Prevention of Future Deaths reports · 2021

Christopher Taylor

Regulation 28 report to prevent future deaths, reference 2021-0175, written 25 May 2021. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report25 May 2021
Reference2021-0175
DeceasedChristopher Taylor
CoronerPaul Smith
Coroner areaLincolnshire
CategoryRoad (Highways Safety) related deaths
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

Paul D SMITH
HM Acting Senior Coroner
County of Lincolnshire

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:

1. Driver and Vehicle Standards Agency

CORONER

I am Paul D SMITH HM Acting Senior Coroner for the coroner area of Lincolnshire, 4 Lindum Road,
Lincoln, Lincolnshire, LN2 1NN.

CORONER’S LEGAL POWERS

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and
regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.
http://www.legislation.gov.uk/ukpga/2009/25/schedule/5/paragraph/7
http://www.legislation.gov.uk/uksi/2013/1629/part/7/made

INVESTIGATION and INQUEST

On 30/06/2020 I commenced an investigation into the death of Christopher Lloyd TAYLOR, aged
49. The investigation concluded at the end of the inquest on 13/04/2021. The conclusion of the
inquest was that Christopher Lloyd TAYLOR died as a result of Road Traffic Collision, the medical
cause of death being:

1.

2.

3.

Pelvic and upper leg injuries sustained in a road traffic collision

1a.
1b.
1c.
2.

4.

CIRCUMSTANCES OF THE DEATH

1. Mr Taylor was a keen recreational cyclist and on the afternoon of 15 June 2020 was riding his
cycle on the U130, a minor rural road running between the villages of Kingthorpe and Apley
near to Wragby, Lincolnshire.

2. The road was of tarmac construction and was wide enough for only a single vehicle. There were

no road markings. The carriageway way was bordered by a large overgrown hedge.

3. At a point near to 'Glad Wood' the carriageway turned through 90 degrees to the left for Mr

Taylor.

4. As Mr Taylor entered the bend he encountered an agricultural crop sprayer approaching from

the opposite direction. Visibility through the bend was limited and the evidence suggested that
the two vehicles would only have been visible to each other for a matter of seconds.

5. Mr Taylor braked fiercely, falling from his cycle onto the ground where he was run over by the

wheels of the crop sprayer causing fatal injuries.

6. The evidence suggested that Mr Taylor was not seen by the driver of the crop sprayer prior to

the collision.

5.

CORONER’S CONCERNS

1

 Paul D SMITH
HM Acting Senior Coroner
County of Lincolnshire

During the course of the inquest the evidence revealed matters giving rise to concern. In my opinion
there is a risk that future deaths will occur unless action is taken. In the circumstances it is my
statutory duty to report to you.

The MATTERS OF CONCERN are as follows. –

(i) The driver of the crop sprayer sat in a cab at the front of his vehicle.
view of the road with full length windows to the front and both sides.

It provided an elevated

(ii) Directly in front of the driver was a steering wheel and an A pillar at each front corner of the

cab.

(III) To the right hand A pillar there was affixed a flat screen monitor. That was for use only when

the crop sprayer was being used for agricultural purposes.

(IV) A police reconstruction established that the presence of the screen fixed created a 'blind-spot'

in the drivers field of view extending several metres in depth.

(v) The driver of the crop sprayer had not seen the cyclist approach throughout the limited time he

would have been in view. On balance that occurred directly as a consequence of the
presence of the screen.

(vi) The screen had no function at all whilst the vehicle was being driven on the public highway

and did not need to be on a fixed mounting.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and I believe you AND/OR your
organisation have the power to take such action.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report, namely by
20/07/2021. I, the coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken, setting out the
timetable for action. Otherwise you must explain why no action is proposed.

6.

7.

8.

COPIES and PUBLICATION

I have sent a copy of my report to the Chief Coroner and to the following Interested Persons

a)
b)
b) Lincolnshire Police

I am also under a duty to send the Chief Coroner a copy of your response.

The Chief Coroner may publish either or both in a complete or redacted or summary form. He may
send a copy of this report to any person who he believes may find it useful or of interest. You may
make representations to me, the Coroner, at the time of your response, about the release or the
publication of your response by the Chief Coroner.

Date: 25/05/2021

 Paul D SMITH
HM Acting Senior Coroner
County of Lincolnshire

Paul D SMITH
HM Acting Senior Coroner

3

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