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01. |
Poor Value Perception |
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02. |
Poor Safety Awareness |
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03. |
Inadequate Risk Recognition |
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04. |
Carelessness |
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05. |
Insufficient Precaution |
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06. |
Inadequate Handling |
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07. |
Ignorance |
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08. |
Insufficient Knowledge |
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09. |
Poor Experience |
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10. |
Planning and Design |
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11. |
Poor Planning |
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12. |
Poor Purge Planning |
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13. |
Regular Operation |
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14. |
Nonobservance of Procedure |
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15. |
Malfunction |
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16. |
Poor Hardware |
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17. |
Cavitation |
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18. |
Secondary Damage |
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19. |
External Damage |
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20. |
Explosion |
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21. |
Bodily Harm |
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22. |
Injury |
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23. |
Loss to Organization |
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24. |
Economic Loss |
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25. |
Direct Monetary Damage 5 million yen |
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Explosion caused due to generation of a combustible gas-air mixture at a naphthalene oxidation reaction plant
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Knowledge Comment: |
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Steam invaded into a process piping during turnaround shutdown maintenance and a trouble occurred at start-up. Never directly connect process piping with utility piping. |
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