Coronial
SAother

Coroner's Finding: Greenhalgh, Kym Charles

Deceased

Kym Charles Greenhalgh

Demographics

50y, male

Date of death

2008-04-01

Finding date

2012-09-11

Cause of death

multiple injuries sustained when struck by a multi-tyred road roller

AI-generated summary

A 50-year-old road worker was struck and killed by a multi-tyred roller he was operating while reversing during road spray-sealing work. The driver made steering errors while reversing—the primary human factors being: unfamiliarity with the specific roller model (DM83), which lacked a foot brake unlike his previous equipment; hydraulic steering lag causing delayed correction; and critically, the unsafe operational practice requiring drivers to reverse for half their working day while twisted looking over their shoulder. When the roller drifted off course, the driver attempted to brake using a non-existent foot brake rather than lifting off the deadman's plate. This tragic accident highlights systemic workplace design failures. Enhanced operator familiarisation, machine design improvements enabling forward-facing operation during reversing, and engineering solutions to eliminate the need for prolonged reversing manoeuvres could have prevented this death.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.

Contributing factors

  • operator unfamiliarity with DM83 roller model
  • lack of adequate induction/training on DM83 specific features
  • operator expectation of foot brake that did not exist
  • hydraulic steering system lag during reverse operation
  • steering error in moment of crisis
  • unsatisfactory operational method requiring prolonged reverse driving
  • operator fatigue after 6-7 hours operation including 3+ hours reversing
  • deceased worker in unexpected location due to roller's sudden course change

Coroner's recommendations

  1. Minister for Transport and Infrastructure and Minister for Industrial Relations should jointly develop a strategy to overcome the unsafe method of roller operation, in consultation with interstate and Federal counterparts
  2. Implement machine designs enabling operators to face forward while vehicle reverses, to eliminate the need for twisted posture while reversing
  3. Consider engineering solutions to reduce or eliminate the requirement for operators to reverse rollers for extended periods during road surface compaction work
Full text

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