Adaptation and Modification of Tool Results in Injury (BSEE Alert)

Modified Wrench BSEE

Modified Wrench BSEEDuring offshore energy operations, a worker was recently injured while attempting to install a hydraulic line on a pipe-handling machine. The worker determined that the combination wrench on hand was too long for this particular use and attempted to manually alter the tool by placing the wrench into a vice to shorten the length using a hacksaw.

During the wrench alteration process, the worker cut a gloved hand with the sharp edge of the altered wrench handle, resulting in a laceration requiring sutures.

Upon investigating the incident, the operator’s Incident Investigation Team identified the following causal factors:

  • The worker did not pause or stop work to consult with a supervisor when the job scope changed and/or the proper tool was unavailable. The decision to modify the combination wrench was not discussed with the supervisor before modifying the tool.
  • The worker did not explore the potential for other avenues and/or options for locating the proper tools (i.e., checking with other work groups).
  • A proper wrench fitting in the tight area was not readily available on the rig floor.
  • When the worker decided to alter the hand tool, the worker chose a readily available hand saw versus a more appropriate/potentially safer method, i.e., a
    bandsaw.

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