Scenario

01. Insufficient Analysis or Research
02. Insufficient Practice
03. Lack of Imagination
04. Poor Value Perception
05. Poor Safety Awareness
06. Inseufficient safety measure
07. Planning and Design
08. Poor Planning
09. Poor Design
10. Usage
11. Maintenance/Repair
12. Wrong heat insulation
13. Failure
14. Large-Scale Damage
15. Leakage
16. Secondary Damage
17. External Damage
18. Fire

Fire of leaked oil from a heat exchanger caused due to slow action of an emergency cut-off valve at a fluidized catalytic cracking unit
Case Details

Knowledge Comment:
Remote control valve for emergency use must be reqired quick action. The required quickness is a function of the viscosity.

Field Chemicals and Plants
Author DOBASHI, Ritsu (School of Engineering, The University of Tokyo)
TAMURA, Masamitsu (Center for Risk Management and Safety Sciences, Yokohama National University)