RISK BASED PSM PROCESS SAFETY MANAGEMENT INDIA CONSULTANT INCIDENT INVESTIGATION HAZOP TRAINING ROOT CAUSE ANALYSIS AND LESSONS FROM INCIDENTS
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March 30, 2018
March 27, 2018
March 24, 2018
March 22, 2018
March 18, 2018
Ghosts of Bhopal?
In
a CSB investigation report about a Nitrous oxide explosion in 2016 that
killed an employee, the following causes were listed in the report.
Many of the causes identified by the CSB are identical to the causes of
the Bhopal gas disaster in 1984. Can you identify some of them?
1. XXXXXX did not evaluate inherently safer design options that could have eliminated the need for the pump;
2. XXXXXX never evaluated its process to identify and control process safety hazards;
3. XXXXXX did not effectively apply the hierarchy of controls to the safeguards that the company used to prevent a possible nitrous oxide explosion;
4. XXXXXX installed equipment that increased the likelihood of an explosion without performing a management of change safety review;
5. XXXXXX did not apply an essential industry safety instrumentation standard, or key elements of a voluntary safe storage and handling standard, both of which are intended to prevent nitrous oxide explosions;
6. XXXXXX safeguards that failed to prevent the explosion include an automatic shutdown safety control and an explosion prevention device;
7. The automatic shutdown safety control XXXXXX relied on required the XXXXXX worker to be physically present – and located immediately adjacent to the trailer truck – in order to bypass the shutdown at a time when an explosion was most likely to occur; and
8. The XXXXXX explosion prevention device – a flame arrestor – was never tested or inspected to ensure it could protect workers from an explosion.
9. XXXXXX failed to apply lessons from previous nitrous oxide explosions; and
10. XXXXXX did not provide its Cantonment facility with an appropriate level of technical staffing support.
1. XXXXXX did not evaluate inherently safer design options that could have eliminated the need for the pump;
2. XXXXXX never evaluated its process to identify and control process safety hazards;
3. XXXXXX did not effectively apply the hierarchy of controls to the safeguards that the company used to prevent a possible nitrous oxide explosion;
4. XXXXXX installed equipment that increased the likelihood of an explosion without performing a management of change safety review;
5. XXXXXX did not apply an essential industry safety instrumentation standard, or key elements of a voluntary safe storage and handling standard, both of which are intended to prevent nitrous oxide explosions;
6. XXXXXX safeguards that failed to prevent the explosion include an automatic shutdown safety control and an explosion prevention device;
7. The automatic shutdown safety control XXXXXX relied on required the XXXXXX worker to be physically present – and located immediately adjacent to the trailer truck – in order to bypass the shutdown at a time when an explosion was most likely to occur; and
8. The XXXXXX explosion prevention device – a flame arrestor – was never tested or inspected to ensure it could protect workers from an explosion.
9. XXXXXX failed to apply lessons from previous nitrous oxide explosions; and
10. XXXXXX did not provide its Cantonment facility with an appropriate level of technical staffing support.
March 15, 2018
PGS 29: New risk-based Dutch regulations for storage terminals
PGS 29: New risk-based Dutch regulations for storage terminals: Alwin van Aggelen, CEO of A-Risc, explains how terminals can deal with new scenario analyses and risk assessment requirements for PGS 29
March 12, 2018
March 9, 2018
March 5, 2018
Fatal accident while repair of insulation on ammonia storage tank
A fatal accident occurred in 2015 when workers were weatherproofing the outer layer of a large ammonia tank, when a piece of equipment struck the tank’s valve,
which caused an ammonia leak that killed one worker.
This accident highlights the need to ensure that proper job safety analysis is carried out especially when working with ammonia tanks.
This accident highlights the need to ensure that proper job safety analysis is carried out especially when working with ammonia tanks.
March 1, 2018
And then there is a fatality!
How many of you have experienced good safety records when suddenly a
fatality occurs in a non process area? Well, you have? The management of
Process Safety and Occupational Health and Safety in a chemical plant
have a few common elements like incident investigation, work permits,
training, emergency planning and response etc. However there is one most
important underlying foundation for both- it is a good safety culture.
Recently, a large chemical plant experienced two fatalities within a
span of two months. Both the fatalities were not in a process area
(covered process as defined in PSM) but were road accidents within the
factory complex. One of them could have been prevented if the driver was
wearing a seat belt. I had visited the plant a month before the fatal
road accident (driver without seat belt) and had observed that in the
township (where employees reside) of that plant, many of the staff were
not wearing crash helmets when riding a two wheeler or were not buckling
up when driving a car. This is the problem. You cannot throw away your
rules just because you have come out of the factory and entered the
township! Safety Culture should be developed assiduously by management
both in and outside the plant. Breaking safety rules outside a plant
will carry the same behavior inside the plant and other employees will
start emulating this. After a fatality, there is always a lot of
introspection, but don't forget the basics - Management staff must walk
the talk both inside and outside the plant. Plain and simple.