Inquest into the death of Darryll Stuart Davis

Contributing factors

• failure to adequately isolate electrical equipment before work—duct tape alone does not comply with Australian safety standards
• no evidence of re-testing circuit with multimeter after work was interrupted or resumed
• inadequate identification of dual hot water circuit breakers—both unmarked to distinguish which service they supplied
• power to circuit restored by unknown person while deceased was working
• deceased did not use mandatory lockout or removal of cables/connectors as required by AS/NZS 4836:2001
• poor switchboard design and lack of locking mechanism on circuit breaker panel cover
• communication barriers—safety tags in English not understood by non-English speaking household occupants

Coroner's recommendations

1. The Minister should amend AS/NZS 4836:2001 standards to provide that where electrical isolation is required and non-English speaking persons are present, there must be mandatory padlock isolation of the switchboard to physically prevent access to the circuit breaker panel
2. Implementation of mandatory switchboard lockout rather than reliance on individual circuit breaker devices, due to the variety of different circuit breaker types
3. Review of electrical safety standards to address practical application in communities with non-English speaking populations and cultural barriers to standard warning tags
4. Improved labelling of circuit breakers, particularly where dual services of the same type are installed on a single property