Incidents unsafe

The state of lack of control is characterised by the presence of deviations in the system. These are events or conditions that depart from the norm for the faultless or planned processes of the system. In the accident research literature, we find different terms used to illustrate the concept of deviation such as critical incident , unsafe act , unsafe condition , disturbance . Various types of norms appear in the literature ... 

Damage incident Unsafe event, which only resulted in some kind of damage. 

An LTI is a lost time incident, mentioned earlier as an accident which causes one or more days away from work. A non-LTI injury does not result in time away from work. A near hit (often called a near miss) is an incident which causes no injury, but had the potential to do so (e.g. a falling object hitting the ground, but missing personnel). An example of an unsafe act would be a poorly secured ladder, where no incident occurs, but which potentially could have been the cause of an incident. 

Process Safety Considerations. Unit optimization studies combined with dynamic simulations of the process may identify operating conditions that are unsafe regarding fire safety, equipment damage potential, and operating sensitivity. Several instances of fires and deflagrations in ethylene oxide production units have been reported in the past (160). These incidents have occurred in both the reaction cycle and ethylene oxide refining areas. Therefore, ethylene oxide units should always be designed to prevent the formation of explosive gas mixtures. 

It is hoped that this volume will provide some guidance to operators, plant safety engineers and designers, and that some of the design practices are adopted particularly in older plant operations that do not apply proper pressure let down procedures and flaring practices. Many unsafe operations and even catastrophic failures have been observed by the author in overseas assignments to such countries as Ukraine and other Newly Independent States (NIS) in older plant designs. These incidents have prompted the preparation of this reference. 

We will not comment on why workers fail to report, but continue to believe that documentation of potential problems, unsafe conditions, and especially near misses (or more accurately referred to as near hits ) are important in the prevention of incidents at all types of sites. 

As vent collection systems normally contain vapor/air mixtures, they are inherently unsafe. They normally operate outside the flammable range, and precautions are taken to prevent them from entering it, but it is difficult to think of everything that might go wrong. For example, an explosion occurred in a system that collected flarmnable vapor and air from the vents on a number of tanks and fed the mixture into a furnace. The system was designed to run at 10% of the lower explosion limit, but when the system was isolated in error, the vapor concentration rose. When the flow was restored, a plug of rich gas was fed into the furnace, where it mixed with air and exploded [17]. Reference 34 describes ten other incidents. 

According to the AMC News article authorities summed up the report by pointing out that the incident was not the direct result of normal operations, but rather was the result of an unusual condition, and that the design and operating procedures were not unsafe when considered in the context of the total hazardous environment. The process in the nitration and purification building was operating normally when the rubber hose was introduced into the system. 

Chemical Exposure Index (CEI) (Chemical Exposure Index, 1994 Mannan, 2005, pp. 8/22-8/26.) The CEI provides a method of rating the relative potential of acute health hazard to people from possible chemical release incidents. It may be used for prioritizing initial process hazard analysis and establishing the degree of further analysis needed. The CEI also may be used as part of the site review process. The system provides a method of ranking one risk relative to another. It is not intended to define a particular containment system as safe or unsafe, but provides a way of comparing toxic hazards. It deals with acute, not chronic, releases. Flammability and explosion hazards are not included in this index. To develop a CEI, information needs include... 

Incident Safety Officer The incident safety officer is a position mandated by Occupational Safety and Health laws. He/she is attached to the incident commander, and should be the person with the most knowledge about the various safety aspects at a hazardous materials scene. As provided under OSHA law, the incident safety officer has the power and authority to alter, suspend, or terminate the operation when, in his/her opinion, the conditions are unsafe. 

Liability is an issue without clear boundaries. An incident that occurs in one country may be raised in litigation in another country to show a pattern of unsafe conditions or lack of management follow-through on the experience. Even when liability is clearly absent, opponents of a company can use reports to sway public opinion. Possible solutions include ... 

The incident scene is sometimes a desirable location for the interview. When the interview is conducted at the incident scene, it will seem less like an interview and more like an informal discussion this will help to relax the witness. The visual cues at the incident scene may help the witness to remember information. The witness will also have something to do during the interview, walking around and pointing out equipment, which will put him more at ease so he will tend to talk more. There is also a great deal of information that the witness will commimicate at the incident scene that they may not otherwise think to tell the interviewer, for example, the distance between a valve and indicator. However, there are some reasons not to conduct the interview at the accident scene. They include the potential distractions at the scene such as other personnel, repair activities, demolition activities, the presence of other potential witnesses, unsafe conditions. In addition, poor weather can also be a problem. Finally, the accident scene may be too emotionally painful for the witness, especially if a friend of the witness was injured or killed. 

Some investigators review each of the causal factors to determine the immediate causes (unsafe acts or rmsafe conditions) of the incident, as an... 

A broad spectrum of diseases in children are known (or suspected) to be associated with unhealthy environments. For much of the world, traditional environmental health hazards continue to remain the primary source of ill-health. These include lack of adequate nutrition, poor sanitation, contaminated water, rampant disease vectors (e.g. mosquitoes and malaria), and unsafe waste disposal. In addition, rapid globalization and industrialization coupled with unsustainable patterns of production and consumption have released large quantities of chemical substances into the environment. Although the term environmental exposure can encompass a variety of factors, the focus of this document is specifically on environmental chemical exposures. Most of these substances have not been assessed for potential toxicity to children, nor have the most vulnerable subpopulations of children been identified. The incidence of a number of important paediatric diseases and disorders (e.g. asthma, neurobehavioural impairment) is increasing in several parts of the world. Although a variety of factors are likely to be involved, this may be due, in part, to the quality of the environment in which children live, grow, and play. 

Standard operating procedures serve several purposes. Foremost, they require that the process be thoroughly planned, all known safety procedures be incorporated, and the operation made as independant as possible of personnel changes. In the event of an incident they aid in pinpointing the step responsible for the accident (i.e. it helps identify the unsafe act). In the event of injury or loss of equipment, it serves as a legal document to show that all known precautions were employed. It serves as a teaching aid for new employees. 

The description of less severe incidents (i.e., below the threshold for inclusion in a lagging metric), or unsafe conditions that activated one or more layers of protection. Although these events are actual events (i.e., a lagging metric), they are generally considered to be a good indicator of conditions that could ultimately lead to a severe incident. 

Serious process safety incidents involving loss of life, serious injury, or property damage are often preceded by multiple less-serious incidents or near misses as well as recurring unsafe behaviors or insufficient operating discipline. Process safety metrics are established, collected, and acted upon to help companies and... 

Commonly reported near misses include such events as exceeding operating limits, a release of a chemical or other hazardous substance that does not meet the threshold for a process safety incident metric, activation of relief valves, interlocks, or ruptured disks. Companies may establish near-miss metrics based on the specifics of their operation, based on their observations of frequent upsets or failures, or to track and correct observed unsafe practices or behaviors. 

In addition to differentiating among the severity of a metric (incident, near miss, unsafe behavior), a metric can track activities (whether an action occurs) as well as the outcome (the quality or performance) of the action. 

Percentage of near misses and incidents identified as being caused by unsafe acts or shortcuts X ... 

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