Morris, Daniel Paul
Deceased
Daniel Paul Morris
Demographics
23y, male
Date of death
2011-03-23
Finding date
2013-08-15
Cause of death
Electrocution
AI-generated summary
Daniel Paul Morris, 23, died from electrocution while welding at Ridley Agriproducts in March 2011. He was sitting on a metal hopper (workpiece) with dangling legs in humid conditions, causing perspiration that increased body conductivity. When changing a welding rod, he contacted the electrode and received a fatal shock. The welder complied with standards for Category B environments but lacked a hazard-reducing device (HRD). Critical clinical lessons: Mr Morris was inadequately supervised—the site manager was not replaced and remote supervision was infrequent; he was also not trained or authorized for welding. The coroner found that implementing Australian Standard AS1674.2 control measures (insulation from workpiece) would likely have prevented death. Key preventability factors include lack of HRD on the welder, inadequate workplace supervision, failure to prevent unauthorized welding work, and absence of mandatory safety devices for tropical/humid conditions. The case highlights systemic failures in workplace safety management and supervision rather than individual clinical error.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Procedures
Contributing factors
- Contact with live electrode in welder while in contact with workpiece
- High body conductivity due to perspiration from humid conditions
- Low resistance pathway from hand to foot via metal hopper
- Absence of hazard-reducing device on welding machine
- Inadequate supervision of employee
- Employee performing unauthorized welding work outside scope of employment
- Lack of hot work permit system
- No replacement site manager following departure of previous manager
- Infrequent remote supervision from head office
- Non-compliance with Australian Standard AS1674.2 control measures
Coroner's recommendations
- Australian Standards should amend Australian Standard 1674.2 to mandate the fitting of hazard-reducing devices (HRD) to welding power sources used for manual metal arc welding when welding is carried out in Category B and C environments
- WH&S should amend fact sheets published on its website to reflect the recommendation that HRD be fitted to all manual metal-arc welding machines which are used in humid conditions and/or Category B or C environments
- WH&S should re-open the investigation into whether Ridley should be prosecuted under the Work Health and Safety Act in light of new evidence regarding supervision failures
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