**April-June 1999 *Fathom***

**Table of Contents**

**Cover**

Navy photo by PH2 Felix Garza. An ET1 checks radar equipment high above
USS *Carney* (DDG 64).

**Editor's Note**

My special thanks go to EMC(SW) Carl Henry, whose patience,
understanding and technical expertise made this issue possible. Bravo
Zulu on a job extremely well done. Best wishes on your return to the
fleet as an LDO. I also must thank PH2 Matthew J. Thomas, USNR-R, who
provided the lion's share of photos for this issue. It was inspiring to
work with someone who meets every challenge with a friendly, can-do
spirit.

**Features**

**Recipe for a Shock**

The author outlines the basic ingredients for an electrical shock. By
GSCM(SW) Richard Eckenroth.

**Deadly Shipmate Strikes Again**

Three hours after an ET2 starts doing PMS on a signal-data converter in
radio, an RM1 finds him dead on the deck. By ETCS(SW) Dave Williamson.

**Twist of Fate**

An MM2 dies when he grabs a metal-cased electrical-plug adapter and
twists it to verify a good connection. By CWO3 Tom Fayet.

**Articles**

**Same Snake Bites Four**

After four shipmates get shocked, work-center supervisors finally decide
to find and fix the problem. By EMCS(SW) Michael Coleman, USN(Ret.).

**"Is This Cable Live?"**

An EM3 feels the wrath of a 440-volt cable that workers left behind when
they replaced a ship's scullery machine. By Ken Testorff.

**Top 10 Reasons Why Sailors Get Zapped**

The author looks at the 10 most common electrical problems found during
surveys. By EMC(SW) Carl Henry.

**Electricity Is Everywhere\...**

Electrician's mates and electronics technicians aren't the only
shipboard Sailors who face the perils of electricity. By ET2 Fred G.
Bell.

**Don't Overload Your Outlets**

Electrician's mates aboard USS *Dwight D. Eisenhower* are getting about
30 trouble calls a day, instead of the usual five or six, because
crewmen are overloading receptacles. By JOSN Sarah Deal.

**Shock Injuries Not Always Just Skin-Deep**

Most victims of electrical shock suffer internal injuries. By Capt.
James Fraser.

**Zap Puts More Zip in Your Snap**

Some shipboard Marines learn their lessons about electrical safety the
hard way; others benefit from familiarization materials they receive
before reporting aboard. By Ken Testorff.

**Who Takes Precautions Seriously?**

After working in a ship's electrical shop for a couple of months and
attending a safety stand-down, a fireman gets shocked while helping a
shipmate repair a bulkhead-mounted fan. By Lt. Robert M. Swain.

**Blind Leading the Blind**

An AT3 who isn't PQS-qualified agrees to install a fan in a

squadron's work center and gets zapped. By Lt. Edric Morgan.

**A Power Surge My Ticker Didn't Need**

A Sailor rests his forearm on top of a transmitter while aligning its
converter and is shocked by 1,000 volts of direct current. By ET2 Leroy
Kirkland.

**Let Me Count the Violations**

A PO3 gets shocked while working inside an energized switchboard. By Lt.
Tom Binner.

**What's Biting the Hands That Feed You?**

Hazards in shipboard food-service areas, especially energized equipment,
are taking a toll on the junior Sailors who work there. By CWO3 Tom
Fayet.

**Sailor "Cooks" His Goose, Then Slices It**

Instead of calling an electrician's mate to replace a blown fuse, an MS3
does it and ends up getting shocked by 440 volts and cutting a
five-inch-long gash in his arm. By Ltjg. Daniel Morris.

**Thanks, You S.O.B.**

Rubber electrical gloves save the life of a seaman who is ordered to
buff a ship's mess decks. By Lt. John H. Parker.

**Departments**

**Editorial**

**What's Biting the Hands That Feed You?**

*By EMCM(SW) Larry Solis,*

*Staff, ComNavAirLant,*

*and CWO3 Tom Fayet*

Electricity, that's what. The food-service attendants (FSAs) who do much
of the cleaning in their work area often have little shipboard
experience. They may have even less time in the galley. In many cases,
supervisors compound these problems by letting the FSAs work on and
clean energized equipment.

Here are examples of why it's important to look out for these junior
shipmates:

**Will You Have It Light or Dark?**

An FSA was shocked while replacing a toaster in its mounting. Inspection
revealed that one of four moving contactors had become welded to its
fixed counterparts. These contactors moved each time someone used the
front lever of the toaster. Pulling up the lever interrupted power to
the heating elements. Then a metal retaining bracket for the moving
contactors, which was connected to the operating lever by one screw,
became misaligned. The result was a twisted retaining bracket that
intermittently touched a live terminal, energizing the toaster's metal
casing. Inspection also showed the toaster's grounding wire wasn't
connected to the ground inside the junction box that provided power to
the unit.

**With Just the Flip of a Switch**

While washing utensils in a deep sink, an FSA turned on a garbage
disposal and received an electrical shock. The problem was a missing
rubber boot on the start button for the disposal.

**"I Barely Touched It"**

An FSA was cleaning behind a reefer when he brushed an exposed
electrical wire that was touching the metal enclosure for a junction
box. The result was an electrical shock.

**Should Have Ignored That Dust**

Seeing dust under the top of a pantry grill, an MS3 removed the splash
guards between the griddle top and burner plates, then moved the burner
plates to one side so she could clean. While reaching under the griddle
with a soapy sponge, she touched electrical connections and was shocked.
An investigation revealed that the MS3 didn't tag out the griddle or
secure power before removing parts. Even though she saw exposed wiring
after removing the splash guards, she didn't heed the electrical-safety
training she had received.

To avoid similar hazards, you should consider these points:^1^

**\*** All plugged-in shipboard equipment requires electrical-safety
checks. Although toasters fall under the provisions of mobile electrical
equipment, which require annual checks, don't omit initial safety checks
when you install one. If electrician's mates had connected the ground
wire in the junction box in the first incident, the current flow from
the broken toaster would have taken the path of least resistance. The
ground conductor, instead of the FSA, would have taken the jolt.

**\*** All equipment using electrical power, including appliances in a
galley and messdecks, must have their metallic frames connected to a
ship's ground.

**\*** Food-service electrical equipment, such as refrigerators and
coffee makers, must have their own circuit and isolation transformer in
a ship's lighting-distribution system. When you plug these appliances
into the ship's existing 120-VAC receptacles, you can overload the
circuit and create a fire hazard.

**\*** FSAs must be trained to follow tagout procedures and secure power
to electrical equipment before cleaning it. Make sure they know where to
find the electrical panels and switches that control galley equipment.
Label all galley ranges, ovens, griddles, electrical switches, breakers,
and controllers. Most galley mishaps involve using wet or damp materials
to clean energized electrical equipment. Galley supervisors should ask
electrician's mates to teach the FSAs about electrical hazards.

**\*** Because of the hazards in food-service areas, galley supervisors
must train FSAs how to recognize and avoid such dangers as bare wires,
missing protective covers and guards, and frayed cables. Don't let them
operate, maintain or clean galley equipment until they are qualified.
Post operating instructions and precautions near each piece of galley
equipment. Set the example; watch for obvious hazards and be alert for
hidden ones, as well. If you find any problems, immediately place the
equipment out of commission and report the hazards to the galley
supervisor. Make sure qualified electrician's mates do all electrical
repairs.

*At the time the authors wrote this article, they were assigned to the
Afloat Safety Programs Directorate at the Naval Safety Center.*

**For More Info\...**

^1^ To avoid the problems described here, follow the guidance in PMS MIP
3000, Mil-STD-1310e (Navy); General Specifications for Overhaul of
Surface Ships, Sections 651 and 320; NSTM, Chapter 300; and the NavOSH
Program Manual for Forces Afloat (OpNavInst 5100.19C), with change 1,
Chapters C19 and D13.

*Mishap reports about Sailors getting shocked while working in shipboard
food-service areas are a dime a dozen. The tale that follows concerns a
Sailor who learned the meaning of "double jeopardy."*

sidebar 1

**Sailor \"Cooks\" His Goose, Then Slices It**

*By Ltjg. Daniel Morris*

We had come through a difficult restricted availability, a busy training
cycle, and two trips out of country for port visits without submitting a
single mishap report. We had had our share of cuts and scrapes, but
nothing that required more than a few stitches. I was living every
safety officer\'s dream.

During the second month of a six-month deployment, my dream came to an
abrupt end. It began with a call to the pilot house at the end of a long
midwatch. An MS3 had been baking for the morning meal and had cut
himself. The ship\'s corpsman was calling to report the details for the
deck-log entry. Although this situation seemed simple at first, it
started to spiral downhill.

Investigators found that a cut wasn\'t the MS3\'s only problem. He also
had been shocked. While replacing a fuse in one of the fans used to
circulate air in the oven, he used a butter knife to open a panel
containing this warning placard: \"Disconnect power before opening.\" He
then reached in with the knife and tried to reset what he thought was a
circuit breaker. The knife touched a live contact, and the MS3 suddenly
was \"cooking\" himself with 440 volts.

When he finally was able to jerk his hand free, the MS3 caught his wrist
on the panel and sliced a five-inch-long gash from his forearm to the
inside of his palm. Once the ship\'s corpsman was able to stop the
bleeding, the OOD set emergency flight quarters, and the MS3 was taken
to an aircraft carrier for more treatment.

This cruise was the MS3\'s last one, but instead of spending only one
more month on active duty after the ship returned from its deployment,
he had to stay for six months. The extension allowed him to complete
physical therapy and regain the use of his hand.

This mishap was another example of what can happen when someone doesn\'t
take the time to do a job right. All hands learned a valuable lesson
that night. I think the real tragedy here is that it nearly always takes
an incident like ours to remind us that we\'re constantly at
war\--against attitudes that can injure and kill.

*At the time the author wrote this article, he was assigned to USS*
Merrill *(DD 976).*

*Now read about a food-service attendant whose life was spared because a
lieutenant made him don a pair of electrical-grade rubber gloves before
he buffed the mess decks.*

sidebar 2

**Thanks, You S.O.B.**

*By Lt. John H. Parker*

"Go get some rubber electrical gloves on before you plug in that
buffer," I admonished a seaman, who was getting ready to scrub the
messdecks.

I then chastised the messdecks MAA, a BM1 who was supposed to be
supervising the seaman. "Why aren't you enforcing the safety rules?" I
asked. "Don't let me see any more food-service attendants using buffers
or any other electrical equipment without the proper PPE, or you'll be
answering to me."

Looking a little perplexed, the BM1 blurted out, "Sir, you give me too
much to do, with too few people and too little time. On top of all that,
you expect me to be an S.O.B. and make sure the troops follow every
ridiculous, little safety rule."

"You don't have to be the only S.O.B.," I told the BM1. "I'll be one,
too. You tell them it's you, me and naval directives that are making
them follow all these 'ridiculous, little safety rules.' But I'd better
not catch anyone violating them, or you and that person will be
explaining your actions to me. Do we understand each other?"

"Yes, sir," replied the BM1.

With that, I was off to the supply office. About 10 minutes later, I
heard, "Duty corpsman to the messdecks! Duty corpsman to the messdecks!"
over the 1MC. I ran out of the supply office and forward to the
messdecks, where I found a crowd gathered around the seaman I had
encountered earlier. He was unconscious on the deck. I could smell burnt
rubber, and I saw some pale, blue-white smoke.

Seconds later, the duty corpsman arrived. As he moved the crowd back and
started to work on the motionless seaman, the corpsman asked what had
happened.

"He just started buffing the wet deck when a huge arc of electricity
shot out of the buffer, and he just fell down," said the shaken BM1.

In about six minutes, the seaman came to, and an ambulance took him to a
medical center. Doctors released him two days later, fit for duty. The
medical report they sent to the ship said the seaman had received a
severe electrical shock. Because he was wearing electrical-safety
gloves, though, most of the current had not entered his body.

A year after that incident occurred, the seaman and his wife asked me to
be the godfather of their daughter. "Why me?" I asked.

"Well, sir," the seaman replied, "if I may be so direct, you're the
S.O.B. who saved my life."

All I could think of that day was, "Yes, safety rules can seem like a
pain, but if enforcing them makes a person an S.O.B., then you can call
me that anytime."

**Recipe for a Shock**

*By GSCM(SW) Richard Eckenroth,*

*Staff, ComNavSeaSysCom*

It won't make Betty Crocker's collection of world-famous recipes, but
here's a list of the basic ingredients for cooking up yet another
electrical-mishap report:

-   Any class of ship

-   One maintenance person (the more junior, the better)

-   One maintenance action (any job, any priority)

-   A small amount of experience

-   Too little training

-   Spotty supervision

-   One piece of energized equipment

Stir in a little urgency and a pinch of overconfidence, blending them
with a shortcut or two. Note: Tagouts and PPE are not part of this
recipe. Start the job and give yourself time, write the lessons learned,
and hold training\--but don't change the recipe. For spectacular
results, use this recipe on energized switchboards, load centers, and
high-voltage equipment. Occasional replacement of maintenance personnel
will be required.

*At the time the author wrote this article, he was assigned to the
Afloat Safety Programs Directorate at the Naval Safety Center.*

*The stories of two Sailors who died in electrical mishaps follow.*

sidebar 1

**Deadly Shipmate Strikes Again**

*By ETCS(SW) Dave Williamson, USN(Ret.)*

An ET2 had been assigned an annual PMS check to verify voltages and
waveforms on a signal-data converter in radio. The MRC showed the job
should take a half-hour to complete. Three hours after the ET2 started
the job, an RM1 found him dead on the deck in front of the converter.
Medical personnel reported finding two small burn marks on the back of
the victim's right hand.

The ET2's work-center supervisor knew he had been having problems with
the PMS check. Most of the check was to measure 120 volts direct current
(VDC) at test points on the front panel. The ET2 reported, however, he
was reading only 30 VDC. A caution on the MRC alerted users about a
potential problem. According to that note, the metal, spring-loaded caps
covering the external points could short the test point to ground if
allowed to touch the test-equipment probe.

The ET2 and his leading chief had discussed this caution before the PMS
check started. Apparently, though, they didn't talk about it again when
the ET2 reported the low-voltage reading. They also didn't decide how to
isolate the problem.

Fifteen minutes before the RM1 found the victim, another shipmate
reported seeing the ET2 at work. At that time, no equipment covers were
open or removed. A witness, however, said the front panel of the
signal-data converter was removed when he entered radio. The top cover
of an ancillary power supply on a shelf above the converter also was
open. Both were de-energized, but the circuit breakers on the power
panel still were on. Three leads, which were inputs from the power
supply, inside the converter had been disconnected from a terminal board
in the equipment.

How was the victim electrocuted? One theory is he may have accidentally
touched charged capacitor leads. Immediately after the mishap, testing
by ship's force showed a capacitor was retaining its charge up to five
minutes. Mishap investigators, however, could not duplicate this
condition or the original problem of low voltage at the test point.

Another theory is the ET2 may have touched 115 volts. Even with the
power switches off in the front panel, energized circuit breakers on the
bulkhead supply 115 VAC on one side of the on-off switch. There's also
115 VAC present on a terminal board inside the equipment.

Another possibility is the ET2 may have brushed his hand against one or
more of the three disconnected leads, then turned off the power supply
before his heart stopped.

Fatigue may have affected the victim mentally and physically. He may
have had as little as five hours of sleep during the preceding 48 hours.
Two days before this mishap, the victim was on liberty in a foreign
port, where he reportedly was drinking heavily. He had only one hour of
sleep before reporting to the ship for duty the next day. On his duty
day, shipmates observed him working in radio until about 2300. He then
had the 0400-0800 watch the next day\--the day of the mishap. The OOD
had counseled the ET2 for being sluggish and not paying attention on
watch. At quarters, his leading chief had noticed that he looked drowsy.
Although most Sailors don't like to shirk duty, they are responsible for
telling their supervisors when they are too tired to do their jobs.

A warning placard wasn't posted, showing that multiple power sources
(115 volts and the ancillary power supply) fed the signal-data
converter. This discrepancy, however, didn't relieve the ET2 from his
obligations. Before starting to work, maintenance people should study
schematics and learn all sources of input power, capacitors that store
voltage, high-voltage components, and any other hazards. Investigation
also revealed that the ET2 was using the technical manual for an earlier
model of the power supply involved. This mistake could have confused his
troubleshooting.

Maintenance people must discharge all capacitors and use a voltage
tester to verify all conductors are de-energized before working on a
circuit. The fact that investigators didn't find electrical-grade rubber
gloves or a shorting probe at the scene indicates the victim neglected
this critical procedure. Electrical gloves are required anytime you are
exposed to more than 30 volts.^1^ If it's too cumbersome to wear
electrical gloves on both hands, then you must wear a glove on your free
hand. Because all conductors are assumed to be live until tested, the
ET2 should have worn electrical gloves to make those measurements.

The ET2 departed from troubleshooting procedures in the technical manual
but didn't notify his chain of command he was doing so. The manual does
not call for disconnecting the three input leads from the power supply.
Before making this mistake, the victim should have stopped and discussed
his plan with his supervisors. He should have found out if his proposed
procedure was safe and if it would work.

Measuring voltage with the leads disconnected required the CO's
permission. This permission is necessary anytime you work on energized
equipment and don't follow PMS or troubleshooting procedures in the
technical manual. Besides involving senior technicians, asking
permission also alerts the CO to a situation that places personnel at
increased risk. The CO weighs the risk against the necessity and decides
if the possible gains outweigh the increased risk. The important point
to remember is that only the CO can make that decision.

If the ET2 planned to troubleshoot energized equipment, he also needed a
safety observer who could give first aid and secure power. He was
obligated to keep his supervisors informed and to ask for help if he
needed it. Don't be afraid to demand that procedures be followed. If you
know that a safety observer, a pair of electrical gloves, or a shorting
probe is required, get them.

Meanwhile, supervisors must take an active part in all operations. In
this case, the supervisor knew the ET2 was having problems. They even
discussed the problems but didn't decide what to do. In hindsight, the
supervisor probably should have assigned someone to help the ET2 when he
started having problems completing a 30-minute PMS check. Instead, three
hours passed before the RM1 found the victim's body.

*The author wrote this article while he was assigned to the Afloat
Safety Programs Directorate at the Naval Safety Center.*

**For More Info\...**

^1^ The requirements for wearing electrical gloves are outlined in NSTM,
Chapter 300, Section 2.

sidebar 2

**Twist of Fate**

*By CWO3 Tom Fayet*

An MM2 planned to use a mobile air compressor to repair a ship's valve.
Using a metal-cased electrical-plug adapter, he joined the compressor
cable to a 75-foot extension cord, which was connected to a 440-volt
receptacle. There was a problem, though: The compressor wouldn't start.

In his effort to find the cause, the MM2 grabbed the adapter and twisted
it to verify a good connection. This mistake proved to be his last. For
two or three seconds, 440 volts of electricity coursed through the
victim's body. He then dropped the adapter, staggered backward, and fell
against a platform.

When shipmates reached the MM2, he had stopped breathing and had no
pulse, so they immediately started CPR. They also called
medical-emergency-response personnel, who tried unsuccessfully to
defibrillate him. An ambulance took the MM2 to a hospital where doctors
pronounced him dead.

Blatant disregard for precautions led to this tragedy. For example, the
metal-plug adapter he was using is prohibited aboard ship. Personnel in
the ship's supply department probably never saw it. If they had, they
would have turned it over to the electrical-tool-issue room for
inspection before issue. Supply-department personnel pay particular
attention to items that Sailors get through open purchase or from
ServMart.

If the metal adapter hadn't killed the MM2, the extension cord could
have. Technicians who made up this cord obviously ignored regulations.
It always has been illegal to jury-rig equipment (e.g., make up a
three-conductor cable for a three-phase system without a fourth
conductor for the ground connection). The technicians compounded their
blunder by using cable that didn't meet the amperage requirement of the
compressor. In a matter of time, the cord would have burned and could
have hurt someone.

None of these problems, however, would have mattered if the correct
players had been involved from the beginning. For example, the people in
the electrical-tool-issue room didn't get a chance to check the air
compressor when it arrived\--as requirements dictate. If so, they
wouldn't have made an extension cord for it. Instead, they would have
replaced the unit's original cord with one not more than 100 feet long
and capable of handling the unit's amperage draw.

This action would have removed the other deathtrap: the lack of a
grounding conductor on the portable compressor. Requirements are
specific about tools or devices that need to be grounded. When the
portable cord supplied with these items doesn't include the necessary
extra conductor, personnel must not use the equipment until it is
rewired correctly.

The twisting of the "hot" adapter simply completed the recipe for
disaster. As it turned out, one phase of the compressor plug touched the
outer case of the metal adapter when the victim twisted it, which
provided a current path through him to ground.

The victim might be alive today if he had followed the "so simple they
sound stupid" procedures for connecting and disconnecting electrical
equipment. According to these rules, you always connect the cord of
portable electrical equipment to an extension cord before you stick the
cord into an energized receptacle. Always unplug the extension cord from
the energized receptacle before unplugging the equipment from the
extension cord.

After I had read about this mishap, I couldn't help wondering what
happened to the concept of letting only trained electrician's mates and
technicians troubleshoot and repair electrical and electronic equipment.
More importantly, why hadn't the victim's supervisors noticed at least
one of the many glaring safety violations? At least four of 15 general
precautions were ignored. The references^1^ say to report any unsafe
equipment or material condition. This system allows trained personnel to
fix problems before they hurt or kill someone. The supervisors should
have made sure all the electrical and electronic equipment in the space
met electrical-safety requirements.

I also questioned what kind of training the workers must have been
getting. For training to be effective, it must be held regularly.
Considering all the violations that jumped out at me while reading this
tragic account, it seems evident personnel weren't spending much time
studying electrical-safety rules.

*At the time the author wrote this article, he was assigned to the
Afloat Safety Programs Directorate at the Naval Safety Center.*

**For More Info\...**

^1^ Electrical-safety information is found in NSTM, Chapter 300, Section
2; NavOSH Program Manual for Forces Afloat (OpNavInst 5100.19C), with
change 1, Chapters B7, C9 and D5; and Standard Organization and
Regulations Manual of the U.S. Navy (OpNavInst 3120.32C), Paragraph
630.17.

**Who Takes Precautions Seriously?**

*By Lt. Robert Swain, Jr.*

"Certainly not Fireman Smith," you may say. This Sailor was eager to
become an electrician's mate, so he spent a couple of months in the
electrical shop getting practical experience for the next advancement
exam. When his ship held a safety stand-down, he had a front-row seat
for the electrical-safety lecture.

A week after the stand-down, someone called the electrical shop about a
broken bulkhead-mounted fan in the junior officers' bunkroom. Fireman
Smith volunteered to help an electrician's mate do the work.

Upon entering the space, the two Sailors noticed the room was hot, and
condensation covered everything. They began looking for obvious
problems. As the electrician's mate turned to find the power switch, FN
Smith tilted the fan for a better look. The electrician's mate heard a
faint yelp and saw FN Smith jerk his hand away from the fan.

Why did this mishap occur? The instructor for the electrical-safety
lecture at the stand-down had covered such situations. Did FN Smith's
mishap mean the stand-down was ineffective or something was missing?

No.

A person doesn't start taking precautions seriously just because he
attends a lecture or takes a course. The key is the person's supervisor,
who should start discussing precautions for a particular job during the
planning phase. This action gets everybody thinking about priorities.
Allow enough time to set up controls, tag out the equipment, and do
maintenance with a qualified safety observer on station, if required.

Supervisors also should review checklists for key items. You may find
that your own checklist overlooks important information. If you have to
develop a new list of precautions, start with the technical manuals. Pay
particular attention to all warnings and precautions listed for each
job. Your safety petty officer also can be a valuable resource. Before
publishing a new safety checklist, let the safety officer look at it
because his training may reveal areas no one else considered.

Maintenance people stock their tool kits with all the tools they need.
In similar fashion, supervisors should ensure workers have all the
safety tools (e.g., precautions and warnings). Review the checklist with
workers before they leave the shop; maintenance people have to know what
must be done before starting a job. Emphasize any special concerns that
you have and give the workers time to ask questions.

Monitor progress closely. You'll only get what you inspect. Don't let
cumbersome electrical-safety gloves, bulky respiratory equipment, and
uncomfortable faceshields find their way into a pile in the corner.
Insist on everyone wearing the required protective gear.

Impress on workers that they must follow the procedures developed in
planning throughout the project. Looking the other way sends a strong
message that speaks much louder than words. Consistency and dedication
will be rewarded.

Any mishap that causes an injury or death is one we cannot afford. Set
the right example, and others will develop the same habits.

*At the time the author wrote this article, he was assigned to USS*
Antietam *(CG 54).*

The story that follows describes another Sailor's encounter with an
energized shipboard fan.

sidebar

# Blind Leading the Blind

## By Lt. Edric Morgan

Despite efforts to promote electrical safety in the fleet, some Sailors
still don't realize the hazards involved with power-distribution systems
aboard Navy ships. Supervisors sometimes add to the problem by failing
to provide training. Here's the story of a Sailor who suffered the
consequences:

On the request of his supervisor, an AT3 started hard-wiring a fan into
a squadron's work center aboard ship. Unfortunately, he didn't tag out
the 115-volt circuit or de-energize it. Instead, he climbed a ladder,
removed the cover plate from the junction box, and began connecting the
leads. He was hooking up a hot lead when he got shocked. As he crumpled
against the ladder, a PO3 and an AA rushed to help him down.

When corpsmen arrived on the scene, the AT3 had no pulse. His breathing
was shallow and slow. The medical people diagnosed cardiac arrest and
started CPR. Using a portable life pack, they defibrillated the victim's
heart twice before it returned to normal. Then they stabilized him and
moved him to medical for more treatment and observation.

After this mishap, investigators checked the training records of 124
squadron personnel to see what electrical-safety classes they had
attended. Only six of the records revealed shipboard training. Another
57 showed the people had attended some training ashore. The remaining 61
records had no entries for any electrical-safety training. No one had
received this training during indoctrination. Finally, the records
showed no one had attended tagout training. The victim in this mishap
had some shore and aircraft electrical-safety training but no shipboard
or tagout training.

The AT3 wasn't PQS-qualified as a shipboard electrician.

Squadron personnel had sent a memo to E division five days before this
mishap, asking them to install the fan. However, they hadn't submitted a
work request.

The supervisor, who drafted the memo to E division, got the AT3 to
install the fan because he didn't feel E division would respond quickly
enough. He and other supervisors also knew the AT3 had installed two
fans in another space. The PR1 didn't know the AT3 wasn't qualified to
work on shipboard-electrical circuits. The PR1 didn't supervise the
installation.

To avoid similar problems, make sure everyone who works with
shipboard-electrical systems is PQS-qualified and follows all
precautions and requirements. Ship's force and embarked squadron and
detachment personnel must establish and follow the procedures for
electrical repairs and installations. All hands must follow the guidance
in the ship's tagout instruction.

*At the time the author wrote this article, he was assigned to the
Afloat Safety Programs Directorate at the Naval Safety Center.*

**Don't Overload Your Outlets**

*By JOSN Sarah Deal,*

*USS* Dwight D. Eisenhower *(CVN 69)*

We have a problem aboard *Ike*: The crew jams the 115-volt wall outlets
with too many hair dryers, CD players, computers, coffee pots, and other
personal items. When the outlets are full, the crew gets a surge
suppressor and fills all of its outlets. Then comes another surge
suppressor.

What happens next is no mystery; a fuse blows. "The receptacles in *Ike*
are only capable of safely accepting thirteen amps. If you plug in an
item or several small items that draw more than thirteen amps, the fuse
blows," says EMC(SW) Charles Spagnuolo.

Perhaps you have the same situation on your ship. According to safety
surveys, many ships do. The problem aboard *Ike* is that the ship was
designed in the '60s, when there was no idea how far the field of
electrical distribution would advance. Nearly everything on *Ike* runs
off 110-to-440-volt receptacles. There are six or seven receptacles
running on each electrical line throughout the ship to meet the
maximum-draw requirement of 13 amps.

Outlets in homes are built with a hot lead and a neutral lead. Shipboard
outlets, on the other hand, have two hot leads, and they are not
protected against a power surge. Apart from the hazard caused by
personal items that aren't safety checked, there is a problem with
people overloading office receptacles with too much equipment. As more
and more electrically powered equipment is used in ships, requests for
more receptacles continue to flow into the electrical officer. "To
install more receptacles," Chief Spagnuolo explained, "we have to add
more power panels or locate a panel with room for the extra lines."

Putting in higher-amp fuses is not an option! What *Ike* crewmen don't
seem to understand is that if too much current passes through a
receptacle, it can heat the wires enough to start a fire.^1^

Chief Spagnuolo often finds surge suppressors plugged into each other.
"In some cases, they aren't even the approved model^2^," he said.
Besides using the wrong surge suppressors, some crewmen take it upon
themselves to increase the fuse's amperage.

The solution to these problems starts with Sailors leaving their hot
plates, air conditioners, and other unauthorized items at home. They
also need to get personal gear safety checked. Here are some more tips:

-   Turn off all unnecessary equipment before using a buffer because the
    power surge from a buffer can blow a fuse.^3^

-   Use the approved surge suppressor only for office equipment.

As Chief Spagnuolo pointed out, *Ike*'s electrician's mates have more
things to do than just replace blown fuses. "Instead of getting the
usual five or six trouble calls a day for fuses, we're getting about
thirty," he said.

**For More Info\...**

^1^ Paragraph 300-2.7.3.5 of NSTM 300 provides a formula for calculating
the number of receptacles that can be on one circuit. Meanwhile, the
General Specifications for Overhaul of Surface Ships lists the
requirements and limits on the number of receptacles in a space.

^2^ The stock number for the approved surge suppressor is NSN
6510-01-362-7192.

^3^ GSO, Section 303, states that F09B15VAS-type fuses, which blow
slowly, are to be used in shipboard receptacle circuits.

**A Power Surge My Ticker Didn't Need**

*By ET2 Leroy Kirkland,*

*USS* Juneau *(LPD 10)*

As I placed a non-metallic tweaker on the transmitter's potentiometer, I
used the DC-to-DC converter for stability. That's what the procedures in
the technical manual called for, and I was following them closely,
because working on energized equipment is delicate business. In fact,
this particular job\--aligning the converter\--is so delicate it's
impractical to wear electrical-safety gloves.

I wish I could tell you I finished this task without a problem. However,
I made a mistake. For just a moment, my attention wandered, and I
absent-mindedly rested my left forearm on top of the transmitter.
Because the cover was made of fiberglass, it flexed downward under the
weight of my arm\--far enough to cause a high-voltage arc from the
power-amplifier-tube plate under it. Immediately, 1,000 volts of direct
current shocked me, burning the tip of the finger I was using for
stability.

A safety observer alertly secured power to the equipment and took me to
medical, where corpsmen hooked me up for an electrocardiogram, for the
rest of the workday.

What did I learn from this encounter?

-   Pay attention to what you touch, especially when working on
    energized equipment.

-   Safety observers can be lifesavers.

-   Know your equipment, as well as all the potential shock hazards for
    a job.

After this mishap, the electronics-material officer had us cut a piece
of rubber matting to fit around the transmitter to reduce the chance of
another shock.

**Top 10 Reasons Why Sailors Get Zapped**

*By EMC(SW) Carl Henry,*

*USS* Nicholson *(DD 982)*

Think of electricity as a powerful and dangerous tool, held in check by
a triangle made up of training, QA and supervision. If one side of the
triangle fails, electrical hazards eventually will run out of control.
Here are the 10 most common electrical problems I find during
surface-ship-safety surveys:

**1. Many electrical circuits are overfused or underfused.**^1^ The next
time you have to replace fuses in a fuse box, why not do the job right?
You have to tag out the fuse box anyway (unless vital equipment is
involved), so don't just replace the fuses. Instead, take an extra
minute before you start to work and make sure the wiring diagram is OK.
If you find problems, submit them up the chain of command. Something
that I find amazing is the number of man-hours shipboard personnel spend
ensuring all fuses match the requirements listed on label plates (3-amp
label = 3-amp fuse), even after the crew has done PMS.^2^

**2. Fuses with the wrong ferrule material (brass or nickel, instead of
silver) are installed.**^3^ I was shocked to find one ship that still
had brass-ferruled fuses in the 115-volt lighting circuits. Instead of
being in a fuse box, they should have been in a museum. In case you
didn't know, brass-ferruled fuses haven't been authorized since Nov. 5,
1991.

**3. Megger test holes are not plugged on the power-supply circuit
breakers of manual-bus transfers.**^4^ Type-commander messages^5^ make
it clear: Power panels and manual-bus transfers must have the megger
holes covered.

**4. Fuse boxes are not labeled correctly with the circuit controlling
the phases or polarities and the fuse-ampere ratings.**^6^ When I survey
ships, it doesn't take long to find fuse boxes incorrectly labeled with
grease pencils. Some ships make the mistake of writing directions on
tape about what circuit is involved. For ships with new installations
(after 1996), and whose fuses boxes are three-phased input and
single-phased output, the single-phased loads are required to show which
phases (e.g., AB, BC, CA) have a load. This requirement makes it easier
to maintain a better load distribution for the power system.

**5. Fuse boxes and distribution panels aren't maintained.**^7^ How many
power panels aboard your ship have only one or two screws holding the
cover in place? Did you ever wonder what happened to all the other
screws? As I walk around ships, looking into fuse boxes, I find many
that are missing hardware, with no supporting documentation to purchase
replacements. I also find circuits that have two sets of conductors
coming from a single set of fuses (in one case, neither was labeled). In
some cases, I find the missing wingnuts from covers inside fuse boxes,
along with extra fuses. Investigation usually reveals that maintenance
people are looking at the boxes; they just aren't trying to fix any of
the problems. They also aren't taking the time to put all the screws
back in the covers.

**6. Dead-ended cables aren't identified and isolated correctly.**^8^
About every 18 months, IMA people or ship's force inspect cableways.
Still, we find a lot of problems during our surveys; the safety petty
officers should find these problems when they do the compartment
inspection and PMS.^9^ In one case, we found the end of a cable hanging
merely inches above the scullery dishwasher being used by a food-service
attendant. There was just one problem: The cable was live! Another time,
we found the end of a live cable hanging about shoulder height in a
maintenance office. No one had taken the time to report it.

**7. Shore-power cables aren't roped off and protected.**^10^ A Sailor
was burned severely on his body and arms when a cable failed, and the
resulting fire engulfed him. Cables need to be roped off from traffic.
Because they're left out in the weather, check them periodically for
damage from the elements.

**8. Electrical repairs lack quality assurance.**^11^ Junior Sailors are
doing too much maintenance and daily repairs with too little involvement
of work-center supervisors, LPOs and CPOs. We have to make the junior
people aware of the hazards so they can identify them later.

**9. Accountability for electrical-tool issue is poor.**^12^ When
tool-issue operators go around a ship looking for electrical gear,
divisions usually have one or two pieces missing. These pieces seldom
are found, even after the parent division searches for them. Because the
equipment is lost, a tool-issue custodian fills out the necessary
paperwork to delete the item from the EGL. Months later, however, often
when an assist team is aboard, someone finds the gear and uses it. The
team, of course, checks and finds the PMS on the item is delinquent,
which sends everyone into a panic.

**10. Galley equipment is in various stages of disrepair.**^13^ How many
people will have to get shocked before we finally understand how
dangerous a galley is? I remember an incident that happened as I was
reporting aboard a ship for duty. A fellow chief was taking me to the
CPO mess when I saw an HTC using a knife to get his toast from a
toaster. I stopped him, and he explained the toaster spring had broken.
That shock-waiting-to-happen, though, was no worse than some I've read
about in mishap reports during my tour at the Naval Safety Center. For
example, an MS was shocked when he opened a Gaylord hood's control
cabinet (the cabinet screw was missing) to clean its electrical
components. How about the electrician's mate who didn't secure the
grease trap on a griddle? When an MS used the griddle, he was shocked
because the trap chafed the wiring.

With all the emphasis placed on electrical safety in the fleet for so
many years, doesn't it seem like we should have learned more than our
track record shows? I checked two years' worth of post-survey comment
sheets prepared by my predecessors, then compared them with mine, and
found many similarities. I also found many of the same similarities when
I compared my findings with those of InSurv and the Engineering Training
Group. We have to keep electrical safety on the front burner every day,
not just when we're getting ready for the scrutiny of an assessment
team.

*The author was assigned to the Afloat Safety Programs Directorate at
the Naval Safety Center when he wrote this article.*

**For More Info\...**

^1^ Refer to Paragraph 300-2.5.4 of NSTM 300 for guidance about fusing
electrical circuits.

^2^ PMS 3301/005, 18M-1 outlines requirements for making sure that
installed fuses match the sizes listed on label plates.

^3^ Check Paragraph 300-2.5.4.1 of NSTM 300 for details about using
silver-ferruled fuses.

^4^ Refer to Mil-P-23928D and ComNavSeaSysCom message DTG 230319Z Nov 98
(NOTAL) for information about plugging megger test holes.

^5^ Guidance on plugging megger test holes also is contained in
ComNavSurfLant message DTG 112205Z Dec 98 (NOTAL) and ComNavSurfPac
messages DTG 150124Z Dec 98 (NOTAL) and 080504Z Jan 99 (NOTAL).

^6^ Refer to General Specifications for Overhaul of Surface Ships,
Sections 305e and 602g, for details about labeling fuse boxes.

^7^ MIP 3301/005 provides guidance on the correct maintenance for fuse
boxes and distribution panels.

^8^ Paragraph 300-2.5 of NSTM 300 and General Specifications for
Overhaul of Surface Ships, Section 305F, describe the proper ways to
identify and isolate dead-ended cables.

^9^ PMS 6641/4, S-3R describes the procedures for doing the
compartment-check-off-list maintenance.

^10^ General Specifications for Overhaul of Surface Ships, Section 332d,
outlines procedures for roping off and protecting shore-power cables.

^11^ Paragraph 300-2.1.4 of NSTM 300 discusses QA for electrical
repairs.

^12^ NavOSH Program Manual for Forces Afloat (OpNavInst 5100.19C), with
change 1, Paragraph B0704, contains guidance on tool-issue
accountability.

^13^ Paragraph 300-2.5 of NSTM 300 and NavOSH Program Manual for Forces
Afloat (OpNavInst 5100.19C), with change 1, Chapters C19 and D13,
contain guidance about the dangers of galley equipment.

# "Is This Cable Live?"

## 

## By Ken Testorff,

## Naval Safety Center

That's the question an MMFN asked an EM3 while they were cleaning a
berthing compartment. The MMFN had seen the loose cable in the overhead.

The EM3 said he assumed the cable was dead. "It's probably just left
over from an old ship's entertainment system," he explained. He proved
otherwise, however, when he grabbed the cable to move it. This mistake
knocked him to the deck.

The chain of events leading to this mishap started when workers replaced
a scullery machine. The replacement didn't need one of the pumps the
original machine required. As a result, the workers disconnected and cut
off a 440-volt cable flush with a stuffing tube in the deck. However,
they didn't mark the cable, tag out the motor controller, or remove the
obsolete pump's label from the fuse box.

Later, while removing the scullery's terrazzo deck, a contractor cracked
the stuffing tube at the deck. After he finished the new deck, ship's
personnel found water leaking into a berthing compartment below the
scullery through the cracked stuffing tube. Workers pulled the dead-end
cable through the tube into the berthing compartment and put it in the
overhead. Then they sealed the stuffing tube. An electrician's mate
tested the cable and found it still was energized, but he didn't do
anything about the hazard.

A week later, the EM3 learned about the energized cable the hard way.
After he got up off the deck, he told the MMFN not to let anyone enter
the area and left to get medical attention. En route to sick bay, he
reported the hazard.

After this mishap, electrician's mates traced the dead-end cable back
through an energized controller, pulled the fuses, and tested the cable
again. They also removed the controller, the cable and the fuse-box
label.

Here are some more tales about Sailors and their encounters with live
cables they thought were dead.

**Beware Alternatives**

A GSM2 was pulling a dead-end cable when it got stuck on an angle iron
in the overhead. Instead of trying to free the tangled mess, he decided
to cut the cable with a pair of uninsulated lagging pliers. As he made
the first cut, he was shocked badly enough to make him drop the pliers.
He went to sick bay, where a corpsman found him fit for duty. Why did
this mishap occur? Because the GSM2 **assumed** the cable was dead, even
though it didn't have a tag or cap on the dead end as required.^1^

**A Case of Mistaken Identity**

A Sailor and his co-worker had to remove a dead-end cable from a ship's
pipe shop. Electrician's mates had located and de-energized the cable.
When the two Sailors found what they thought was the correct cable, they
picked it up and tried to locate its source. Moments later, a piece of
electrical tape covering the bare connector end came off in one Sailor's
hand, giving him a 440-volt shock.

As any of these victims will tell you, it's smarter taking a few extra
minutes to make sure a cable really is dead, rather than feeling its
live wrath.

*The author's e-mail address is ktestorf@safecen.navy.mil.*

**For More Info\...**

^1^ The requirement for dead-ending cables is spelled out in the NSTM,
Chapter 300.

**Electricity Is Everywhere\...**

*By ET1 Fred G. Bell,*

*TacTraGruLant, Dam Neck*

And you could be the next victim. As a young third class, I was shocked
by more than 300 volts alternating current (VAC), which threw me across
a space and burned my hand. I've also heard about shipboard Sailors
getting zapped by 440 VAC, and I know that some electronics gear
contains more than 6,000 volts direct current (VDC). But fewer people
die from this impressive-sounding voltage than from the common 115 volts
found in a wall socket.

What many people don't realize is that it's the current (measured in
amperes), not the voltage, that's dangerous. Most of us have seen fuses
and circuit breakers rated at 10 to 25 amperes. You might conclude that
one ampere is nothing, right?

**Wrong!**

At 1/1,000th ampere, you feel a tingling sensation. At 1/100th ampere,
you get a hard kick. One-tenth ampere will make your muscles go rigid,
and if that includes your heart muscle, you're dead!

These figures apply to a person whose body is dry. When you're wet, as
little as 30 volts can cause enough current flow through your body to
stop your heart.

Now the average Sailor may say, "That's great information to know if
you're an electrician's mate or an electronics technician, but what does
it have to do with me?" Do you have a stereo? Do you ever use an
electric grinder to prepare a bulkhead for painting or a buffer to make
the deck shine? At the same time, consider that you serve aboard a steel
ship surrounded by salt water\--two excellent conductors of electricity.

Here are some precautions that will keep you from getting zapped:

Navy equipment that is not hard-wired to a power source must have a
three-prong plug. The third prong is the ground lead, which connects all
exposed metal parts of the device to the hull of the ship. All three
prongs should be clean and free of corrosion. Only two kinds of plugs
are acceptable aboard ship: a molded plug installed by the manufacturer,
or a plug that's imprinted "hospital grade." Get rid of any plugs with
chips, cracks or exposed metal.

Examine the cord. The only thing keeping the voltage (and current) from
you is the insulation. If it's cracked, there's a strong chance that
grabbing the cord in that spot will bounce you off the nearest bulkhead.
Finally, check where the cord enters the equipment. The cord must be
seated firmly within the equipment case.

Because water is an excellent conductor of electricity, it's a bad idea
to work with electricity in the rain, while standing on moist surfaces,
or in any condition where your body becomes wet (including sweat). Wear
approved rubber gloves, and don't run cords through puddles of water.

Don't try to repair electrical or electronic equipment. Leave that task
to the professionals.

Make sure all electrical equipment has a tag attached to the cord,
showing the date of the last safety check and stating how often the
equipment has to be checked. If the device is past due for a check,
don't use it.

Authorized personal electrical and electronic gear requires a safety
check every six months by a qualified electrician's mate or electronics
technician. Unauthorized personal items don't even belong aboard ship.
Among these items are fans, portable extension cords and extension
lights, high-intensity and reading lamps, electric blankets, and heating
pads.^1^

Devices such as radios and tape players that will be used only on
battery power also should be checked. Any input for AC power should be
disconnected. Never use any of these items in the shower or head.

Every day in the fleet, at least one Sailor gets shocked\--usually
minor, sometimes major. If you happen to find someone who has been
electrocuted, don't touch him until you're sure he isn't attached to a
live circuit. Otherwise, you could become the next casualty.^2^

*At the time the author wrote this article, he was assigned to USS* John
F. Kennedy *(CV 67).*

**For More Info\...**

^1^ Refer to the NSTM, Chapter 300, for a complete list of personal
electrical items that are prohibited from shipboard use.

^2^ NSTM 300-2.1.3 tells you the procedures for removing victims of
electrical shock from the source.

**Shock Injuries Not Always Just Skin-Deep**

*By Capt. James Fraser,*

*Naval Safety Center*

Mishaps involving electricity kill more than 1,000 people a year in the
United States. Countless thousands are injured, including hundreds of
Sailors.

If you get shocked, the seriousness of your injury depends on the type
of voltage involved, the resistance of your body at the point of
contact, the path of the current through your body, and how long the
current flows through your body.

Volt for volt, direct current (DC) is less damaging than alternating
current (AC). The former often produces muscle contractions that knock
the victim away from the current source. However, alternating current
can cause victims to clench their hands, which fixes them to the current
source. Consequently, AC is considered to be about three times more
dangerous than DC.

Victims of electrical shock may immediately show the effects. Common
signs include a tingling sensation, burn marks or an irregular
heartbeat. In other cases, though, these effects are delayed.

For example, a food-service attendant (FSA) was cleaning a drink machine
and nearby surfaces with a wet sponge. A bulkhead behind the
beverage-line equipment had been removed a few days before. Cables and
junction boxes were hanging from the overhead at eye level. While the
FSA was wiping one of the cables, water from the sponge ran into a
25-amp, 440-volt, circuit-connection box, causing an electrical shock.

He went to sick bay, complaining of sore hands. A doctor treated and
released him, but he returned two hours later, saying his arms and hands
were bothering him. During this exam, the doctor found an irregular
heartbeat and ordered an ambulance crew to take the FSA to a medical
center for follow-up treatment. Upon release a few hours later, he
returned to full duty.

Anytime an electrical shock triggers an abnormal heartbeat, the victim
can suffer a heart attack, and CPR may be necessary to save the victim's
life. Alternating current of 60Hz at 110 to 220 volts traveling across a
person's chest for less than one second can trigger a heart attack. You
find this kind of current in buffers, tools and personal appliances, as
well as galley equipment, such as toasters, grills and deep-fat fryers.

Electrical shocks can burn the body at the point of contact. A burn mark
also may appear at the exit (or grounding) point. Here are the stories
of two Sailors who suffered such injuries and required treatment:

**\*** A PO2 suffered second-degree burns to his arm when he was shocked
by 440 volts during PMS checks. To complete the job, he had to reach
deep inside an energized cabinet. He wore the prescribed PPE (1,000-volt
electrical gloves), but much of his arm was exposed because the gloves
were too short. After this mishap, suggestions surfaced to redesign the
cabinet, to design an electrically insulated tool for the job, or to
design gloves that would offer more protection.

**\*** A PO1 was helping a tech rep troubleshoot a casualty in a piece
of equipment. While removing part of the unit, the PO1 became concerned
that cables attached to it might get entangled. He went to the back of
the unit to guide the cables. During this process, his hand must have
touched (although he swears it didn't) a 440-volt, input-power terminal,
which shocked him. At sick bay, doctors found a third-degree burn that
began on the bottom of his hand and ended as a red mark on his shoulder.
They took him to a clinic where he received an EKG and two intravenous
injections. Doctors diagnosed his injury as a superficial surface burn
and returned him to full duty.

External injuries aren't the only damage that occurs to the body during
an electrical shock. In most cases, tissues inside the body also are
hurt as the current flows along nerves and blood vessels, which, like
muscles, are much more sensitive to electrical-shock injuries than other
tissues are.

Electrical current can "cook" muscles in parts of your body far removed
from the site of the injury; the amount of damage is proportional to how
resistant the tissue is. Bone is a poor conductor but retains heat a
long time, often causing severe damage to deep tissues, while the
surrounding layers are less affected. Because of all the harmful
substances produced when muscle is cooked and destroyed, victims are at
risk of kidney failure. Shock victims also can injure muscles and bones
as a result of the violent contraction of muscles during the shock. If
victims are working on platforms, they can injure themselves when they
fall.

These unexpected and invisible injuries are why victims of electrical
shock always should get hustled to medical. They may require a period of
close observation in a hospital.

*Capt. Fraser is head of the aeromedical division of the Aviation Safety
Programs Directorate at the Naval Safety Center. His e-mail address is
<jfraser@safecen.navy.mil>.*

**Zap Puts More Zip in Your Snap**

*By Ken Testorff,*

*Naval Safety Center*

What will snap a Marine to attention (or put him at parade rest) faster
than any drill instructor (DI) can, regardless of how much bite the DI
has in his bark? Electricity.

For example, a Marine was helping a ship\'s electrician\'s mates by
replacing a burned out light bulb. When he removed the cover, he noticed
that the glass part of the bulb was missing. Its metal base, however,
was still in the socket, so he grabbed a leatherman tool and started
trying to remove the base. Unfortunately, he didn\'t think about
securing power and tagging out the circuit. Because of this mistake, he
spent the next 24 hours in a medical ward. Later, all hands attended a
lecture on the hazards of working on live circuits.

In another case, a Marine was trying to switch off lights in a berthing
area. The switch didn\'t work. Without permission, he went to the power
panel and was removing a fuse when he was shocked by 110 VAC.

Finally, there\'s this story about a Marine corporal and a Navy AT2 who
were working on an ultrasonic flaw detector. While they were replacing
the unit\'s casing, the corporal repositioned an electrical wire that
touched a cathode ray tube (CRT). Both *thought* the equipment was
de-energized, but it wasn\'t. The corporal ended up with a shock, and
everyone else got a briefing on procedures that call for verifying the
discharge of a CRT or capacitor before starting to work.

Shipboard Marines don\'t have to learn their lessons about electrical
safety the hard way. You can reduce the problem by following the example
used aboard USS *Nassau* (LHA 4). Safety personnel there prepare for
deployment by making sure Marines scheduled to sail with the ship
understand shipboard electrical safety.

The training starts before Marines arrive. The pre-deployment package
includes copies of \"Regulations for Embarked Troops,\" which describes
shipboard electrical-safety requirements. The Marines also receive
pamphlets and flyers discussing specific regulations and outlining
policies for electronic equipment.

When the Marines, their weapons, and supplies are loaded, personnel in
the ship\'s SITE-TV station start airing closed-circuit TV programs
about ship\'s routine, special services, and mishap prevention. \"We
encourage supervisors to let the Marines view these programs before
setting up shop,\" noted a CPO in the safety department. \"That way,
they learn the hazards of using their electrical equipment aboard ship
before electrician\'s mates inspect it.\" This system of orientation
eliminates a need for safety observers while the Marines set up their
spaces.

To speed up the equipment-check program, *Nassau* personnel post signs
in common areas directing Marines to the testing sites (central
locations). \"As an extra precaution against electrical mishaps,\" the
chief continued, \"we visit the spaces while Marines set them up. This
action promotes hospitality and helps ease bad feelings a newcomer may
have about our shipboard rules.\"

Although troop berthing and weapons stowage are always primary
considerations when Marines deploy aboard an LHA, they\'re not the only
concern. It\'s also important that the Marines know the dangers of using
untested or prohibited equipment. As the chief concluded, \"Why should
anyone have to be jolted by an untested electric razor before getting
our message?\"

*Some of the information for this article came from a 1991* Fathom
*article by AEC(AW) Mark Childers, who then was the safety office CPO
aboard USS* Nassau*. He now is assigned to VAW-120.*

*The author's e-mail address is ktestorf@safecen.navy.mil.*

# Same Snake Bites Four

## By EMCS(SW) Michael Coleman, USN(Ret.)

"Chief, I just got shocked by this portable light," said a lieutenant.
"How about getting someone to check out the problem?"

"I'll take care of it," responded the EMC, who was standing nearby.

Assuming the light was the problem, the chief told an electrician's-mate
striker to replace it. The striker left and returned a few moments later
with a new one, which the EMC plugged into the extension cord used with
the first light. "Ouch!" he hollered, yanking his hand away from the
plug. "This light is bad, too, or something else is wrong," he grumbled.
Like the lieutenant, though, he didn't pursue the problem.

An ET1 came along a little later with a portable air sampler. "Ah! I'll
use this extension cord," he said. Immediately, he also got zapped, but
he just shook it off.

The stage now was set for yet another shock because the ET1 told an ET3
to get a new air sampler. When the ET3 entered the space, she
accidentally brushed against a vidmar cabinet. Like her shipmates, she
found out what it feels like to have electricity reach out and touch
you. At this point, the work-center supervisors finally decided to find
and fix the problem.

"Ridiculous!" you're probably saying. "You made up that story. What ship
ever has four people get shocked before someone takes the initiative to
remedy the situation?" I assure you it really happened.

Investigators found these problems:

-   No one had safety-checked the extension cord before using it.

-   The extension cord was missing its ground connection.

-   The receptacle was loose, so it shorted out when anyone pushed on
    it.

Although this chain of events could have had tragic results, it ended
harmlessly, which may satisfy some people. However, it doesn't pay to
accept such an all's-well-that-ends-well attitude. Why? Because there
are too many reports of similar mishaps. The victims come from all
ratings.

The reason behind this problem is familiarity, which breeds a
contemptuous attitude. Experienced technicians sometimes get careless.
They take chances, use shortcuts, don't follow tagout procedures, don't
wear rubber gloves, or work without supervision.

A key element in reducing or eliminating electrical shocks on your ship
is making sure your supervisors accurately assess the risks involved.
They also have to know how to manage those risks. In other words, they
must think and plan ahead.

To ensure success, reacquaint everyone in electrical and electronic
ratings with all the references^1^ that govern their work. These
references make great required quarterly reading for your twidgits and
snipes. Also, make sure everyone who does any kind of maintenance gets
their required, annual, tagout training.

At the time the author wrote this article, he was assigned to the Afloat
Safety Programs Directorate at the Naval Safety Center.

**For More Info\...**

^1^ Everyone in electrical and electronic ratings should be familiar
with these references: MIP 3000 A8-R; OpNavInst 5100.19C (with change
1), Chapters B11, C9 and D5; NSTM, Chapter 300, section 300-2.5; EIMB,
Chapter 3; OpNavInst 3120.32C, Section 630.17.

**Let Me Count the Violations**

*By Lt. Tom Binner,*

*Naval Safety Center*

I cringe to think the only good news in a recent mishap report was that
a Sailor who got shocked wasn't killed.

The sequence of events started with a very short safety brief. Four
Sailors (a chief, a PO2, a PO3, and an FN) then began removing a bad
power supply from an energized switchboard. Their ship was in its
homeport in a cold-iron status. After completing the energized-equipment
checklist and reviewing technical info, the two senior people donned PPE
and removed the power supply.

The PO3 then laid on the deck on his stomach to remove a bolt from
inside the switchboard. Meanwhile, the FN grounded himself to the
uninsulated, metal frame of the switchboard. The only PPE either wore
were electrical gloves. They weren't wearing faceshields, which would
have made it hard for them to reach the work area. Their boots offered
no protection since they were lying down.

The FN held the bolt from below while the PO3 used his gloveless right
hand to turn the nut from above. When the PO3 lifted his head to get a
better view of the bolt, he touched the 115-volt side of a step-up
transformer. His body convulsed, causing him to strike the back of his
head on other energized equipment above the transformer. Instinctively,
his partner pulled him from the switchboard, placed him on the deck
outside the safety lines of the work area, and checked for breathing and
pulse.

The PO3 was dazed for about eight minutes and had a weak, rapid pulse,
but he could breathe normally. He didn't need any sutures for his cuts,
but he spent the night in a hospital for observation.

I compared the narrative in the mishap report with the prescribed
procedure^1^, then, finding several unanswered questions, I called the
ship to clarify a few points:

**\*** An independent safety observer wasn't on the scene. The senior
person became a worker, which kept him from watching the big picture and
protecting the people and equipment.

**\*** The ship was in a cold-iron status, so the workers didn't have to
do this job with the switchboard energized.

**\*** The safety brief inadequately described the energized circuits
and their location.

**\*** The workers didn't know all the requirements for working on
energized equipment, including the rule for placing an insulating
blanket over any nearby energized electrical equipment and exposed metal
in the work area. They knew they needed the CO's permission to work on
energized equipment. However, he was off the ship for a conference, and
the engineer officer was on leave, which left the engineering department
without senior leadership. The main-propulsion assistant (MPA) was new
aboard the ship and new to his position. The workers took the work
authorization to the XO for signature.

Another problem was a lack of operational risk management. No one
identified or assessed the hazards or considered the potential severity
and probability of a mishap. When the XO, MPA and chief decided to work
on energized equipment, their decision was based solely on convenience.
The controls described in the previous paragraph clearly were necessary,
but no one made sure they were in place. In the absence of the engineer
officer, neither the MPA nor the electrical officer supervised the
operation.

This mishap is another example of the problems that plague the fleet:
lack of training and smug attitudes.

*The author's e-mail address is <tbinner@safecen.navy.mil>.*

**For More Info\...**

^1^ Paragraph 300-2.5.2 of NSTM 300 (Electrical Plant-General) describes
how to work on energized equipment.

**Editorial:**

**Is Breaking the Rules Worth the Gamble?**

*By EMC(SW) Carl Henry,*

*USS* Nicholson *(DD 982)*

Until I came to the Naval Safety Center in April 1998, I thought I was
the only fleet electrician's mate who ever cut corners to get a job
done. I had no idea so many others were making the same mistake. Now I
understand why electrician's mates are always under the microscope
during major inspections and assist visits.

Here's an example of a shortcut-gone-wrong that I found while
researching this editorial:

A PO3 was helping his chief petty officer and work-center supervisor
troubleshoot the ventilation system in a main space. The PO3 was looking
over the shoulders of these two senior technicians, watching their every
move.

When the chief and the supervisor left to investigate the vent motor,
the PO3 decided to check the controller some more. He found a wire had
been damaged by heat. As he reached in and touched the wire, he made an
important discovery: The controller still was energized.

Too often, our quest to take care of all the problems that arise during
a hectic day turns into a painful demonstration of what happens when you
take shortcuts. We continuously and consciously toss rules aside, and
soon this bad habit becomes an accepted way of life.

I was staggered to learn that electrical mishaps aboard surface ships
and submarines numbered 1,095 for FY96 through FY98. In other words,
ships reported a mishap a day for three consecutive years. Here are some
of the major causes I found during my research:

**A lack of QA by repair personnel.** Senior leaders from the electrical
and electronic ratings didn't make sure repairs were made as required.

**A lack of supervision.** These problems stemmed from insufficient
planning to ensure the right person was assigned to do the job. In
troubleshooting, repairs and PMS, supervising junior personnel is
crucial.

**A lack of training.** How can we expect a fireman or new third class
straight from "A" school to know everything about shipboard equipment?
Supervisors know it takes deckplate training to prepare junior Sailors
to do maintenance and repairs adequately. Nevertheless, we routinely
think, "They will figure it out," and send them off.

In some cases, overwhelming workloads interfere with training schedules.
Leaders have so many high-priority items on their work lists that little
time is left for training. The danger in this situation is that Sailors
who mistakenly think they understand a system may decide to "wing it."
This choice may be especially tempting if they happen to be working in
an isolated area with no one around to monitor their actions.

**Broken or damaged equipment**. This problem can start with something
as simple as a technician not repairing a piece of equipment correctly.
Before long, you probably will have other equipment problems (e.g.,
chafed cables inside controllers, caused by improper routing of cables;
or missing hardware).

**Failure to tag out equipment.** We know better than to let people hang
red tags inside fuse boxes, so why let them just tag out the 115-VAC,
400-Hz circuit on a piece of gear with multiple power supplies? How are
we going to feel if they get zapped because they are too busy to read
the warning placard about multiple power sources?

As supervisors, we need to insist that workers do tagouts for all
necessary work. Even if they have to leave another job to go do a tagout
that may delay their liberty\--don't let them off the hook. The
alternative is a "touching" experience like the one the PO3 in the
earlier example had. Many ships already are short-handed. We can't
afford to lose more Sailors.

How do we solve the tagout problem? I feel we need a tougher system of
accountability, starting with supervisors. Hold them accountable for
giving workers the training, test equipment, PPE, and time to do their
jobs correctly. If these efforts fail, we need to try EMI and comments
in fitness reports and evaluations. As a last resort, I recommend that
we take them to Captain's Mast. That's already happening aboard a
*Ticonderoga*-class cruiser I visited recently.

From a program point of view, if Sailors get shocked or electrocuted
because of improper tagouts, then the QA and training programs also have
failed. This cascading effect can doom a ship trying to pass an exam,
which, unfortunately, is usually the only time anyone ever considers the
total package. The thinking should be that a ship is always in an exam.

Generally speaking, if a ship isn't in some kind of training mode and no
one is watching, the violations will occur. Why? Because the prevailing
attitudes usually are, "Who cares?"

Use this electrical-safety issue of *Fathom* to supplement the official
guidance.^1^ When you short-cut these rules and established procedures,
you increase the risks. Even if nothing happens, you're gambling\--and
stacking the odds against yourself.

*The author was assigned to the Afloat Safety Programs Directorate at
the Naval Safety Center when he wrote this article.*

**For More Info\...**

^1^ The "official guidance" includes the NSTM, Chapter 300; the NavOSH
Program Manual for Forces Afloat (OpNavInst 5100.19C), with change 1;
OpNavInst 3120.32C.