101A cross-linked tower and No
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5
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At about 13:10 on March 21, 2019, the attached lifting scaffold (hereinafter referred to as climbing scaffold) at the northeast corner of No
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According to the work safety law of the people’s Republic of China, the regulations on the reporting, investigation and handling of work safety accidents and the guiding opinions on standardizing the reporting, investigation and handling of work safety accidents issued by the municipal government, the municipal government has established the Municipal Emergency Management Bureau, the Commission for Discipline inspection and supervision, the Public Security Bureau, the Bureau of housing and urban rural development, the Federation of trade unions and the economic and Technological Development Zone with the director of the Municipal Emergency Management Bureau as the group leader The “3.21” major accident investigation team with relevant personnel of departments and units as members
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Indirect causes of the accident 1
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101A cross linked tower and No
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101A cross linked tower of AVIC Baosheng offshore cable engineering project in Yangzhou Economic and Technological Development Zone fell during descending operation
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2
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The accident grade is “major accident”, and the accident nature is “production safety responsibility accident”
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All the anti falling devices and anti overturning devices of the climbing frame were manually removed, and the signal wire of the synchronous control device was pulled out
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The direct cause of the accident is that the operators work on the falling frame and cross work on the landing frame in violation of regulations
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（2） The owner, AVIC Baosheng Offshore Engineering Cable Co., Ltd., was established on August 26, 2015
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With the “work safety license” issued by the Department of housing and urban rural development of Guangdong Province, the scope of license is construction
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101b cross linked catenary climbing frame project of AVIC Baosheng offshore engineering cable project (not reported) and the construction safety production agreement
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There are some problems in the construction safety management of the Municipal Bureau of housing and urban rural development, such as the work foundation is not firm, the hidden danger investigation and treatment is not thorough, the safety risk is not resolved in place, the management and control of dangerous large projects is not effective, the supervision responsibility is not carried out in depth and in detail, and the construction safety supervision work is not carried out strictly and practically
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The relevant information is reported as follows: 1
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Project management confusion
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First, Xiao Feibiao, the person in charge of the safety department of Nanjing techen, directed the construction personnel of the climbing frame to remove part of the anti falling and anti overturning device of the climbing frame through wechat, which resulted in the climbing frame losing the anti falling control; second, Yang Dong, the manager of the Engineering Department of the project Department of the second construction bureau of China, and LV Chengcheng, the safety officer, illegally directed the personnel of the climbing frame sub contractor and the labor sub contractor on the climbing frame and landing frame at the same time Third, in the case that the landing frame has not passed the acceptance, Yang Dong illegally directed the personnel of the labor sub contractor to engage in the external wall plastering operation; fourth, in the process of climbing down, Yang Dong illegally directed the personnel of the labor sub contractor to engage in the wall hole repair operation on the climbing frame
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Firstly, Suwei company found that there were hidden dangers in the climbing operation, and did not take effective measures to stop it; secondly, Suwei company did not check the climbing project according to the relevant requirements of the Ministry of construction on the inspection of dangerous large projects; thirdly, Suwei company did not track and supervise the implementation in place when it knew that the project manager of the subcontractor was not on duty for a long time and the relevant personnel pretended to be the project manager’s signature
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3
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did not seriously perform the unified coordination and management responsibilities, resulting in the confusion of on-site safety management; secondly, LV Chengcheng, the safety officer of the project of China Construction Second Engineering Bureau, concurrently served as the construction worker, deleted the signature column of the supervision unit in the inspection and acceptance form before climbing and descending; thirdly, ou chuanfei, the former project manager of haitechen, was absent for a long time, and Liu Shengwei, the safety officer of Nanjing techen, acted as the supervisor The actual person in charge of the site pretended to be the project manager’s signature, and the relevant parties did not take effective measures to stop it; fourth, the operation time of the safety management personnel of the project department was inconsistent with that of the labor service personnel, and the operation process was lack of effective supervision
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All the above certificates are within the validity period.
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During the falling process, it collided with the landing scaffold at the bottom of the cross linked tower (hereinafter referred to as the landing scaffold), causing 7 deaths and 4 injuries
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General situation of the project and accident unit (1) general situation of the project
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The scope of permission is construction
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There are some problems in the project, such as affiliation, illegal subcontracting and falsehood of scaffolders
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On November 30, 2018, the main structure of No
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101b cross-linked catenary building were in progress
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It has the “construction enterprise qualification certificate” issued by the Ministry of housing and urban rural development and the “work safety license” issued by Beijing Municipal Construction Commission
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When the load of the lifting point near the frame increased, causing local damage, the frame lost the overload protection and shutdown function, resulting in chain reaction, causing damage to the frame The whole body falling is the direct cause of the accident
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The actual construction unit of climbing frame is Nanjing techen Technology Development Co., Ltd
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The sub contractor of climbing frame: Qianhai techen, established on January 14, 2015, has the qualification certificate of construction enterprise issued by Shenzhen Bureau of housing and urban rural development
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Construction professional subcontractor in August 2017, China Construction Second Engineering Bureau subcontracted the climbing frame project to Shenzhen Qianhai techen Technology Co., Ltd
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Recently, Yangzhou Emergency Management Bureau released the accident investigation report
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Because Nanjing techen did not obtain the construction enterprise qualification certificate and work safety license and other relevant qualifications at that time, it was unable to contract the project, so it contracted the climbing frame project in the name of Qianhai techen
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Ineffective implementation of regulatory responsibilities
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2
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（3） The general contractor of construction is China Construction Second Engineering Bureau Co., Ltd
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101A cross-linked tower of AVIC Baosheng offshore cable project in Yangzhou Economic and Technological Development Zone descended In the process of falling, it collided with the floor scaffold at the bottom of the cross-linked tower (hereinafter referred to as the floor scaffold), resulting in 7 deaths and 4 injuries
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The project has the “construction permit of Construction Engineering” issued by Yangzhou urban and Rural Development Bureau on February 20, 2017
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First, Nanjing techen contracted the climbing frame project by affixing the qualification of Qianhai techen; second, Qianhai techen illegally contracted the labor work to Li Bin who did not have the qualification; third, the scaffold wage certificate held by the climbing frame operators (Li Bin, Liao Junhong, Gong Xing, etc.) was forged
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(hereinafter referred to as Nanjing techen)
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Attached with the full text of accident investigation report: investigation report on the accident of “3 · 21” attached lifting scaffold falling seriously in Yangzhou AVIC Baosheng offshore cable project
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The project supervision is not in place
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At about 13:10 on March 21, 2019, the attached lifting scaffold (hereinafter referred to as the climbing scaffold) at 16.5-19 floors in the northeast corner of No
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4
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(hereinafter referred to as China Construction Second Bureau), which was established on December 9, 1980
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101b cross-linked catenary building of AVIC Baosheng offshore engineering cable project (hereinafter referred to as AVIC Baosheng project) is located in Yangzhou Economic Development Zone, with a total construction area of 37000 m2
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Firstly, AVIC Baosheng Offshore Engineering Cable Co., Ltd
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101A cross-linked tower was capped, and the interior and exterior decoration, roof, doors and windows, indoor mechanical and electrical installation and other work were in progress at the time of the incident; the exterior wall coating, interior door finishing and other work of No
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Illegal command
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All the above certificates are within the validity period
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On October 19, 2016, the company signed the construction contract with China Construction Second Engineering Bureau Co., Ltd.; on October 28, 2016, the company signed the construction supervision contract with Jiangsu Suwei Engineering Management Co., Ltd
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(hereinafter referred to as Qianhai techen), and both parties signed the professional subcontracting contract for No
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The above contracts are reported to the Municipal Bureau of urban and rural development for the record
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In view of the above reason analysis, the investigation team determined that the accident was caused by illegal command, illegal operation and management confusion, and cross operation led to the expansion of accident consequences
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In accordance with the principles of “four not let go” and “scientific and rigorous, law-abiding, practical and pragmatic”, the accident investigation team, through on-site inspection, technical analysis, investigation and comprehensive analysis, found out the course and cause of the accident, identified the nature and responsibility of the accident, and put forward suggestions for dealing with the relevant responsible personnel and units, aiming at the problems exposed in the accident The preventive measures are put forward
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The direct cause of the accident was that the steel wire rope was used to replace the climbing frame lifting support
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The new project of No
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