When workers say to me, “that hardly ever happens” I just shake my head. It happens far more often than most people think. I mean, think about why did OSHA promulgate the LOTO standard – people were turning on machines with workers inside. But this case was exceptionally bad! A father found his son inside a ribbon blender without LOTO being applied. He removed his son and applied a LOTO lock to the electrical disconnect. He took the key home with him that night. The next day, the area supervisor said the machine was ready to start up. The father went home, got the key, came back to the plant, unlocked his lock, and turned the disconnect on. There was another worker inside the ribbon blender at the time, and he died. Here is the OSHA case file:
At 10:53 a.m. on July 6, 2020, an employee was working for a manufacturer of farm supplies. The firm manufactured additives for feed. The firm had two ribbon blenders or mixing machines on the production floor. They were designated AA and AB. The employee was cleaning out blender AB with rags.
The ribbon blender he was cleaning had a hopper or trough. It was approximately 1.04 meters (41 inches) wide, 1.57 meters (62 inches) long, and approximately 1.22 meters (48 inches) deep. The top of the hopper started approximately 0.91 meters (36 inches) off the working platform. An object approximately 180 millimeters (7 inches) from the top of the hopper would come into contact with the blades. The ribbon mixer blades took up almost all the space in the hopper.
The machine’s 480-volt disconnect had been locked out a few days earlier by a coworker who had found his son in the machine. The coworker took his son out and put a lock on the disconnect. The coworker informed the supervisor that the key for the lock was at home. The coworker drove home and got the key. When he returned, he took the lock off, disconnected, and, not thinking, activated the knife switch to the ‘on’ position. The employee was still cleaning the mixer when the machine started up. He was caught in the blades of the ribbon blender. He suffered lacerations, contusions, and fractures. He was killed. Pressurized air presented another form of hazardous energy.
Source: https://www.osha.gov/ords/imis/accidentsearch.accident_detail?id=127575.015