OSHA Accident Investigation · Summary #887869
ENGLISH AMERICAN TAILORING COMPANY
WESTMINSTER, MD·
Event description
Employee's arm burned by carbon dioxide laser beam
Investigation abstract
On February 22, 1989, Employee #1, a trained employee with three years of experi test cuts are made prior to beginning work to detect problems, and weekly and m onthly maintenance checks are also performed per the manufacturer's specificatio ns. Documented major repairs are performed by an outside contractor. On the day of the accident, a test cut was performed and, because no problems were detected , Employee #1 inserted a pallet, initiated the first cut, and moved away to revi ew documents in preparation for the next cut. When she returned to the control p osition, she noticed that no cuts had been made. She leaned forward, looked into the plexiglass, and reached up with her right hand to hit the halt button. She felt pain in her left forearm. Employee #1 had sustained second- and third-degre e burns from a carbon dioxide laser beam. She was treated at a local hospital an ence, was operating an Acme Cleveland Corp. model l510-S laser cutting system to d released to return to work after scheduling follow-up visits. Subsequent inves tigation by the company found that a screw had become loose on one of five refle ctive mirrors that controlled the laser path direction. The resulting shift in t he mirror allowed the beam to overshoot it and exit the cutting area. The manufa cturer has built-in provisions for automatic shutdown of the laser due to overhe ating, but not for a misalignment of the beam path. A maintenance technician res ecured the mirror, checked all other mirrors, and applied Locktite to all screws to prevent a reoccurrence of this incident. The same was done for the employer' s two other systems, which are identical to the unit involved in this accident. manufacture men's and women's custom tailored suits. The system consists of a p allet shuttle that moves pallets with fabric into a cutting area with an enclose d top, bottom, and two sides. Plexiglass shielding is located at the pallet entr ance and exit, with a small square opening at the lower corner on each side. The pallet is removed for review after cutting and then passed on to another portio n of the shuttle, where the pallet is lowered and returned to the beginning of t he system. All movement is controlled by an operator via computer console. Daily
Victim
-
#1 Hospitalized Age 21 Female
- Nature of injury
- Burn/Scald(Heat) (5)
- Part of body
- LOWER ARM (17)
- Accident type
- STRUCK BY (1)
- Source of injury
- OTHER (43)
- Occupation
- Miscellaneous precision apparel and fabric workers (674)
- Human factor
- MISJUDGMENT, HAZ. SITUATION (1)
- Environmental factor
- OTHER (18)
- Task assigned
- Task regularly assigned (1)
Labels are OSHA's own, from the code dictionary published with the accident-investigation file. The raw code is shown beside each one so this page can be reconciled against OSHA's bulk data. OSHA notes that nature of injury, part of body, source of injury and accident type in this file are not coded to the Occupational Injury and Illness Classification System, and that the occupation titles are not standardised — so these values are not directly comparable with the OIICS-coded severe injury reports.