Source · Prevention of Future Deaths

Emma Powell

Ref: 2022-0416Deceased Date: 28 Dec 2022 Coroner: John Gittins Area: North Wales (East and Central) Responses identified: 2 / 2 View PDF

Retailers fail to provide essential safety advice at the point of paddleboard sale, specifically regarding the mandatory wearing of life-saving equipment and appropriate leash usage for varying water conditions.

Date 28 Dec 2022

56-day deadline 22 Feb 2023 est.

Responses identified 2 of 2

Other related deaths Wales prevention of future deaths reports (2019 onwards)

Coroner's concerns

AI summary

View full coroner's concerns

The evidence at inquest indicated that Miss Powell had purchased a paddleboard from Tesco at Llandudno Junction on the evening of the 14th of July 2022, that she had taken it to Conwy Morfa and had thereafter used it in an unsafe manner, whereby she did not wear any life saving equipment and the safety leash on the board was by way of an ankle leash which was inappropriate for the fast flowing water.

The evidence further indicated that at the point of sale, there was no safety advice or guidance provided in relation to either the advisory wearing of a safety vest, or the need to be aware that the positioning of a safety leash should take into account the environment/water conditions where the paddleboard is to be used as per the below information:

Unless action is taken to improve the provision of information to purchasers of paddleboards and/or to regulate the sale of paddleboards to ensure that the provision of advice of this nature becomes a mandatory requirement at the point of retail sale, then there is an ongoing risk that further accidents will occur and that lives may be lost as a result.

Responses

2 respondents

Tesco Other

21 Feb 2023 PDF

Action Taken

Tesco will add a sticker to the front of their paddleboard packaging with safety information and a QR code linking to British Canoeing's website, and will share information with other retailers via the British Retail Consortium's Product Safety Committee. They have made arrangements for stores to receive and affix the stickers to units delivered in 2022. (AI summary)

View full response

Dear Mr Gittins Re. Report for the Prevention of Future Deaths Inquest of Emma Louise Powell 21 February 2023 I am writing on behalf of Tesco Stores Limited (Tesco') in response to your letter dated 28 December 2022 in relation to this matter. First of all, please can I express on behalf of Tesco our sadness at the death of Miss Powell. Tesco work hard to ensure we only sell products that are safe whether that be our own-brand or branded lines and to learn that any of our customers have died whilst using one of our products is very upsetting. Tesco sell two paddleboard products which are branded from a single supplier and are not Tesco lines. We only sell these in a limited number of our large Extra and Superstores that are at waterside' locations. Following your letter (and in fact before we received it, based on the media reports on your Hearing) we have been working with our supplier to review the products and information, including safety warnings, accompanying them. Based on this review, we have concluded that the products are safe and have appropriate instructions. However we have agreed with the supplier that a sticker will be added to the front of the product packaging with the following information: Tesco Stores Ltd, (519500). Company Registered in England. Registered Office: Tesco House, Kestrei Way, Weiwyn Garden City, Hertfordshire, ALl 1GA 1

¯ IMPORTANT PLEASE READ BEFORE USE: Life saving devices such as Life Jackets OR Buoyancy aids should be used at all times and checked before each use. ¯ Contains calf leash. IMPORTANT: not to be used in fast flowing water or where there's a risk of snagging/entrapment. Please note this sticker is currently being designed (we have had to seek the permission of British Canoeing and obtain a high resolution image, both of which we now have), but it will be approximately A5 in size. The sticker will be included on all product units which will be delivered to stores for sale in Spring / Summer 2023. We also have a limited number of units (c. 600) which were delivered to stores in 2022 so do not display the new sticker. Small numbers of these units are currently sold on an ad hoc basis and arrangements have been made for stores to receive and affix the stickers to these units, once the stickers are available. We anticipate stickers being ready for distribution to stores by April 2023. Working with British Canoeing, they have updated the graphic to include a QR code that takes the user to wider safety information on their website. We believe that placing this sticker on the front of each product box is the best way to inform customers of the steps they can take to manage the risk of snap / entrapment, by positioning and/or using a leash appropriate to the environment they paddle in. By securing the sticker on the box, the information is made available to both the customer who purchases the product in-store, and to other users who may not have been in-store but otherwise receive the product after the point of sale. We have also agreed to share information about what we have done and the support we have received from British Canoeing with other retailers via the British Retail Consortium's Product Safety Committee. Regards Technical Director, Home & Clothing For and on behalf of Tesco Stores Limited Tesco Stores Ltd, (519500). Company Registered in England. Registered Office: Tesco House, Kestrel Way, Weiwyn Garden City, Hertfordshire, AL7 1GA 2

Department for Business Trade Central Government

24 Mar 2023 PDF

Action Planned

The Department for Business and Trade has referred the report to Hertfordshire Trading Standards, asked the Office for Product Safety and Standards (OPSS) to write to the British Retail Consortium and major retailers, liaise with enforcement partners and manufacturers, and write to the British Standards Institute to consider industry standards relating to paddleboards. (AI summary)

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Dear Mr Gittins,

INQUEST INTO THE DEATH OF EMMA LOUISE POWELL

Thank you for your Regulation 28 Report (Prevent Future Deaths), dated 28 December 2022, following your investigation and inquest into the death of Emma Powell, caused by submersion in water while using a recently purchased paddleboard.

The Report was sent to the Prime Minister’s Office at No10 Downing Street and was subsequently redirected to me to respond as the Minister responsible within the Department for Business and Trade. I apologise for the delay in responding.

I would first like to say how deeply saddened I was on hearing of this tragic death. If you have an opportunity, please pass on my condolences to Miss Powell’s family.

I would like to assure you that the Government is committed to ensuring that the UK has a product safety system designed to provide a high level of protection. This applies to the purchase of any consumer product, including paddleboards such as the type involved in this tragic incident. The findings of your inquest provide an opportunity to assess whether further lessons can be learned.

The regulations that apply to paddleboards are dependent upon a number of factors, including the length of the paddleboard and its intended use. The two sets of regulations that could apply are the General Product Safety Regulation 2005 (GPSR), and the Recreational Craft Regulations 2017 (RCR).

Manufacturers of products such as paddleboards are under an obligation to place only safe products on the market (Regulation 5 of GPSR). They must also provide safety information to enable consumers to assess risks that are not immediately obvious without adequate warnings and to take precautions against those risks (Regulation 7 of GPSR). Distributors have a duty of care to ensure that products they offer for sale comply with the law; are safe; and to pass on information on the risk posed by the product (Regulation 8 of GPSR).

Similarly, under the RCR manufacturers are required to ensure products do not endanger the health and safety of persons when used as intended (Regulation 6 of RCR). As with the

GPSR, distributors have a duty of care to ensure the product complies with the law; specifically that it is safe (Regulation 27 of RCR); and is accompanied by any instructions provided by the manufacturer on their safe use (Regulation 28 of RCR).

Under both sets of regulations, when sold, a product should therefore include information on ‘how’ it is to be used safely as you suggest. We know that, separately to this incident, some manufacturers are printing safety information on the paddleboard to help ensure the information is always readily available when using the product. This is a welcome step by manufacturers.

Your Report states that there was no evidence that there was advice or instruction given at the point of sale on the safe use of the product. As stated above there are obligations and duties on both manufacturers and distributors to ensure adequate advice is provided. I have therefore referred your Report to Hertfordshire Trading Standards, the Primary Authority responsible for the regulatory relationship with Tesco, so that they may decide if any further action is needed in addition to that already taken in this specific case.

I have also asked the Office for Product Safety and Standards (OPSS) to write to the Business Reference Panel, that includes the British Retail Consortium and a number of major retailers, such as Tesco, to ensure that distributors are aware of this issue and their obligations.

In addition, I have asked OPSS to liaise with their enforcement partners, and through them where appropriate manufacturers, to ensure that there is awareness of this incident so that if necessary appropriate action can be taken.

Finally, OPSS will also write to the British Standards Institute so that they may consider whether the industry standards relating to paddleboards remain appropriate.

I am copying this response to Tesco PLC, Hertfordshire County Council Trading Standards, and the Prime Minister’s Office at No10.

Thank you again for bring this issue to my attention.

Report sections

Investigation and inquest

On the 16th Of July 2022 I commenced an investigation into the death of Emma Louise Powell (DOB 22.10.97 DOD 15.7.2). The investigation concluded at the end of the inquest on the 8th of December 2022. The conclusion of the inquest was that the death was the result of an accident, the cause of Miss Powell’s death being recorded as 1(a) Immersion

Circumstances of the death

The circumstances of the death are as follows : On the 14th of July 2022 at Conwy Morfa, the deceased got into difficulties whilst paddleboarding. The current of the Spring tide resulted in her being unable to make her way to safety and she was recovered from the water after being submerged for a period in excess of ten minutes. She was taken to Ysbyty Gwynedd where her death was confirmed shortly after midnight on the 15th of July.

Similar PFD reports

Shared signals

Related inquiry recommendations

Report details

Reference: 2022-0416Deceased
Date of report: 28 December 2022
Coroner: John Gittins
Coroner area: North Wales (East and Central)

Responses identified

Responses identified 2 of 2

All listed responses identified

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 22 Feb 2023 (estimated).

Sent to

Prime Minister’s Office

Tesco PLC

Source links

Judiciary.uk page → Report PDF →

Data: judiciary.uk under OGL.