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An investigation into reducing operator injury within the baler area at ILM LV3 Award in first line managment By Stuart Rogerson Candidate number – BCN7926

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ILM LV3

Award in first line managment

By

Stuart Rogerson

Candidate number – BCN7926

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Contents

SECTION 1

BACKGROUND INFORMATION

Company background My role and duty’s

SECTION 2

THE SITUATION AND REASON FOR CHANGE

The situation and why change is needed Who does it affect

SECTION 3

THE INVESTIGATION

Individual investigations Findings from investigation

SECTION 4

RESOULTION OF THE PROBLEM

Wants and would likes Options generated Ranking matrix Option selected, costs, timeframe

SECTION 5

IMPLEMENTAION AND COMMUNICATION OF THE RESOULTION

Communication of change Effects of change My role within the change

APPENDICES

Candidate number BCN7926 1

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SECTION 1

Company Background,

Eastman chemical company was founded in Kingsport Tennessee in 1920, by George Eastman, it was formally known as Eastman Kodak, Eastman Chemical Company was spun off in 1994 and became a public traded company the company now own and operate sites throughout the world employing approximately 13500 personnel over 43 manufacturing sites and serving over 100 countries

Eastman Chemicals Company’s business is divided into five segments,

Additives and functional products

Adhesives and Plasticizers

Advanced materials

Speciality Fluids and intermediates

Fibres

The Manufacturing Site at Workington falls into the fibres business it produces Cellulose Acetate Tow which is used as filter tips for cigarettes, it has been producing Acetate Tow on the Workington site since 1968, originally as a joint venture between Eastman Chemicals and Filtrona Chemicals, the operation was known as Ectona Fibres, Eastman became the sole owner of the operation in 1984

In 2005 Eastman Chemicals invested $100 million to expanded the plant the expansion came online in 2008, increasing production volume by 40%, Eastman chemical Workington primary supplies acetate tow to Cigarettes factories in Western and Eastern Europe, Russia and Turkey the Workington manufacturing site employs, approximately 130 people of which, 90 are on a shift system split over 6 crews.

Candidate number BCN7926 2

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My Role within the organisation

I joined the company in 2008 as part of the expansion recruitment and in 2012 I Was appointed manufacturing Shift Team Manager for Crew E reporting directly to the Site super-intendant I have a crew of 14 operators that are split into five different job roles (Department Organization, appendix 1) whom operate a continuous manufacturing process on the production of acetate tow 365 days a year, operating on a 12 hour shift system over 6 crews,

(See Shift Rotas in Appendix 2)

My Duty’s

My main Management duties include safety checks, coaching individuals, assist with training, monitor critical process operations, process audits, crew and site wide health and safety audits and best practise, man power deployment, co-ordination with engineers and process operators, and planner overseeing a safe work permit system, and emergency planning and crew development, holiday planning, and crew administration and time keeping.

The manufacturing process is very fluid with breakdowns, events and issues often arise on a shift that require immediate action from a shift manager such as critical equipment failure to operator injury.

During this assignment I will be investigating and looking for a resolution to operator injuries within a specific area of the production process.

Candidate number BCN7926 3

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Section 2

The Situation and why it needs to change

The Problem

Since the 2008 expansion project the company has seen an increase in accidents or incidents within the baler area of the plant, although the majority of incidents are minor or near miss this issue needs to be resolved before a major incident or accident occurs.

What Has Brought the Problem to the forefront?

We as a company have always been good at recording and investigating injury and lost time accidents in the workplace, but operators would not report small injuries such as bumps and scrapes or near miss incidents.

During 2011 and continuing onwards all operators undertook an IOSH working safely one day health and safety course, which expressed the value in recording all incidents, however small. During that year Eastman launched a safety first initiative, which would record all incidents in an online event tracker system all data including near miss incidents are logged and investigated and any areas of concern are raised, and fed back to site leadership team.

The event tracking log, has a three year retention on any information imputed, after that time the data is erased to date over the 3years there are 713 incidents logged, that figure moves about as data drops off and new data added of those 713 currently logged 217 are baler related.

All site incidents must be reported to the on duty shift manager who will fill out the tracker and appoint a steward to look after the event until a resolution (if any) is found, this data is then feedback via a monthly health and safety meeting with the site leadership team.

During a regular health and safety meeting we reviewed the trends from each area of operations on plant, and spotted a clear trend within the baler area, as a former operator with experience in that area I was nominated as a steward for the problem.

Candidate number BCN7926 4

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How big is the issue and who does it affect

The issue is far reaching throughout the Workington plant and beyond to the local community and to our customers, if we continue to have a high rate of near miss incidents and or unsafe acts the like hood of a major accident gets higher (see fig 1.1)

Fig 1.1 H.W Henirich’s incident pyramid 1931

Source HSE.gov.uk

If a work place injury does occur it accounts for a large number of working days lost (see fig 1.2) with that in mind it’s important to focus on safe practice during the plant operations process

Source HSE.gov.uk

Based on our site at Workington, below is a brief summary of the affects and potential affects an avoidable accident has on the site.

Candidate number BCN7926 5

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Cost

The company has been tasked with a £1.5millon saving, a percentage of that saving can be made up with a reduction of lost time accidents which could in turn reduce insurance premiums and overtime bill covering lost time incidents

Reputation

The company prides its self as a safe company to work for the reputation of Eastman goes along way with the customers we supply, if a potentially serious accident where to occur it could potently lead to loss of orders.

Duty of care

The baler area has a 5 man crew on shift with 6 shifts 30 operators are exposed to injury risk every operator has a family if something where to happen in a small community like Workington the effects could be devastating for the individuals and for the company.

Legal obligation

The company has to work to HSE laws, breaking these laws can lead to fines or imprisonment.

Lack of Operator engagement

Operators now appear to feel the company doesn’t care for their wellbeing working in an around machinery that is awkward and has potential to cause them injury, there is a distinct lack of motivation from the baler operators as there seems no follow up on accidents

Candidate number BCN7926 6

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SECTION 3

Investigation

During the course of my investigation I have gathered information from various Sources, to determine what was the most likely cause of injury’s to operators within the baler are, I gathered this information via the following sources.

Questionnaire to operators ( See Appendix 3 & 3a )

This short questionnaire was issued to each operator that worked within the baler area, it was targeted to identify at risk behaviours and tasks that each operator in had experienced or though could cause potential injury, it also went into some detail of potential ideas for change

Eastman Site Leadership team

I brought the issue of operator safety in the baler area with the SLT; I asked how they perceived the problem, and how they thought it could be tackled along with any constraints they would like to build into the project.

Eastman Health and Safety officers/crew safety reps

I asked for some time during our monthly H&S meetings to discuss the issues with the baler area, accident and near miss incidents, and also to source any information and concerns that where raised by site H&S and Crew Safety Representatives.

Baler Crew Meeting/RCA session

From all the information gathered we formed a team with operators from each crew able to attend from this we had a brainstorming session which was then used to move forward using Ishkawa RCA fishbone system, we looked for a way forward and improve safety within the balers and overall for the company

(See Appendix 4 ishikawa diagram)

Candidate number BCN7926 7

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Liaise With American shift manager

I also spoke to shift managers who run the much larger American plant in Kingsport; they use the same equipment as the Workington site and as a bench mark talked about their experiences and what if anything they do different to us,

Other factors

I also researched other factors from external sources, such as the governments HSE website/ACAS, although we are unique in what we make we do use similar equipment such as hydraulics presses and rams which account for a large number of serious accidents in the UK.

Candidate number BCN7926 8

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Findings

From the results of questionnaires and meetings this is what was discovered and what give us the foundations for options going forward,

The questionnaires were issued on 12 February 2013 with all questionnaires being anonymous and returned via a ballet box of 40 operators who were eligible, 36 where handed back giving me a 90% return on completed forms, see Pie Chart for details and appendix 3 for full results details

Likely Area for an injury to occur

1. Incident occurred due to production interruptions and join ups2. Injury’s due to trips and falls 3. Operator error4. Charging production waste to waste baler5. other

Whilst the questionnaires were handed out I had several meeting with the site leadership team who give support to operators safety on site but had to put a reasonable cost on the project, any findings had to be reported back to them before a solution(if found) could be agreed,

Candidate number BCN7926

26%

21%

6%

35%

12%

1

2

3

4

5

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From the results of the questionnaires and feedback from site leadership it gave foundations for a brainstorming session,

And from that to a group RCA, (see appendix 4) Smaller Focus groups concentrated on each section from there we developed some options moving forward

Those options that where appropriate

Redistribute manpower – use other operators to help in areas Change methods or dealing with interruptions – follow a American

system Change the environmental conditions- deal with the machinery

and not the man, eliminate any risk Make no changes – leave everything as it was

All these options will be discussed in detail whilst looking for a resolution for the problem.

Candidate number BCN7926 10

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Section 4

Resolution of the problem

From the investigation, it gave us four solid option to move forward those options are examined in detail before it could be decided all options where imputed on the ranking matrix, to find the best solution, but ideal from the solution I would like to incorporate the following

Wants

1. To see better systems in place to protect baler operators

2. Reduce near miss incidents, and minor accidents within the baler area

3. Feedback system in place so operators can follow a near miss or injury until its conclusion

4. To have measures in place to monitor results

Would like

1. to introduce a cost effective safety system with a minimum cost to the company, but with maximum results

2. to see a reduction in near miss incidents and operator injuries

3. To get the support of the Site Leader Ship Team and operators to reduce injuries

Candidate number BCN7926 11

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Option 1

Deal with Production interruptions elsewhere, as in our sister plant in the United States, the baler operators don’t touch the baler systems during a production interruption, the CDO operator would carry out the correction from above leaving the operator in the balers just to wrap the finished product, eliminating the potential risks

Pros-

This system is tried and tested in the American plant, it is cost effective and also proven to work, the baler operators would only be exposed to the bale at the completion, there is only one injury whilst doing this last year so it would become low risk task.

Cons-

The Workington site has a lower number of reject product (in Comparison to the USA Plant) because baler operators can remove defective product this during interruption, (thus saving the bale) this facility is unavailable to the US plant, so if a defected is in a product that then bale becomes reject.

Effectiveness

It would be very effective at reducing operator injury’s by a potential 35% based on operator survey

Candidate number BCN7926 12

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Option 2

Operators and manpower, each line has its own run times to produce the product each bale can run between 3 and 5 hours it’s a unstoppable process the bale must be out of the press within 9 mins otherwise it will cause a production choke, if an operator has several bales to wrap and deal with an interruption at the same time he is likely to be rushing, an operator from another department could drop into the baler area during these times to relieve pressure,

Pros,

This option is cost neutral; there is an operator on a constant patrol whom could be-retrained to fulfil this role during his patrols, becoming effectively a 6th man on the baler crew as and when they require it

Cons,

Operator resistance, the patrol operator does have his own tasks to complete adding extra to his role might not be well received, the patrol operator may also be dealing with a spill or other incident and may not be able to attend leaving it as it was before

Effectiveness-

This option may gave short team gains by relieving pressure on a team that is pressed and is rushing, there is no real evidence that getting the baler crews to take their time would reduce injury’s, only time would tell

Candidate number BCN7926 13

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Option 3

Equipment modification, the environment requires attention new lighting and changing safety catches allowing hold up bins and slides to be raised and secured out of the way (see equipment overview appendix 5) so the operators don’t need to duck inside the baler during interruptions allowing them to stand without stooping, also the introduction of a tipping buggy to allow operators to safely discharge waste without twisting or stooping

(See Photograph set 1&2 in appendix 6)

Pros

Hazards are effective removed allowing operators an easier access to the baler would also make it much better for the operators trying to spot defects within the product

Cons

Higher cost than every other option operators would also need retrained in the use of new safety systems potentially adding extra cost

Effectiveness

This option would be highly effective at reducing accidents and injury’s within that environment

Option 4

Continue as before and do nothing but log accident data

Pros

No cost, no extra labour

Cons

The situation would get worse, moral would drop off, and company reputation would suffer as a result of unsafe practise.

All options would have a training element by allowing operators to be trained in there event log system, allowing operators to follow their own injury and near miss incident and be involved in the resolution of an issue,

Candidate number BCN7926 14

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Ranking Matrix to help decide which option is most appropriate for reducing accident/injury within the baler area at Eastman Workington

Scoring System

1. Does not meet any expectations

2. Meets 25% of expectations

3. Meets 50% of expectations

4. Meets 75% of expectations

5. Meets all expectations

Option

Has Minimum cost to the company

Effective at reducing

injury’s or potentialinjury’s

Ability to deliver

effective training on

job role

Buy-in from site

leadership and

operators

Not a task heavy

production project

TOTALSCORE

1Deal with

issue elsewhere

5 2 5 1 1 14

2Use

effective manpower

5 2 2 3 1 13

3Equipment 1 5 3 4 5 18

4Do Nothing

5 1 1 1 5 13

Candidate number BCN7926

OBJECTIVES SCORE 1 to 5

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Having reviewed all the option on the ranking matrix, I have discussed the outcome with the Baler operators, department heads and shift managers and have decided that option 3 is the best solution to implement,

Cost

Unfortunately there is high cost involvement, but there is a budget for safety, the site leadership agreed and allowed the budget to complete the works, providing it was in the new finical year, 2013/2014 and was under £29000

Below is a table detailing the cost involved?

AREA OF COST Individual cost Total Required totalRazing safety catches

Each system adjustment is £400

28 £11200

new tipping buggies

1 tipping buggies £700

6 £4200

Retraining and overtime

Overtime 18 p/h 12hours/training

40 operators 12 hours O/T to cover

£8640

Time Frame

The work will be carried out over a ten week timeframe, there are always two spare pairs of balers at any one time used for waste product, these could be modified on a rota basis as each baler is cycled over time normally on a monthly basis allowing work to be carried out without production interruptions, this chart is adapted to allow a switch each day allowing work to be carried out on each baler as required (bale switch plan appendix 7),

Candidate number BCN7926

Project total

£24040

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Section 5

Implementation and communication of the solution

We have a time scale of up to 10 weeks to complete the work, the changes will be gradual as each baler will be upgraded on a day by day basis, see (Gantt chart Appendix 8)

How the change will be communicated

I will set up a meeting with the site leadership team, and team managers to discuss the proposed baler changes and agree on a final method when all systems and paperwork are in place each team manager will communicate all relevant information to their respective teams prior to the first works been completed

Training

Each baler operator would require a one day 12 hour training session to be carried out as overtime on the operators rest days (see shift rota appendix2) the baler technologist would formulate a training plan and use the baler trainers to deliver a quality training session on the new procedures and safety catches this would also allow a written record of the fact the training has been received and understood, the trainer would also go through how to use the event tacking system.

Moral and Benefits

It is perceived that with a proactive management of the safety of the baler crews, the operators will feel more valued in the job an as they were involved in the democratic way the options where discussed and decided upon it was in effect there idea they will feel some sort of motivation and support of the plan,

Review and Monitor

We have the data from the last three years of accidents/near miss at Eastman we should be able to review that Month on month and statistically monitor the situation, with senior baler operators monitoring that the new procedures are physically followed.

Candidate number BCN7926 17

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My role within the change

As the person responsible for the implementation of the new systems will coordinate the initial schedules meetings and relevant paperwork’s required so the transition goes smoothly, I will undertake the initial communication of the new systems to site leadership and to the management teams and shift managers, the shift managers will then be responsible to managing their team and ensure all operators on their respective crews carry out the work

Candidate number BCN7926 18

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APPENDICES

APPENDIX 1

Eastman chemical organization chart

APPENDIX 2

Eastman Shift Rotas (6 month Snapshot)

APPENDIX 3 & APPENDIX 3a

Example of operator Questionnaire & results

APPENDIX 4

RCA Diagram

APPENDIX 5

Standard baler layout/pre and post ram

APPENDIX 6

Interruption photos

APPENDIX 7

Amended baler rotation chart

APPENDIX 8

Gantt chart (progress planning)

Candidate number BCN7926 19

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Eastman Organisation chart- ACETATE TOW PLANT

Candidate number BCN7926

Appendix 1

CREW “A” Team manager

R.Cradduck

CREW “C” Team manager

B.Wilcock

CREW “B” Team Manager

N.Sloan

CREW “E” Team manager

S.Rogerson

CREW “D” Team manager

T.Brombley

CREW “F” Team manager

L.Maxwell

K.Mcadam G.Cullen W.Relph P.Coulthard A.Rowntree K Rowntree T.Roper G Wolfenden R.Thomas J.Sloan S.Young L.Holland C.Newton A.Hudson

P.Brough D.Clifford M.Tindall P.Eland R.Mewse J.Sansom S.Clague P.Heywood G.Hay R.Foy C.Towers S.Ashbridge N.Woolaghan P.Sharples

A.Janulis D.Lawman J.McCourt K.Armstrong P.Cremmins T.Teasdale P.Haughin J.Graham N.Talbot M.Heap A.Mcluckie B.Hutton G.Hughes M.Wright

R.Bell I.Dickinson S.Bougley S.Eland M.McCathey P.Rushforth C.Hewer S.Wood M. Holden T.Hodgson M.Casson P.Hilland B.Cass M.Penn

G.Denwood A.Wigham S.Thornthwaite A.Burns J.Plaza G.Fearon G.Wilson M.Tayor M.Frizzel J.Hymers J.Scott JNR K.Walsh S.Tunstall S.Sharp

J.Strong A.Sibbald S.Pattinson J.Bowman D.Miller J .Eve C.Rudd M.Duncan D.Steadman G.Routlage G.Pala I.Palmer C.Pickering S.Gorman

DAY CREW Team manager

A.Johnston

S.Bowes G.Persival H.Storry S.Curren P.Bigrigg R.McCoubory M.Crone C.Mcadam

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Eastman chemicals shift rota 2013M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu

APR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

A 8 8 8 8 8 D D N N D D N N D D N NB D D N N D D N N D D N N D D N NC D D N N D D N N D D N N D D ND N D D N N D D N NE D N N 8 8 8 8 8 8 8F 8 8 8 8 8 8 8 8 8 8 D D N N D

W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th FMAY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

A D D N N D D N N D D N N D D N NB D D N N D D N NC N 8 8 8 8 8 8 8 8 8 8D 8 8 8 8 8 8 8 8 8 8 D D N N D D N NE 8 8 8 D D N N D D N N D D N N D DF D N N D D N N D D N N D D N N

Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa SuJUN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

A 8 8 8 8 8 8 8 8 8 8B 8 8 8 8 8 8 8 8 8 8 D D N N D D N NC D D N N D D N N D D N N D D N ND D D N N D D N N D D N N D DE N N D D N N D D N N D D N NF D D N N D D N N

M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W

JUL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

A D D N N D D N N D D N N D D N NB D D N N D D N N D D N N D D N NC D D N N D D N N D D N ND N N D D N N 8 8 8E 8 8 8 8 8 8 8 8 8 8 D D NF 8 8 8 8 8 8 8 8 8 8 D D N N D D N N D

Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa

AUG 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

A D D N N D D N N D D N NB D D N N 8 8 8 8 8C 8 8 8 8 8 8 8 8 8 8 D D N ND 8 8 8 8 8 8 8 D D N N D D N N D D N NE N D D N N D D N N D D N N D DF D N N D D N N D D N N D D N N

Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M Tu W Th F Sa Su M

SEP 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

A 8 8 8 8 8 8 8 8 8 8 D D N NB 8 8 8 8 8 D D N N D D N N D D N NC D D N N D D N N D D N N D D N ND D D N N D D N N D D N N D DE N N D D N N D D N NF D D N N 8 8 8 8 8 8

Candidate number BCN7926

Appendix 2

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Operator Questionnaires

over several months our plant has seen an increase in operator injury’s in and around the baler area, as part of the Eastman “all in for safety” campaign we have issued the following short questionnaire to gauge you feed back of potential safety issues and changes that can be made in the baler area.

1. On a Scale of 1-10 Please indicate how safe from potential injury’s you feel the working environment is, Please Circle, 1 being unsafe 10 safe, ( No injury’s near miss etc.)

Unsafe - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - Safe

2. What works well (with regards to safety) within the baler are

3. What doesn’t work well as regards to Safety?

4. What injuries are you likely to see within the baler area?

5. What would you like to implement to make your working environment safer?

6. Do you think You Have adequate PPE provided by the company?

7. When do you think your most at risk of injury?

Candidate number BCN7926

Appendix 3

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On a Scale of 1-10 Please indicate how safe from potential injury’s you feel the working environment is, Please Circle, 1 being unsafe 10 safe, ( No injury’s near miss etc.)

What works well (with regards to safety) within the baler area?

What doesn’t work well as regards to Safety?

Candidate number BCN7926

Appendix 3a

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What injuries are you likely to see within the baler area

What would you like to implement to make your working environment safer?

Do you think You Have adequate PPE provided by the company?

YES – 87% NO – 13%

When do you think you are most at risk of injury?

Candidate number BCN7926

REVIEWWRONG FOR TASK TRAINING

Appendix 3a

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Candidate number BCN7926

Appendix 4

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Candidate number BCN7926

Appendix 5

HOLD UP BINSTRIP BIN SLIDE (out)STRIP BIN RAM BALE PLATERNSLIDE (inn)

HOLD UP BIN

BALER IN NORMAL PRE-RAM STATE

Appendix 5

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Operators dealing with a production interruption

Candidate number BCN7926

Appendix 6

Operators charging waste to spare baler

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Candidate number BCN7926

Appendix 7

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Candidate number BCN7926

Appendix 8

Gantt Chart Detailing how the changes to the balers at Eastman Chemicals

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