A FINAL report and recommendations have been handed down following the death of a miner at Cobar last year.
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Jeremy Junk, 41, died after his head struck the underside of a platform while he was being hoisted upwards in an ore bucket about 4.20am on March 16, 2013.
Mr Junk had been working as a supervisor for contractor Macmahon Mining Services at the CSA mine at the time of his death.
The contractor had been undertaking a major shaft refurbishment project at the mine.
The NSW government's Mine Safety Investigation Unit completed an investigation into the incident.
It found the ore bucket (kibble) had been suspended by a single head rope with no guide ropes, allowing it to move sideways freely.
The clearance between the kibble and the kibble well was "relatively small" as it passed though two stage decks, creating "a hazardous nip point" when people were raised in the kibble.
Workers reported Mr Junk extended his head over the side of the kibble to communicate with a shaft worker on the stage.
As the kibble approached the stage's upper platform, workers reported seeing Mr Junk's head impact between the kibble and the upper platform of the stage.
"The principal control measure used on this job to prevent this type of injury appeared to be that people travelling in the kibble must ensure body parts did not extend beyond the confines of the conveyance," the report read.
"This incident highlights the inadequacy of such procedural controls on their own.
"More effective controls, such as elimination of the hazard, substituting, isolating or implementing engineering controls are required wherever reasonably practicable."
Among the recommendations was for there to be adequate clearance for kibbles to eliminate "potential pinch points".
The use of man riding cages instead of kibbles was recommended for use in shafts wherever possible, and workers should be adequately trained in the use and safe operation of all shaft sinking equipment.
A further recommendation was that there be specific signals to identify when people were riding in shaft sinking conveyances.
Factors including fatigue, work hours and human error should also be considered when reviewing shaft sinking risks, it was recommended, along with mine operators ensuring contractors' safety management plans were approved and consistent with their own.