RISK BASED PSM PROCESS SAFETY MANAGEMENT INDIA CONSULTANT INCIDENT INVESTIGATION HAZOP TRAINING ROOT CAUSE ANALYSIS AND LESSONS FROM INCIDENTS
On November 17, 2005, Employee #1 and other employees noticed a plugged drain. The employee poured an undetermined amount of Red Devil Lye Drain Cleaner into the drain. A violent splash back deposited sodium hydroxide onto Employee #1 and the nearby surroundings. The employee was wearing his personal protective eyeglasses. Employee #1 suffered chemical burns on his head. The employee was hospitalized.
Source: OSHA.gov
On August 1, 2007, Employee #1 was working as a Sampler in East Palo Alto. He was opening sealed 55-gallon metal drums containing flammable liquid which had been received in a batch of 12 metal drums on July 26, 2007. The drums had to be sampled to verify whether the waste received was consistent with information on the manifest and the waste profile the facility kept on its records.
The Drum Sampling Area was located adjacent to the North Drum Storage Area, which was designated for storage of waste solvents and organic wastes. An air hose was available to be used with an impact wrench .The pneumatic impact wrench (air gun) was equipped with an attachment to open the bung on the drum and weighed approximately 7 pounds.
At approximately 8:30 a.m., Employee #1 had lined up all the 12 drums and put sampling jars on top of each drum, while the Production Manager and several other workers were standing nearby, chatting. Employee #1 was wearing his full-facepiece respirator, gloves, rubber apron and Tyvek over his long sleeve uniform and long sleeve T-shirt. After opening four or five drums using the air gun, he attempted to open the next drum, which did not show any indication of bulging or deformity. As soon as the air gun hit the bung, the drum burst open in flames. The accident was most likely caused by the mechanical sparks created from the impact of the air gun with the drum bung, which ignited the flammable vapors released from the drum. The exploding drum hit Employee #1 in the stomach area and engulfed him in flames. His clothes caught on fire. Employee #1 started running up the aisle, where he was spotted by the Production Manager, who rolled him down on the ground to put out the flames on his clothes. Another employee sprayed him with a Class D fire extinguisher. Employee #1 was taken to Stanford Medical Center Emergency Room by paramedics, where he was treated for first- and second-degree burns on his right ear.
Source: OSHA.gov
"After a series of highly publicized operator errors at its Cleveland plant, a chemical manufacturer, installs a software based control system to prevent accidental releases of toxic substances. The system relies on a machine learning model trained on millions of hours of operating data from their facilities. Using sensor data from the plant, the model can identify when it is safe to open the plant’s exhaust vents. Thanks to its extensive “experience,” the model adapts seamlessly to process changes and physical modifications within the complex plant, which were blamed for confusing human operators in the past. The new
software system proves highly reliable and becomes a trusted tool within the company. Months later, a windstorm disrupts several of the plant’s sensors. Based on the flawed sensor input, the
control system continues to read “safe,” and the plant operators act accordingly, leaving the vents open, even as managers elsewhere in the plant begin an unscheduled production run in response to an urgent customer request. The run produces a cloud of lethal chlorine gas, which escapes through the open exhaust vents and drifts toward downtown."
Source: https://cset.georgetown.edu/publication/ai-accidents-an-emerging-threat/
Interesting article Ai in PSM- adouble edged sword for PSM
https://www.leancompliance.ca/post/ai-in-psm-a-double-edged-sword-for-process-safety-management
At 6:45 p.m. on October 28, 2021, an employee was circulating a tank of hydrogen sulfide when a burner box, which was 15 feet away, was turned on and the hydrogen sulfide that was in the atmosphere ignited. The employee was hospitalized to treat second and third-degree burns to his hands and face.
Source: OSHA.gov
"On or about January 28, 1993, Employee #1, a contract welder, was repairing and replacing flanges on storage tanks in order to install a closed ventilation system. The storage tanks contained sodium sulfide, which reacts with acid to generate hydrogen sulfide gas. This highly flammable gas accumulated in a vapor space. Prior to the accident, a tank flashed while being cut or welded into by the employee. When a lighted torch was brought in proximity, the tank ruptured. Employee #1 died. Employee #2 had gone up on a tank to tell Employee #1 not to cut into the tank when the tank exploded. Employee #2 was hospitalized."
Source: OSHA.gov
"At 10:30 a.m. on September 30, 2019, an employee was performing maintenance on a storage tank battery for oil and gas operations support. The employee was on a crew which was working on a line which was not pressurizing properly. As the employee was working on the line, the pop off valve relieved causing the employee to be struck by released hydrogen sulfide. The employee fell off the tank, rupturing his kidney and fracturing his left fibula and right hip. The employee was hospitalized".
Source: OSHA.gov