On November 14, 2018, a 60-year-old male municipal sanitation worker, who was on the exterior riding step of a refuse collection truck that was backing up, was crushed against a parked lawn service truck and then run over by the refuse collection truck. The decedent was employed by a town sanitation department. He was a helper on a three-men refuse collection crew consisting of two helpers and a driver who was the crew chief. On the day of the incident, the crew was doing residential curb-side pickups along a designated route. At approximately 2:30 p.m., the crew arrived at the last street of their collection route. The truck was to back approximately 0.34 miles all way to the end of the street before moving forward for the helpers to pick up garbage on right side of the street. While the truck was backing, the two helpers were riding on the riding steps. There was an SUV parked on the driver's side of the street, and a lawn service truck with a trailer parked on the right side of the street. The refuse collection truck backed approximately 330 feet and passed the SUV. When the driver was trying to back past the lawn service truck, his right-side mirror contacted the lawn service truck, and the impact broke the mirror. Due to the broken mirror, the driver could not see the right rear side of the truck where the decedent was riding. The driver continued backing and felt his truck contact the lawn service truck. He stopped and drove forward to pull away. According to the eyewitness, the victim was pinned and crushed in between the lawn truck and the refuse collection truck. As the refuse collection truck pulled away, the decedent fell to the ground, and he was subsequently run over by the rear right tire of the refuse collection truck. The crew member immediately called 911 and the Emergency Medical Services responded within minutes. The injured worker died on route to the hospital. The cause of death was hemorrhage due to blunt force torso trauma. CONTRIBUTING FACTORS - Occupational injuries and fatalities are often the result of one or more contributing factors or key events in a larger sequence of events. The NY FACE investigation identified the following key contributing factors in this incident: 1) Employees were on the riding steps of a refuse collection truck while it was backing up. 2) With an SUV parking on one side and a lawn service truck parking on the other side of the street, the total backing clearance for the refuse collection truck was estimated at approximately five feet, or 2.5 feet on each side of the refuse collection truck. 3) The exterior right-side mirror was broken due to the refuse collection truck contacting the lawn service truck. 4) The refuse collection truck driver could not see his right rear side where the decedent was riding due to the broken mirror. 5) Employer did not address frequent incidents of employee violation of safety requirements when using the riding steps. 6) The progressive disciplinary program was not followed through. 7) There was no refuse collection safety training four years prior to the fatal incident. RECOMMENDATIONS - NY FACE investigators concluded that, to help prevent similar occurrences: 1) Employers should consider prohibiting the practice of riding refuse collection truck riding steps by removing these steps. 2) Employers should conduct incident investigations to identify risk and contributing factors and develop specific prevention measures. 3) Employers should provide employee training to ensure that workers understand the hazards associated with riding on the riding steps of refuse collection trucks and safety rules. 4) Employers should conduct job hazard analysis (JHA) to identify hazards and risk factors and develop effective measures to prevent worker injuries associated with refuse collection truck riding steps. 5) When implementing a progressive disciplinary program, employers should ensure that appropriate disciplinary actions are carried out and followed through. 6) Employers should ensure that the riding steps are inspected regularly, and damaged steps are repaired immediately. 7) Employers should consider implementing an automated system for refuse and recyclable material collection. 8) In-depth studies should be conducted to assess the effectiveness of the current safety regulations on refuse collection truck riding steps.