Fatal incident involving gas water heater

Energy type:

LPG

Event summary:

WorkSafe Energy Safety was alerted to the carbon monoxide poisoning of a 12 year old boy through its media monitoring service. The newspaper article said he was overcome by fumes from a gas water heater in a shower unit.

Accident ID:

181013-04

Accident date:

10 October 2018

Site:

Domestic

Environment:

Building

Voltage:

N/A

Equipment:

Water heater instantaneous

Accident type:

Carbon monoxide poisoning

Casualty:

Fatality

Injury:

Asphyxiation

Property damage level:

No property damage

Outcome of investigation:

There were three elements that led to the fatal CO poisoning:

The unlawful action of installing an open flued gas appliance (water heater) in a prohibited space such as a bathroom.
The unlawful omission of failing to provide adequate fixed ventilation in a space when installing an open flued gas appliance.
The operation of a ventilation system that created negative pressure in an inadequately ventilated space.

These three elements led to a situation where the flame became starved of oxygen (vitiated) which led to a rapid build-up of carbon monoxide in the shower cubicle. The removal of any one of these elements may have prevented the incident.