OSHA Accident Investigation · Summary #570879
OCEAN SPRAY CRANBERRIES, INC.
KENOSHA, WI·
Event description
TEN EMPLOYEES HOSPITALIZED AFTER EXPOSURE TO CHLORINE GAS
Investigation abstract
At approximately 8:45 a.m. on March 4, 1986, Employee #1 was attempting to remov r on the chlorinator, which should have shown that there was still pressure on t he unit. When Employee #1 loosened the single bolt on the chlorinator, there was an immediate full flow of chlorine gas, which spread quickly into a production area on the first and second floor. In addition to Employees #1 and #2, Employee s #3-#10 were exposed either while attempting to stem the flow of gas or in pass ing through the gas cloud as they exited. No respiratory protection was used by any of the employees involved. All ten employees were hospitalized. e chlorine gas cylinders from a distribution point, located beneath a stair well . Eight of the cylinders were mostly full and simply in storage. The system had not been used for five years. One 150-lb cylinder was still connected to an adva nce gas chlorinator regulator made by Capital Controls Co. Calmar, PA, Model Num ber 201 and the manifold. While Employee #2 was removing a loose cylinder to ano ther area, Employee #1 attempted to remove the connected cylinder. When Employee #1 could not turn the cylinder valve with the wrench, he assumed it had been cl osed years ago, when the systems were shut down. He did not observe the indicato
Victims (10)
-
#1 Hospitalized Age 65 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#10 Hospitalized Age 34 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#2 Hospitalized Age 40 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#3 Hospitalized Age 53 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#4 Hospitalized Age 36 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#5 Hospitalized Age 37 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#6 Hospitalized Age 54 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#7 Hospitalized Age 38 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#8 Hospitalized Age 39 M
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
-
#9 Hospitalized Age 31 F
- Nature of injury
- 4
- Part of body
- 28
- Event type
- 8
- Source
- 9
- Occupation code
- 999
- Human factor
- 19
- Environmental factor
- 7
- Hazardous substance
- 0640
- Task assigned
- 1
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