A task-based risk assessment was not performed before a drill fitter was fatally crushed while working on a rig at Rio Tinto's Channar mine in WA's Pilbara region.
Lee Buzzard, 32, was performing maintenance on a blast-hole drill rig on the night of June 19 when he was crushed between the drill rod centraliser arm and drill head, sustaining fatal injuries to his chest and upper abdomen.
The Department of Mines and Petroleum said in a preliminary report the drill rod centraliser arm moved unexpectedly when Mr Buzzard was standing in a potential crush zone.
"The uncontrolled movement of the rod centraliser arm had been identified on pre-start forms in the past but had not been actioned in the maintenance system," the department said.
Not only was a task-based risk assessment not performed before Mr Buzzard began work, the rig was not effectively isolated, which means workers were not guarded against stored, electrical or mechanical energies.
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The department recommended four actions to reduce the potential for injury while maintaining mobile plant including rectifying faults or defects identified during equipment pre-start inspections within a suitable time frame.
Mr Buzzard's death was the first mining-related fatality in WA in 2016.
The department's investigation into the death continues.
