 |
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. |
Organizational Problems |
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05. |
Poor Management |
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06. |
No Function of Checking |
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07. |
Carelessness |
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08. |
Insufficient Precaution |
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09. |
Obscure Indication |
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10. |
Usage |
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11. |
Operation/Use |
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12. |
Electric Heater On |
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13. |
Non-Regular Movement |
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14. |
Movement During Transition |
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15. |
Operate without reconfirmation |
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16. |
Failure |
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17. |
Large-Scale Damage |
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18. |
Rapture |
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19. |
Secondary Damage |
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20. |
External Damage |
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21. |
Leakage/Fire |
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|
|
Fire caused due to overheat of an electric heater caused from operation error during a turnaround shutdown
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Knowledge Comment: |
|
Perfect mis-indication ! It is necessary to establish the preventive system of mis-indication and to educate the receiver of the indication. |
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