Scenario > Explosion and fire induced due to incompatible reactions of residual contaminant at an alkylaluminum manufacturing plant

01.

Poor Value Perception

02.

Poor Safety Awareness

03.

Inadequate Risk Recognition

04.

Organizational Problems

05.

Poor Management

06.

Poor Operation Management

07.

Carelessness

08.

Insufficient Understanding

09.

Carelessness of Operator

10.

Usage

11.

Operation/Use

12.

Washing at Grade Change

13.

Regular Operation

14.

Erroneous Operation

15.

Bad Event

16.

Chemical Phenomenon

17.

Abnormal Reaction

18.

Secondary Damage

19.

External Damage

20.

Explosion/Fire

21.

Bodily Harm

22.

Death

23.

Bodily Harm

24.

Injury

25.

12 person injured

26.

Loss to Organization

27.

Economic Loss

28.

Manetary Damage 210 million yen

29.

Damage to Society

30.

Social Systems Failure

Explosion and fire induced due to incompatible reactions of residual contaminant at an alkylaluminum manufacturing plant

	Knowledge Comment:
	If a washing does not executed perfectly in a multi purpose reactor, it is a matter of course that an accident occurrs !

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