Refrigeration Auto-Purger Overpressure Event – Burns and Eye Surgery

At approximately 9:50 a.m. Employees #1 and #2 worked as mechanical engineering technicians at a food cold storage facility. The two workers were troubleshooting an Auto-Purger. The Auto-Purger removed non-condensable material from the refrigeration system. It was mounted on a wall inside the facility’s anhydrous ammonia compressor room. At the time of the accident, the unit was actively running and leaking liquid onto the floor. The liquid, which contained anhydrous ammonia, was corrosive. Both employees were standing near the unit.

Employee #2 was refitting a cap back onto a bubbler to stop a leak. He was using a wrench to tap the cap onto the pipe section. Within minutes, the bottom pipe section of the cylinder separated from the upper section, resulting in a liquid spray contacting both employees’ eyes, faces, and bodies.

Employees #1 and #2 sustained corneal burns.  Employee #1 needed surgery as a result of this injury.

Causal factors to this accident were the failure to maintain the Auto-Purger to the manufacturer’s design specifications and a clogged drainage pipe leading to a pressure build-up in the system.

Additionally, the employer did not ensure that employees were using adequate eye and face protection.

Violation Summary
Violations/Penalties Serious Willful Repeat Other Unclass Total
Initial Violations 3     5   8
Current Violations 1     7   8
Initial Penalty $26,100 $0 $0 $6,120 $0 $32,220
Current Penalty $4,050 $0 $0 $3,950 $0 $8,000

 

Violation Items
# Citation ID Citaton Type Standard Issuance Date Abatement Due Date Current Penalty Initial Penalty Contest Latest Event
1. 01001 Serious 5189 J04 C 04/26/2013 05/15/2013 $4,050 $18,000 05/13/2013 F – Formal Settlement
2. 02001 Other 3314 C 04/26/2013 05/15/2013 $750 $4,050 05/13/2013 F – Formal Settlement
3. 03001 Other 3382 A 04/26/2013 05/15/2013 $750 $4,050 05/13/2013 F – Formal Settlement
4. 04001 Other 342 A 04/26/2013 06/12/2013 $2,000 $5,000 05/13/2013 F – Formal Settlement
5. 04002 Other 5189 E02 A 04/26/2013 06/12/2013 $450 $450 05/13/2013 W – Empr Withdrew
6. 04003 Other 5189 E02 B 04/26/2013 06/12/2013 $0 $335 05/13/2013 F – Formal Settlement
7. 04004 Other 5189 E02 C 04/26/2013 06/12/2013 $0 $335 05/13/2013 F – Formal Settlement
8. 04005 Other 5189 O 04/26/2013 06/12/2013 $0 $0 05/13/2013 F – Formal Settlement

 

Source: https://www.osha.gov/ords/imis/establishment.inspection_detail?id=313646929

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