 |
01. |
調査・検討の不足 |
 |
02. |
仮想演習不足 |
 |
03. |
想像性不良 |
 |
04. |
無知 |
 |
05. |
知識不足 |
 |
06. |
勉学不足 |
 |
07. |
価値観不良 |
 |
08. |
安全意識不良 |
 |
09. |
リスク認識不足 |
 |
10. |
縮合反応 |
 |
11. |
計画・設計 |
 |
12. |
計画不良 |
 |
13. |
原料変更計画不良 |
 |
14. |
定常操作 |
 |
15. |
誤操作 |
 |
16. |
異常値への対策行動なし |
 |
17. |
不良現象 |
 |
18. |
化学現象 |
 |
19. |
異常反応 |
 |
20. |
二次災害 |
 |
21. |
損壊 |
 |
22. |
爆発・火災 |
 |
23. |
身体的被害 |
 |
24. |
負傷 |
 |
25. |
1名負傷 |
 |
26. |
組織の損失 |
 |
27. |
経済的損失 |
 |
28. |
プラント焼失 |
|
|
 |

有機過酸化物製造用薬品の一部をナトリウム系からカリウム系に替えて爆発
|
◆ |
知識化コメント |
 |
同じアルカリでも水酸化ナトリウムと水酸化カリウムは特性が違う。安易に置き換えないで! |
|
|
|
|