A newly published Health and Safety Executive prosecution report offers a stark reminder that a guard only protects people if it prevents access to the danger zone.
The incident itself happened on 24 June 2020. A production operative at an aggregates depot in Dagenham was drawn into a bag-flattening compression conveyor and later died from his injuries. HSE found that an opening measuring about 600mm by 335mm in fixed guarding allowed access to the moving parts.
The fresh development is the court outcome. On 28 September 2026, Gill Aggregates Ltd was fined £24,000 and ordered to contribute £43,000 towards costs after pleading guilty to breaching regulation 11(1) of the Provision and Use of Work Equipment Regulations 1998. HSE published its report the following day.
The case concerns one machine and one company; it does not establish that every conveyor or older item of plant has the same defect. It does show why a visual check for the presence of a guard is insufficient. The practical question is whether anyone can reach a dangerous part during normal work or a foreseeable intervention.
1. Map every danger zone
Start with the task, rather than the machine’s outer shape. Identify where someone could be drawn in, trapped, crushed, cut or struck during operation. Include belts, rollers, shafts, chains, gears, pulleys, intakes and discharge points.
Then assess every foreseeable state: starting, stopping, setting, cleaning, clearing a blockage, sampling material, adjusting, fault-finding and maintenance. Walk around the equipment and consider access from the rear, underneath, from adjacent platforms and through openings used for materials.
Involve the people who operate and maintain the machine. They usually know where material accumulates, which faults recur and where access is awkward. Record the hazard and the control for each intervention instead of relying on a general instruction to “keep clear”.
2. Apply the guarding hierarchy
HSE’s machinery guidance follows the hierarchy in PUWER regulation 11. Fixed guards should enclose dangerous parts wherever practical. If fixed guarding is not practical because routine access is required, suitable interlocked guards or other protection devices may be needed. Jigs, holders or push sticks come later in the hierarchy, followed by information, training, supervision and protective equipment for residual risk.
That order matters. A warning sign, emergency stop or experienced operator does not replace effective guarding where fixed enclosure is practical.
Check that guard material is suitable for the environment and that mesh sizes and openings do not permit reach to moving parts. A transparent panel may improve visibility, but it still needs enough strength and durability for the duty.
3. Inspect the complete protective system
A guard can be present and still fail. Look for missing panels, enlarged openings, loose fixings, distortion, corrosion, impact damage and gaps created by later modifications. Check where cables, chutes and pipework pass through the enclosure.
Where interlocked guards or trip devices are used, arrange the required inspection and functional testing by a competent person. Verify that the dangerous movement stops before anyone can reach it and that the machine cannot restart unexpectedly when the guard closes.
Record defects and prevent use until the machine is safe. A temporary instruction to avoid a gap is not a lasting repair.
4. Isolate every energy source
Stopping at a control panel is not necessarily isolation. Before cleaning, adjustment, unblocking or maintenance, identify all sources of energy: electrical, hydraulic, pneumatic, mechanical, thermal and gravitational.
HSE advises stopping movement, isolating power, locking off where reconnection is possible, releasing stored pressure and supporting parts that could fall. Mobile plant may also need neutral selected, brakes applied and wheels chocked. Attachments or components supported by hydraulics need suitable mechanical support before anyone works beneath them.
The person doing the work should understand which isolator controls which equipment. Labels, personal locks and a documented isolation procedure reduce the chance that somebody elsewhere restarts the wrong line.
5. Plan for blockages and recurring faults
Blockages create pressure to restore production quickly. They can also hold compressed material or stored energy that releases when the obstruction moves.
Write a machine-specific method before the next blockage occurs. It should identify who is authorised to intervene, the safe-stop and isolation sequence, suitable tools, access arrangements and the conditions requiring specialist help.
Investigate recurring jams rather than normalising repeated intervention. The cause could involve feed rate, material condition, wear, alignment, guarding design or another fault. Any change to the machine, its software or its safe system of work should be assessed and recorded by competent people.
6. Control the return to service
Restart deserves its own check. Confirm that the work is complete, tools and temporary supports have been removed, guards are refitted and secured, safety devices are functioning and everyone is clear.
Where several people or contractors are involved, nominate one person to control handback. They should verify that each worker has finished and that locks are removed through the agreed procedure. Never remove another person’s lock simply to speed up production unless a formal, authorised process deals safely with that exceptional situation.
Use a controlled test from a position of safety. Stop again if there is unexpected movement, noise, vibration, leakage or a failed protective device.
7. Close every defect report
Operators need a clear way to report missing guards, unreliable interlocks, damaged isolators and other faults. They also need authority to stop and secure unsafe equipment without pressure to keep it running.
A useful defect record states what was found, when the machine was taken out of service, who owns the repair and what evidence is required before release. Close the report only after a competent person has confirmed the control is effective.
Review lessons across similar equipment. One enlarged opening, bypassed interlock or poor isolation label may indicate the same weakness elsewhere in the fleet or site.
A short pre-start review
Before machinery returns to work, confirm:
- dangerous parts cannot be reached through or around guards;
- fixings, interlocks, trips and emergency controls are intact and tested as required;
- isolation points are identified, accessible and capable of being secured;
- stored energy and falling parts are controlled;
- cleaning, adjustment and blockage procedures match the actual machine;
- operators and maintainers are trained for their roles; and
- defects, repairs, inspections and handback are recorded.
This checklist cannot replace a suitable risk assessment, the manufacturer’s instructions or competent engineering advice. Its value is in prompting a physical test of the safeguards before work resumes.
For farms, rural contractors, workshops and plant businesses, the commercial case sits alongside the legal and human one. Proper guarding and planned isolation reduce the chance of catastrophic injury, unplanned shutdown, damaged equipment and disrupted work. The standard is not whether a guard is visible. It is whether the complete system keeps people out of danger during every foreseeable task.
Sources
HSE: Aggregates company fined after worker killed in conveyor crush - published 29 September 2026
HSE: Maintenance of work equipment - updated 19 November 2024
HSE: Introduction to machinery safety - updated 19 November 2024
HSE: Providing and using work equipment safely - published 2013; page updated 7 August 2025
