California Department of Public Health

Occupational Health Branch

FATALITY ASSESSMENT AND CONTROL EVALUATIONPROGRAM 

(CA/FACE)

A water truck operator died after being struck by a pressurized hose

Case Report: 19CA003 

SUMMARY

A water truck operator (the victim) died after being struck by a pressurized water hose. The 

victim was filling up a water truck with water from a hydrant that was connected to a water 

tank when the incident occurred. The hose that was used to make the transfer was not of 

sufficient strength or type to accommodate the water pressure involved. The normal procedure 

was to first open the valve on the truck followed by the valve on the hydrant. On the day of the 

incident, the valve on the truck was not opened. The CA/FACE investigator determined that, in 

order to prevent similar incidents, employers with workers who operate water trucks should:

• Ensure that the machinery and equipment provided to transfer high-pressure water can

safely withstand all reasonably anticipated loads.

• Implementpolicies and procedures as part of a safety program to ensure that unsafe 

conditions are identified, and safe work practices are followed.

INTRODUCTION

On August 19, 2019, at approximately 3:00 p.m., a 67-year-old male water truck operator, 

working as a seasonal employee,sustained severe head injuries when a pressurized water hose 

burst and he was knocked to the ground. He died two days later from his injury. The CA/FACE 

investigator received notification of this incident on August 29, 2019 from the Cal/OSHA Weekly 

Fatality Report. On August 30, 2019, contact was made with the employer of the victim. On 

September 5, 2019, the CA/FACE investigator traveled to the location where the incident 

occurred and interviewed the general manager, the victim’s supervisor, and the safety

supervisor. The county coroner, fire department, and sheriff’s department report of the 

incident were also obtained and reviewed. 

EMPLOYER

The employer of the victim was a cooperative of almond growers that provided hulling and 

shelling services to grower members. The cooperative had 550 almond grower members and 

had been in business since 1966. The cooperative had 95 employees; 18 were full time and the 

remainder were seasonal workers.
WRITTEN SAFETY PROGRAMS AND TRAINING

The cooperative had a written injury and illness prevention program (IIPP) with all the essential 

elements required by law. Safety meetings were held on a monthly basis and were 

documented. The safety supervisor provided all safety and other trainings for staff. The victim 

had received training on the proper procedures for transferring water and had done this task 

many times in the past. The seasonal workers began working during the first week of August 

and already attended the cooperative’s mandated safety meeting. 

WORKER INFORMATION

The victim was a 67-year-old water truck operator for the cooperative.He had worked 40 hours 

per week on a seasonal basis for the past six years. 

DESCRIPTION OF WORK

The victim was performing dust control by spraying water on the almond fields that surrounded 

the facility using the cooperative’s water truck. When the water in the truck was empty, he 

would normally refill it at the designated hydrant. However, because the groundwater supply 

was low, the normal hydrant used was not available. Arrangements were made with a 

neighboring business to use their water system which included a 500,000-gallon water storage 

tank which supplied water at a higher pressure. The normal procedure was to connect the hose

(provided with the water truck) to the water tank hydrant outlet ball valve, then to the inlet ball 

valve on the truck. Once the hose was secured in place, the ball valve on the truck was to be 

opened first, followed by the ball valve on the hydrant. Water would then flow from the tank to 

the truck under a pressure that varied from 125 -140 psi.

INVESTIGATION

On the day of the incident, the victim was filling the water truck from the hydrant of the 

neighbor’s water tank (Exhibit 1). The victim used a thermoplastic rubber bulk water discharge 

hose with polyethylene helix reinforcementthat was provided with the water truck (Exhibit 2). 

This hose was only designed to withstand a maximum working pressure of 50 psi, which was in 

the range of the normal groundwater supply. He connected the hose to the truck and hydrant, 

then opened the hydrant’s outlet ball valve.Unlike the normal procedure, the victim did not 

open the inlet ball valve on the truck (Exhibit 3). As he was attempting to fill the truck, the hose 

burst and struck the victim, causing him to fall to the ground and strike his head. The safety 

supervisor was walking by the water truck and noticed the victim on the ground. The supervisor

shut the hydrant off and notified another manager who then called 911. The supervisor

performed CPR on the victim until the paramedics arrived and transported him to a local 

hospital. He died from his injuries two days later. 
CAUSE OF DEATH

According to the medical records, the cause of death was skull fracture with intracranial bleed. 

RECOMMENDATIONS

The CA/FACE investigator determined that, in order to prevent similar incidents, employers 

with workers who operate water trucks should:

Recommendation #1: Ensure that the machinery and equipment provided to transfer highpressure water can safely withstand all reasonably anticipated loads.

Discussion: In this incident, the hose used to transfer water from the water tank to the truck

was a thermoplastic rubber bulk water discharge hose with polyethylene helix reinforcement

(Exhibit 4). This type of hose can only withstand a maximum working pressure of 50 psi. A more 

adequate hose would have been an ethylene propylene diene monomer (EPDM) bulk water 

discharge hose with spiral-plied synthetic fabric reinforcement, a vinyl nitrile water discharge 

hose with wire helix reinforcement, or a polyvinyl choloride (PVC) bulk water hose with a rigid 

PVC helix reinforcement. EPDM bulk water discharge hoses are used for pumping water in 

quarries, mines, construction sites, and other abrasive environments and can withstand 

working pressures up to 300 psi. This type of hose was not on the truck and thus not available 

for the victim to use. Had a hose with the proper design been used to fill the truck, pressure 

from the hydrant would not have caused the hose to burst, thereby preventing this incident. 

Recommendation #2: Implement policies and procedures as part of a safety program to 

ensure that unsafe conditions are identified, and safe work practices are followed.

Discussion: In this incident, the victim began transferring water from the hydrant without first 

opening the intake ball valve on the truck. Because this valve was not turned on first, pressure 

in the hose caused it to swell and then burst, knocking the victim to the ground. 

The victim was an experienced seasonal employee and had transferred water safely on 

numerous occasions in the past. However, this type of water transfer was not the typical source 

that was used. The employer had written safety procedures and training that included the safe

transfer of water. Their correct procedure was to first connect the hose to the water tank 

hydrant outlet ball valve, then to the inlet ball valve on the truck. Once the hose was secured in 

place, the ball valve on the truck was to be opened first, followed by the ball valve on the 

hydrant. In this incident, the victim connected the hose to the truck and hydrant, then he 

opened the water tank valve but did not open the valve on the truck. Although the employee 

had received safety training, there was no communication or method to ensure that the proper 

procedure occurred. For example, written check-off sheets and/or periodic and regular safety 

audits with direct observation can be used to ensure that safe work practices are followed. In 

addition, employee safety training should be verified through written testing, oral confirmation, 

or demonstration. If these procedures had been implemented, the victim may have realized 

that the truck valve was not open, and this incident could have been prevented. 
EXHIBITS:

Exhibit 1. The fire hydrant involved in the incident.

Exhibit 2. The hose connected to the water truck.
Exhibit 3. The inlet ball valve on the rear of the water truck.

Exhibit 4. A portion of the hose involved in the incident.

REFERENCES

California Code of Regulations, Title 8, Subchapter 7. General Industry Safety Orders, Group 1.

General Physical Conditions and Structures Orders, Introduction

§3203. Injury and Illness Prevention Program

Group 2. Safe Practices and Personal Protection

Article 7. Miscellaneous Safe Practices

§3328. Machinery and Equipment
___________________________ ___________________________

 Hank Cierpich Robert Harrison, MD, MPH

 FACE Investigator FACE Project Officer

 ___________________________ June 19, 2020 

 Laura Styles, MPH

 Research Scientist

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FATALITY ASSESSMENT AND CONTROL EVALUATION PROGRAM

The California Department of Public Health, in cooperation with the Public Health Institute 

and the National Institute for Occupational Safety and Health (NIOSH), conducts 

investigations of work-related fatalities. The goal of the CA/FACE program is to prevent fatal 

work injuries. CA/FACE aims to achieve this goal by studying the work environment, the 

worker, the task the worker was performing, the tools the worker was using, the energy 

exchange resulting in fatal injury, and the role of management in controlling how these 

factors interact. NIOSH-funded, state-based FACE programs include: California, Kentucky, 

Massachusetts, Michigan, New York, Oregon, and Washington.

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Additional information regarding the CA/FACE program is available from:

California FACE Program

California Department of Public Health

Occupational Health Branch

850 Marina Bay Parkway, Building P, Third Floor

Richmond, CA 94804

www.cdph.ca.gov/face