Scenario

01. Organizational Problems
02. Poor Management
03. Slackness of Management
04. Poor Value Perception
05. Poor Safety Awareness
06. Insufficient Safety Measure
07. Insufficient Analysis or Research
08. Insufficient Prior Research
09. Insuficient Study of Impurities
10. Planning and Design
11. Poor Planning
12. Poor Design
13. Usage
14. Maintenance/Repair
15. Obsevation
16. Bad Event
17. Chemical Phenomenon
18. Abnormal Reaction
19. Failure
20. Large-Scale Damage
21. Rapture
22. Bodily Harm
23. Death
24. Bodily Harm
25. Injury
26. Loss to Organization
27. Economic Loss

Rupture of a vacuum distillation drum for 4-chloro-2-methylaniline caused due to air leakage and misjudgment
Case Details

Knowledge Comment:
Unexpected situation may occur at the new development technology. Co-operation of scientist, engineer and workes in all cathegories is needed.

Field Chemicals and Plants
Author OGAWA, Terushige (Graduate School of Environment and Information Sciences, Yokohama National University)
TAMURA, Masamitsu (Center for Risk Management and Safety Sciences, Yokohama National University)