1. Safety–Training Media Dev. 2009-376-1103 Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Grave Accident Case in Manufacture Sector 2010- 교육미디어 -1018

2. The copyright of this material is owned by the Korea Occupational Safety and Health Agency (KOSHA) and unauthorized and arbitrary use hereof is strictly prohibited. However, if an individual wishes to use it for a non-commercial objective, he/she may use do so by revealing its source. If a corporation wishes to use it, permission must first be obtained from KOSHA. Any unauthorized use hereof constitutes a breach of copyright law and such action is subject to legal sanctions. Detail II Cause III Prevention IV Overview I I Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head

3. Overview of Accident When: Mar. 29 (Sat.), 2008, 13:20 Where: Oktokki Space Center located in Bureun-myeon, Ganghwa, Incheon Who: Victim, employee of Design Seoul Model, when a dumb waiter lift stopped between the 3 rd floor ceiling structure and 4 th floor slab. How: The victim was checking the lift by sticking his head into the space (estimated) Why: The lift fell and killed the victim between the top of the lift and the 3 rd floor ceiling structure. Ⅰ Ⅰ

4. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Dumb waiter carriage Details of Accident Section Shape Steel Process Ⅱ Ⅱ Food trays collected Food trays washed Food trays piled up again Empty food trays piled (4 th floor) Accident occurred while the dumb waiter was being repaired ㅇ Cause: Cable type dumb waiter (traction type) - Capacity: 150kg - Rated speed: 10m/min - Lift size: 700×900×800mm - Location: 3 rd ~4 th floors - Motor power: 0.75kW

5. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Details of Accident The victim, after his morning duties, heard that the dumb waiter lift did not work. After lunch (12:00 ~ 12:50) he checked the dumb waiter and left the kitchen. ※ The victim had experience in checking dumb waiters because he previously ran a restaurant. At 13:00, the Victim Lee, Hyung-cheol went up to the 4 th floor and using his cellphone, asked his co-worker to bring tools including a hammer. He received the tools at 13:15. Ⅱ Ⅱ

6. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Details of Accident Ⅱ Ⅱ Front view of the lift in accident and accident situation Lifting rope Guide rail Car Interphone Control panel Entrance Traction machine

7. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Details of Accident The dumb waiter lift of the accident was blocked by a foreign object (width: 1.5cm x length: 10cm; wooden block). Meanwhile, the drum cable continued to unroll and stayed without any traction. Ⅱ Ⅱ

8. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Details of Accident Ⅱ Ⅱ Wooden block that is thought to have caused the fault with the dumb waiter

9. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Details of Accident Ⅱ Ⅱ Space between the 4 th floor slab and 3 rd floor ceiling (duct) Space where the victim is thought to have entered

10. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Details of Accident Ⅱ Ⅱ Trace of the victim caught at the bottom of the duct Location where the wooden block is thought to have been inserted

11. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Details of Accident Ⅱ Ⅱ Guide shoe displaced from the guide rail Guide rail

12. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Details of Accident Ⅱ Ⅱ Dumb waiter lift pushed down on the floor of the 3 rd level after removing the body of the victim

13. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Cause of Accident Failure to prevent access Although the cable was lax and had a risk of falling, the victim was allowed to enter the dumb waiter pit and begin checking although no protective measures had been taken. Failure to prevent unqualified staff from accessing The victim checked the lift without proper qualification as a lift technician or work training. Failure to assign supervisor There was no work supervisor assigned to determine the work procedure. Failure to install the dumb waiter protection mechanism The lift (dumb waiter) did not have a protection mechanism in case the cable loosened, and it was not recognized that the rope was lax. Ⅲ Ⅲ

14. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Prevention of Accident Prevent access during repair and check-up In places where a sudden movement of a dump, ram, lift, fork and arm of a machine or equipment supported by hydraulic power, chain or rope, workers’ access should be prohibited. If access is necessary for checking, however, a safety support or block that can withstand the load should be placed in the lift path, the lift placed upon it, and safety measures should be taken to prevent risk of fall. Ⅳ Ⅳ

15. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Prevention of Accident Prevent access during repair and check-up In places where a sudden movement of a dump, ram, lift, fork and arm of a machine or equipment supported by hydraulic power, chain or rope, workers’ access should be prohibited. If access is necessary for checking, however, a safety support or block that can withstand the load should be placed in the lift path, the lift placed upon it, and safety measures should be taken to prevent risk of fall. Ⅳ Ⅳ

16. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Prevention of Accident Observe work scope requirements including qualification and license The National Vocational Qualification Act specifies the qualification of elevator engineers and the Workers Vocational Skills Development Act specifies the regulations on limiting employment to qualified resources to ensure only qualified and trained workforce is used to check up and repair elevators. This is to restrict elevator check-up to qualified resources. Assign work supervisor During the dumb waiter’s installation, assembly, repair, check-up or disassembly work, a work supervisor should be assigned to ensure work procedure and each worker’s distribution are determined appropriately. Ⅳ Ⅳ

17. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head Prevention of Accident Install and maintain elevator protection As per the Act on Elevator Manufacture and Management, Article 13 (Inspection of Elevator) and Agency for Technology and Standards Public Notice No. 2007-602 (Sep. 10, 2007), “Elevator Inspection Standards”, 3.4.6(5), a lift (dumb waiter) should be equipped with a protection mechanism that prevents the cable from becoming lax. Inspect the dumb waiter As per the Act on Elevator Manufacture and Management, Article 13 (Inspection of Elevator), the manager of the lift (dumb waiter) should have all dumb waiters inspected as they are specified as subjects of inspection. Ⅳ Ⅳ

18. Death of the Victim Hit by a Dumb Waiter (Food Lift) on the Head