospital and received treatment for an open fracture caused by a broken bone in their hand and tendon damage. The injured party required surgery to correct the injury and has been absent from work as a result.

Please note -

All breaking out activities must be carefully controlled to ensure that personnel are not put at risk from flying or ejected objects. Protective screening, fencing and netting should be used to reduce the risk and suitable PPE that has been specially selected for these hazards should also be selected.

HAND INJURY CAUSED BY FLYING MATERIAL

Issue to - Managing Director, All Directors, Departmental Heads and all Site Staff

No - 17.01

safe by choice ….not by chance - morrison utility services · grinder when it snagged and kicked...

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