The inquest into the death of an Orillia man at a local quarry heard from its last witness Monday.
David Pinkney, 31, died Feb. 6, 2017, at Walker Aggregates’ quarry in Severn Township while clearing ice and snow from a conveyor.
The bar he was using to remove the ice and snow became caught in the belt and he was pulled in, causing fatal injuries.
Last week, current and former employees testified it was not uncommon for workers at the quarry on Nichols Line to violate safety guidelines — something that was reiterated during the testimony of Monday’s witness.
Because OrilliaMatters has not been able to attend all of the inquest dates, during which other employees who were also said to have violated safety guidelines testified, we are not naming the witnesses.
Two of the main violations being described during the inquest, being held in an Orillia courtroom, involve employees using a skid-steer bucket as a work platform and not locking and tagging out, a practice meant to prevent machinery from being turned on while people are working on it.
“It was common practice throughout the course of the year,” the former employee said of those violations.
In fact, he noted, Pinkney had a close call, under similar circumstances, prior to his death.
The witness recalled a time Pinkney was working on the tail pulley of a conveyor and the belt began to move, but it was shut off in time.
“We got lucky that day,” he said.
The witness, like some who have testified before him, acknowledged he was “just as guilty as anyone else” at the quarry of working in an unsafe manner.
As Walker Aggregates’ lawyer, Carol Nielsen, later pointed out, it was a safety violation that led to Monday's witness being let go from the company.
On March 3, 2017, a month after Pinkney’s death, the witness’s employment was terminated after the company learned he had reached under a protective gate without using the lock-and-tag system.
The witness said his employer offered him a chance to resign, but he refused. He lodged a complaint with the Ministry of Labour, and the matter was “amicably resolved,” Nielsen explained.
While the witness’s claim that unsafe work practices were common aligned with the testimony of previous witnesses, another accusation did not.
When asked by Dennis Chronopoulos, counsel to the coroner, why he chose to violate certain guidelines, the former employee said he felt pressured by his superiors to get the job done quickly.
“We need the numbers. Get the numbers. Run things hard. Tonnage is key,” he recalled being told.
Nielsen asked the jury to take into consideration the fact Monday’s witness was the only one to claim he felt rushed by his superiors. Others have testified there was no specific deadline for finishing the work.
While it was anticipated the inquest would wrap up Monday, it is now expected to conclude Thursday.
The five-person jury began deliberating Monday afternoon. It is being asked to determine how, when, where, why and by what means Pinkney died.
It is also welcome, but not required, to make recommendations aimed at creating safer workplaces at quarries across the province.
In their closing submissions, lawyers submitted their own recommendations for the jury’s consideration.
Chronopoulos, Nielsen and Ministry of Labour lawyer Judy Chan agreed on the first three recommendations: that the Live Safe! Work Smart! training be mandatory for high-school students; that the Ministry of Labour be obligated, as needed, to consult with the Ministry of Education on that curriculum; and that the Ontario Stone, Sand and Gravel Association create an award for safety innovation, to acknowledge those who come up with ways to promote safety in the workplace.
The final two recommendations were jointly submitted by Chronopoulos and Chan. Nielsen said Walker Aggregates was not taking a position on those recommendations, which are to ask the Ministry of Training, Colleges and Universities to ensure a refresher course on the “common core” training for quarry employees be completed every five years, and that the common core module for first-line supervisor training include a focus on human behaviour.
Human behaviour has been at the heart of the inquest, as lawyers and the presiding coroner, Mara Goldstein, have tried to find an answer the question: Why do people choose to take unnecessary risks that are contrary to safe work procedures?
It was noted during final submissions to the jury that, prior to his death, Pinkney had not received specialized training with regard to conveyor maintenance, that Walker Aggregates’ policies surrounding lock-and-tag and skid steers were not being implemented, and that there was inadequate supervision.
Chan also said Walker Aggregates’ internal responsibility system (IRS) — the “underpinning” of occupational health and safety legislation that states workers at all levels are responsible for the safety of themselves and others — was a “catastrophic failure” at the Severn quarry.
“The IRS in this workplace was not working,” Chan said. “The supervisors didn’t even know what the IRS was.”
In her closing submissions, Nielsen reminded the jury of the additional steps Walker Aggregates has taken since Pinkney’s death — “a tragic accident that … shouldn’t have happened.”
The company implemented a zero-tolerance policy for safety violations, completed a risk assessment of safe working procedures, undertook a review and inspection of safety guards/gates at all of its operations in Canada and the United States, and shared information with all of those operations regarding Pinkney’s accident and the skid-steer and lock-and-tag procedures.
It also brought in a third-party mediator to evaluate its internal responsibility system.
While none of the five recommendations made to the jury is directed at Walker Aggregates specifically, Goldstein, in her final instructions, asked jurors to “consider the situation where workers are not feeling supported by management” — referring to a claim made by previous witnesses.
She explained the motto of the Office of the Chief Coroner is, “We speak for the dead to protect the living.”
“In considering your verdict,” she told the jury, “we ask you to speak for David Pinkney.”
