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<td><a href="https://misportal.jlab.org/ll/index.jsf?function=view&lessonId=1162">Implement Stop Think Act and Review (STAR) Principles for Changing Work Conditions to Avoid Injury - Brookhaven National Laboratory</a></td>
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<h2 style="white-space:nowrap">Statement of Lessons Learned</h2>
<pre>It is important to identify changing work conditions and evaluate how they will impact the overall work plan. Small incremental changes may mask larger deviations from pre-planned activities. An injury resulted when a worker failed to realize the variable differences between a two-man lift and a one-man lift. </pre>
<h2 style="white-space:nowrap">Discussion of Activities</h2>
<pre>Shelter assemblies (see photo below) were being fabricated from pressure treated lumber.
<img src=" https://misportal.jlab.org/ll/downloadAttachment?attachmentId=6324" width="400px">
Once constructed, skid sub-assemblies were stored, uncovered, outside the Carpentry shop. As work progressed they were brought back into the Carpenter shop to adjust their dimensions to accommodate each shelter's fit tolerance. At one such time the Carpenter shop's forklift was unavailable and the worker assigned to the adjustment task became frustrated as they wanted to complete the work prior to a scheduled lunch break. The worker, with this self-imposed time pressure, solicited help from another and together they performed a two-man lift bring one of the skid sub-assemblies into the shop and leaned it against a large table. The second worker then left, and the first attempted a one-man lift, using the table as a fulcrum, to position the skid on top. When lifted, the skid pivoted shifting the load's weight. A pop was immediately felt in the left bicep and extreme pain. Work was stopped and the supervisor notified. The resulting injury eventually required surgery. </pre>
<h2 style="white-space:nowrap">Analysis</h2>
<pre>The Stop Think Act and Review (STAR) principles should have been employed prior to using a two-man lift instead of a forklift. The change in this work step was not only not adequately planned, but the success of the two man-lift, to move the skid to the leaning position, gave confidence for using a one-man lift to move the skid from the leaning position up onto the table. Employing the STAR principles would have afforded the worker time to consider and calculate the increase in the load's weight and to recognize that this was a hazard that required mitigation prior to the lift. </pre>
<h2 style="white-space:nowrap">Recommended Actions</h2>
<pre>The following actions were recommended to avoid recurrence:
* Reorganize the Carpenter's shop to accommodate material movement with the use of a pallet jack
* Purchase pallet jack with built in scale
* Post reference guides with weights of stock size lumber (wet, dry, natural and pressure treated)
* Evaluate and update training courses to include manual lifting of loads using pivot points
* Update Job Risk Assessment to include controls for manual material lifting including knowledge of weight of material being lifted and work planning.
</pre>
<h2 style="white-space:nowrap">JLab Preventive Measures</h2>
<pre></pre>
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<h2>Comments</h2>
<h5 style="white-space:nowrap">12/21/2021 8:22:39 AM by Bailey, Mary Jo</h5>
<pre>Submitted to those current in:
SAF502: Forklift Operator
MED05: Safe Lifting (Ergonomics)</pre>
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<fieldset>
<legend>Summary</legend>
<table>
<tr class="row">
<td class="label" nowrap>Lesson ID:</td>
<td class="dataval">1162</td>
</tr>
<tr class="row">
<td class="label" nowrap>Status:</td>
<td class="dataval">OK</td>
</tr>
<tr class="row">
<td class="label" nowrap>Doc ID:</td>
<td class="dataval">2021-JLAB-1162</td>
</tr>
<tr class="row">
<td class="label" nowrap>Priority:</td>
<td class="dataval">Caution</td>
</tr>
<tr class="row">
<td class="label" nowrap>Safety Related:</td>
<td class="dataval">YES</td>
</tr>
<tr class="row">
<td class="label" nowrap>Originator:</td>
<td class="dataval">Bailey, Mary Jo</td>
</tr>
<tr class="row">
<td class="label" nowrap>Issued:</td>
<td class="dataval">12/21/2021 8:09:07 AM</td>
</tr>
<tr class="row">
<td class="label" nowrap>Approved By:</td>
<td class="dataval">Bailey, Mary Jo</td>
</tr>
<tr class="row">
<td class="label" nowrap>Approved On:</td>
<td class="dataval">12/21/2021 8:22:39 AM</td>
</tr>
<tr class="row">
<td class="label">Source:</td>
<td class="dataval">
DOECRD
</td>
</tr>
<tr class="row">
<td class="label" nowrap>Location:</td>
<td class="dataval">BNL</td>
</tr>
<tr class="row">
<td class="label" nowrap>Cost Savings:</td>
<td class="dataval"></td>
</tr>
<tr class="row">
<td class="label" nowrap>Contact:</td>
<td class="dataval">Jean Odin-McCabe, Institutional Lessons Learned Coordinator, 631-344-6055 or odin@BNL.gov</td>
</tr>
<tr class="row">
<td class="label" nowrap>Queued Emails:</td>
<td class="dataval">312</td>
</tr>
<tr class="row">
<td class="label" nowrap>Sent Emails:</td>
<td class="dataval">0</td>
</tr>
<tr class="row">
<td class="label" nowrap>Viewings:</td>
<td class="dataval">1 times</td>
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<li><a target="_blank" href="https://misportal.jlab.org/ll/downloadAttachment?attachmentId=6324">Photo 1 - DOE OPEXShare-BNL.jpg</a></li>
<li><a target="_blank" href="downloadAttachment?attachmentId=6325">DOE OPEX BNL-STARProgram.pdf</a></li>
</ul>
<hr>
</fieldset>
<fieldset>
<legend>Hazard Issues</legend>
<ul class="lesson_attribute_listing">
<li>Ergonomics - Lifting, Carrying, Repetitive Motion</li>
<li>Material Handling Equipment</li>
<li>Powered Industrial Trucks - Forklifts</li>
<li>Other: Poor Work Planning and Communication </li>
</ul>
</fieldset>
<fieldset>
<legend>Skills</legend>
<ul class="lesson_attribute_listing">
<li>SAF502: Forklift Operator</li>
<li>MED05: Safe Lifting (Ergonomics)</li>
</ul>
</fieldset>
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<li>*Division Safety Officers (DSOs)</li>
<li>*Safety Wardens</li>
<li>*DOE Notification</li>
<li>*ESH&Q Liaisons</li>
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