Unit -1

Safety in Engineering Industry- Safety need, General hazards and control

measures in engineering industry, Four significant industrial disasters happened in
the world ( Bhopal, Chernobyl, Flixborough, Rana plaza ), Safety audit- procedure

Accident Investigation- Learning from accident, Layered investigations,

Investigation process and summary

Safety in Engineering Industry

Industrial safety is important as it safeguards human life, especially in high risk areas such as
nuclear, aircraft, chemical, oil and gases, and mining industries, where a fatal mistake can be
catastrophic. Industrial Safety reduces risks to people, and processes. Process control and
safety systems are usually merged. Maintaining a safe and healthy working environment is
not only an important human resources issue, it's the law. Whether they're entry-level
workers, seasoned veterans, supervisors, or plant managers, the employees need to
understand health and safety risks, the steps they need to take to minimize those risks, and
common safety standards and compliance procedures.

Workplace safety is very important for each and every employee in the industry because all
the workers desire to work in a safe and protected atmosphere. Health and safety is the key
factor for all the industries in order to promote the wellness of both employees and
employers. Health and Safety is important because it protects the well being of employers,
visitors and customers. Looking after Health and Safety makes good business sense.
Workplaces which neglect health and safety risk prosecution, may lose staff, and may
increase costs and reduce profitability.

Industrial safety covers a number of issues and topics affecting safety of personnel and the
integrity of equipment in a particular industry.
The following topics are generally discussed:

 General Safety – General aspects of safety which are common to all industries
 Occupational Safety and Health – Particularly associated with the occupation
 Process and Production Safety
 Material Safety
 Workplace Safety – Safety issues directly related to the workplace setting
 Fire Safety
 Electrical Safety – Arising from the equipment used
 Building and Structural Safety – Including installations as per existing building
code
  Environmental Safety – Concerns the direct and indirect environmental impact of
the industry

Some terms used in safety:

Industrial Hazards
Industrial hazards consist of four principle hazards. This is because industries employ many
different processes involving a wide range of different raw materials, intermediates, waste
products and final products. The hazards encountered are fire, explosion, toxic release and
environmental damage.

Fire: This is the most frequent of the hazards however the consequences are generally less.
The effect of fire on people usually takes the form of skin burns and is usually dependant on
the exposure time and the intensity of the heat. Fire can also produce toxic fumes like
Acrolein, Carbon monoxide and Cyanides. Physical structures can be damaged either by the
intensity of the heat or combustion. It may also have an effect on essential services like
power and instrumentation which can cause an escalation of the incident

Explosion: Explosions are usually heard from far away as a ‘bang’. This is the result of a
shock wave. This overpressure can kill people but usually the indirect effects of collapsing
buildings, flying glass and debris causes far more loss of life and severe injuries. There are
different types of explosions which include gas explosions and dust explosions. Gas
explosions occur when a flammable gas mixes with air and is exposed to an ignition source.
Dust explosions occur when flammable solids, especially metals, in the form of fine powders
are intensively mixed with air and ignited.

Toxic/Chemical release: Sudden releases of toxic vapours have the potential to cause death
and severe injuries several miles from the release point. They are carried by water and air.
Their release into public sewage systems, rivers, canals and other water courses, either
directly or through contaminated water used in fire fighting can result in serious threat to
public. The number of casualties depends on the weather conditions, population density in the
path of the cloud and the effectiveness of the emergency arrangements.

Environmental Damage: As well as having the potential for causing injury, loss of life and
damage to property, the hazards of fire, explosion and toxic releases may pose a severe threat
to the environment. Release of other substances, not directly toxic to humans can cause major
pollution problems. It is becoming increasingly recognized that damage to natural resources
such as plant and animal life can have serious long term consequences. E.g. destruction of
trees is increasing the effect of global warming and extinction of animals are severely
disrupting food webs and causing an increase in pests.

Control measures in engineering industry

Design and Pre-modification review: this involves proper layout, facilities and material
selection. Research should be done try to substitute extremely toxic chemicals with safer
ones. Less chemicals should be stored; a reduction in inventory will automatically mean less
damage if an accident is to occur.
Chemical Risk Assessment: Chemicals are assessed based on compatibility, flammability,
toxicity, explosion hazards and storage.
Process Safety Management: A hazard and operability studies, reliability assessment of
process equipment, incorporating safety trips and interlocks, scrubbing system, etc. should be
done before effecting major process changes. Management should try to develop a culture of
safety in industrial organizations
Safety Audits: Periodical assessment of safety procedures and practices, performance of
safety systems and gadgets along with follow up measures should be carried out.
Emergency Planning: A comprehensive risk analysis indicating the impact of consequences
and specific written down and practiced emergency procedures along with suitable facilities
should be done. This can be done by communities as well as national or regional corporation
authorities
Training: Proper training of employees and protective services should be done.
Special times and escorts for dangerous vehicles
Public Cooperation on the road: the public should cooperate with the police and any
tankers and heavy duty vehicles to avoid accidents and allow for the shortest possible on road
time for dangerous vehicles.
Public awareness: Everyone should be aware of potential disasters and informed of
protective and safety measures. MSDS sheets should be readily available to the public.
Cautions must be placed to standout on dangerous household and car care products.
Proper storage of hazardous Materials: All chemicals and hazardous materials should be
kept at proper storage temperature and in locked cupboards away from children and animals.
Also, if reactive substances are stored, it should be stored is a watertight container.

Four Significant Disasters happened in the world

1. Bhopal disaster

The Bhopal disaster, also referred to as the Bhopal gas tragedy, was a gas leak incident on the
night of 2–3 December 1984 at the Union Carbide India Limited (UCIL) pesticide plant
in Bhopal, Madhya Pradesh, India. It is considered to be the world's worst industrial disaster.
Over 500,000 people were exposed to methyl isocyanate (MIC) gas.

Estimates vary on the death toll. The official immediate death toll was 2,259.
The government of Madhya Pradesh confirmed a total of 3,787 deaths related to the gas
release. A government affidavit in 2006 stated that the leak caused 558,125 injuries,
including 38,478 temporary partial injuries and approximately 3,900 severely and
permanently disabling injuries. Others estimate that 8,000 died within two weeks, and
another 8,000 or more have since died from gas-related diseases.

The plant produced pesticides. An intermediate compound in this process is methyl

isocyanate (MIC). It is reactive, toxic, volatile, and flammable. The maximum exposure
concentration of MIC for workers over an 8-hour period is 0.02 ppm (parts per million).
Individuals exposed to concentrations of MIC vapors above 21 ppm experience severe
irritation of the nose and throat. Death at large concentrations of vapour is due to respiratory
distress.

MIC demonstrates a number of dangerous physical properties. Its boiling point at

atmospheric conditions is 39.1°C, and it has a vapor pressure of 348 mm Hg at 20°C. The
vapor is about twice as heavy as air, ensuring that the vapors will stay close to the ground
once released. MIC reacts exothermically with water. Although the reaction rate is slow, with
inadequate cooling the temperature will increase and the MIC will boil. MIC storage tanks
are typically refrigerated to prevent this problem.

The unit using the MIC was not operating because of a local labor dispute. Somehow a
storage tank containing a large amount of MIC became contaminated with water or some
other substance. A chemical reaction heated the MIC to a temperature past its boiling point.
The MIC vapors traveled through a pressure relief system and into a scrubber and flare
system installed to consume the MIC in the event of a release. Unfortunately, the scrubber
and flare systems were not operating, for a variety of reasons. An estimated 25 tons of toxic
MIC vapor was released. The toxic cloud spread to the adjacent town, killing over 2000
civilians. No plant workers were injured or killed. No plant equipment was damaged.

The exact cause of the contamination of the MIC is not known. If the accident was caused by
a problem with the process, a well-executed safety review could have identified the problem.
The scrubber and flare system should have been fully operational to prevent the release.
Inventories of dangerous chemicals, particularly intermediates, should also have been
minimized.Solution is to redesign the process to reduce the inventory of hazardous MIC. One
such design produces and consumes the MIC in a highly localized area of the process, with
an inventory of MIC of less than 20 pounds.

2. Chernobyl Nuclear Disaster

The Chernobyl disaster was a nuclear accident that occurred on 26 April 1986 at the No.
4 reactor in the Chernobyl Nuclear Power Plant, near the city of Pripyat in the north of
the Ukrainian SSR in the Soviet Union. It is considered the worst nuclear disaster in history
both in cost and casualties. It is one of only two nuclear energy accidents rated at seven—the
maximum severity—on the International Nuclear Event Scale, the other being the
2011 Fukushima Daiichi nuclear disaster in Japan. The initial emergency response, together
with later decontamination of the environment, involved more than 500,000 personnel and
cost an estimated 18 billion Soviet rubles—roughly US$68 billion in 2019, adjusted for
inflation

The accident occurred during a safety test on the steam turbine of an RBMK-type nuclear
reactor. During a planned decrease of reactor power in preparation for the test, the power
output unexpectedly dropped to near-zero. The operators were unable to restore the power
level specified by the test program, which put the reactor in an unstable condition. This risk
was not made evident in the operating instructions, so the operators proceeded with the test.
Upon test completion, the operators triggered a reactor shutdown. But a combination of
operator negligence and critical design flaws had made the reactor primed to explode. Instead
of shutting down, an uncontrolled nuclear chain reaction began, releasing enormous amounts
of energy

The core melted down and two or more explosions ruptured the reactor core and destroyed
the reactor building. This was immediately followed by an open-air reactor core fire. It
released considerable airborne radioactive contamination for about nine days that precipitated
onto other parts of the USSR and Western Europe, before finally ending on 4 May 1986.
Some 70% of fallout landed in Belarus, 16 kilometres (9.9 mi) away. The fire released about
the same amount of contamination as the initial explosion. As a result of rising ambient
radiation levels off-site, a 10-kilometre (6.2 mi) radius exclusion zone was created 36 hours
after the accident. About 49,000 people were evacuated from the area, primarily
from Pripyat. The exclusion zone was later increased to 30 kilometres (19 mi) when a further
68,000 people were evacuated from the wider area, and later it became the Chernobyl
Exclusion Zone covering an area of approximately 2,600 km2 (1,000 sq mi)

The reactor explosion killed two engineers and severely burned two more. A massive
emergency operation to put out the fire, stabilize the reactor, and clean up the ejected nuclear
core began. During the immediate emergency response 134 station staff and firemen were
hospitalized with acute radiation syndrome due to absorbing high doses of ionizing radiation.
Of these 134 people, 28 died in the days to months afterward and approximately 14
suspected radiation-induced cancer deaths followed within the next 10 years.
Chernobyl's health effects to the general population are uncertain. An excess of
15 childhood thyroid cancer deaths were documented as of 2011. A United Nations
committee found that to date fewer than 100 deaths have resulted from the fallout.
Determining the total eventual number of exposure related deaths is uncertain based on
the linear no-threshold model, a contested statistical model. Model predictions of the eventual
total death toll in the coming decades vary. The most robust studies predict 4,000 fatalities
when solely assessing the three most contaminated former Soviet states, to about 9,000 to
16,000 fatalities when assessing the whole of Europe

The USSR built the protective Chernobyl Nuclear Power Plant sarcophagus by December
1986. It reduced the spread of radioactive contamination from the wreckage and protected it
from weathering. It also provided radiological protection for the crews of the undamaged
reactors at the site, which were restarted in late 1986 and 1987. Due to the continued
deterioration of the sarcophagus, it was further enclosed in 2017 by the Chernobyl New Safe
Confinement. This larger enclosure allows the removal of both the sarcophagus and the
reactor debris, while containing the radioactive hazard. Nuclear clean-up is scheduled for
completion in 2065

3. Flixborough, England

The accident at Flixborough, England, occurred on a Saturday in June 1974. It had a major
impact on industries in the United Kingdom. As a result of the accident, safety achieved a
much higher priority in that country.

The Flixborough Works of Nypro Limited was designed to produce 70,000 tons per year of
caprolactam, a basic raw material for the production of nylon. The process uses cyclohexane,
which has properties similar to gasoline. Under the process conditions in use at Flixborough
(155°C and 7.9 atm), the cyclohexane volatilizes immediately when depressurized to
atmospheric conditions.

The process where the accident occurred consisted of six reactors in series. In these reactors
cyclohexane was oxidized to cyclohexanone and then to cyclohexanol using injected air in
the presence of a catalyst. The liquid reaction mass was gravity-fed through the series of
reactors. Each reactor normally contained about 20 tons of cyclohexane.

Several months before the accident occurred, reactor 5 in the series was found to be leaking.
Inspection showed a vertical crack in its stainless steel structure. The decision was made to
remove the reactor for repairs. An additional decision was made to continue operating by
connecting reactor 4 directly to reactor 6 in the series. The loss of the reactor would reduce
the yield but would enable continued production because unreacted cyclohexane is separated
and recycled at a later stage.

The feed pipes connecting the reactors were 28 inches in diameter. Because only 20-inch pipe
stock was available at the plant, the connections to reactor 4 and reactor 6 were made using
flexible bellows-type piping, as shown in Figure. It is hypothesized that the bypass pipe
section ruptured because of inadequate support and overflexing of the pipe section as a result
of internal reactor pressures. Upon rupture of the bypass, an estimated 30 tons of cyclohexane
volatilized and formed a large vapor cloud. The cloud was ignited by an unknown source an
estimated 45 seconds after the release.

The resulting explosion leveled the entire plant facility, including the administrative offices.
Twenty-eight people died, and 36 others were injured. Eighteen of these fatalities occurred in
the main control room when the ceiling collapsed. Loss of life would have been substantially
greater had the accident occurred on a weekday when the administrative offices were filled
with employees. Damage extended to 1821 nearby houses and 167 shops and factories. Fifty-
three civilians were reported injured. The resulting fire in the plant burned for over 10 days.

This accident could have been prevented by following proper safety procedures. First, the
bypass line was installed without a safety review or adequate supervision by experienced
engineering personnel. The bypass was sketched on the floor of the machine shop using
chalk! Second, the plant site contained excessively large inventories of dangerous
compounds. This included 330,000 gallons of cyclohexane, 66,000 gallons of naphtha,
11,000 gallons of toluene, 26,400 gallons of benzene, and 450 gallons of gasoline. These
inventories contributed to the fires after the initial blast. Finally, the bypass modification was
substandard in design. As a rule, any modifications should be of the same quality as the
construction of the remainder of the plant.

4. Rana Plaza Disaster

The 2013 Dhaka garment factory collapse (also referred to as the Collapse of Rana Plaza)
was a structural failure that occurred on 24 April 2013 in the Savar Upazila of Dhaka
District, Bangladesh, where an eight-story commercial building called Rana Plaza collapsed.
The search for the dead ended on 13 May 2013 with a death toll of 1,134. Approximately
2,500 injured people were rescued from the building alive. It is considered the deadliest non-
deliberate structural failure accident in modern human history and the deadliest garment-
factory disaster in history.
Rana Plaza was an eight-story commercial building on the outskirts of Dhaka, Bangladesh
where five garment factories made clothes for major brands across the world including the
U.S., UK, Spain, Italy, Germany, and Denmark. It housed a Five separate garment factories
employing around 5,000 people, several shops and a bank.

On 23 April 2013 (one day before the collapse), a TV channel recorded footage that showed
cracks in the Rana Plaza building. Immediately afterward, the building was evacuated and the
shops and the bank on the lower floors were closed. The owner relayed, however, after an
engineer inspection, the building was structurally sound. The next morning, workers
continued to express concern about the safety of the Rana Plaza building as cracks cut
through weight-bearing structures of the were started. the walls, pillars, and floors. Many told
management they didn’t want to enter the building because of the deep cracks. Still,
management ordered garment workers to their usual posts inside, threatening their jobs and
pay if they refused. Early in the workday, the power to the building cut off, the cracks
widened, and concrete fell onto workers sewing, buttoning, and fastening clothes. It took less
than ninety seconds for the eight-story building to collapse and kill 1,134 workers and maim
more than 2,500. More than half of the victims were women, along with a number of their
children who were in nursery facilities within the building.

causes:

The direct reasons for the building problems were:

1. Building built on a filled-in pond which compromised structural integrity

2. Conversion from commercial use to industrial use
3. Addition of three floors above the original permit
4. The use of substandard construction material (which led to an overload of the building
structure aggravated by vibrations due to the generators).

The collapse of the building was preceded by a number of administrative failures, leading to
early warning signs being ignored.

Safety Audit
Safety audit is a planned, independent, documented and a systematical approach of
determining the success level of the Health and Safety Management System. It involves the
collection of data, analyzing it and the result compared with the Organization’s Health and
Safety objective and organizational best practices.

Safety audit accesses the efficiency, effectiveness, and reliability of the total health and safety
management system of a company. It helps to identify emerging safety issues before they
become problems and also serve as a catalyst for necessary changes to improve employee
safety. It helps determine the organizational safety strength and weakness.
Safety audit can be conducted either internally or externally. Internally, it can be done by a
senior management staff who possess the needed expertise or by an external consultant. The
major advantage of internal audit is that; it is cheaper and the auditor also has the first-hand
knowledge of the health and safety system which could serve as a guide during the process.

However, an external audit it mostly preferred in order to prevent bias during the process.

Types of Safety Audits

There are three (3) types of audits:

1. Compliance audit: It is also called condition inspection. This type of audit focuses
more on unsafe conditions; it considers three factors: conformance, record keeping
and training.
2. Program Audit: This type of audit weighs the strategy of the safety programs and its
implementation.

3. Management System audit: This type of audit evaluate the effectiveness and
management commitment to safety compliance, programs, risk control measures and
employee’s involvement.

Audit Techniques

To carry out an effective audit, three key techniques should be followed:

 Document review: The document which should be reviewed include: Health and
Safety policy, Safety plan, Incident reports, Training reports, Emergency plan, etc.
 Interviews: Interview key personnel in the organization, and randomly interviewing of
staff could also be expository.
 Workplace observation: Walking around the site to have a first-hand observation. This
observation will mainly be based on compliance.

Safety Audit Procedure

The audit procedures follow five (5) simple steps:

1. Prefer for audit: Here you will determine who will do the audit, the scope/objective of
the audit, review applicable standards, and the result of previous audit.
2. Conduct audit: As highlighted in the audit technique above.
3. Create an audit report with recommendations: The report should highlight the
findings. The findings should be both positives and negatives. The summary of the
audit report should include recommended actions and areas that need improvement
pointed out.
4. Set priorities for corrective action: Recommended actions should be prioritized and
execution time attached to it. Some may need immediate action while others may not.
 5. Publish the audit result: The recommendations and corrections should be adequately
communicated. This will help everyone understand the necessary changes and how
the change could affect them and their work.

Safety audit is a detailed and organized process. It could be time consuming and requires
money but it is more beneficial at the long run. It also helps improve the overall health and
safety performance and safety culture.

Accident Investigations

The investigation of accidents and near misses (that is,close calls) provides opportunities to
learn how to prevent similar events in the future. Accident investigations, including detailed
descriptions and recommendations, are commonly shared within the industry. Many
professionals believe that this sharing of information about accidents has been a major
contributor to the steady improvement in safety performance. In recent years important
techniques have been developed for improving the effectiveness of investigations.

Learning from Accidents

Every member of an investigation team learns about problems that precipitate accidents. This
new knowledge helps every team member avoid similar situations in the future. If the
investigation is appropriately reported, many others will also benefit. This concept is also
important for reporting minor accidents or near misses. Minor accidents and near misses are
excellent opportunities to obtain "free chances" to prevent larger accidents from occurring in
the future. It is much easier to correct minor problems before serious accidents occur than to
correct them after they are manifested in major losses.

Accident investigations are designed to enhance learning. The fundamental steps in an

investigation include
 Developing a detailed description of the accident
 Accumulating relevant facts
 Analyzing the facts and developing potential causes of the accident
 Studying the system and operating methods relevant to the potential causes of the
accident
 Developing the most likely causes
 Developing recommendations to eliminate recurrence of this type of accident
 Using an investigation style that is fact-finding and not faultfinding

Good investigations help organizations use every accident as an opportunity to learn how to
prevent future accidents. Investigation results are used to change hazardous practices and
procedures and to develop management systems to use this new knowledge on a long-term
and continuous basis.
Layered Investigations
The important concept of layered investigations is emphasized by T. Kletz. It is a technique
that significantly improves the commonly used older methods. Older investigation methods
identified only the relatively obvious causes of an accident. Their evidence supported their
conclusions, and one or two technical recommendations resulted. According to Kletz, this
older method developed recommendations that were relatively superficial. Unfortunately,
most accidents are investigated in this style.

The newer and better method includes a deeper analysis of the facts and additional levels or
layers of recommendations. This recommended deeper analysis identifies underlying causes
of the accident that are analyzed to develop a multilayered solution to the problem - layered
recommendations.

The number of relevant facts accumulated in an accident investigation is usually limited.

Further investigation usually cannot uncover additional facts. A deeper analysis of the facts,
however, often leads to new conclusions and recommendations. This deeper analysis is, for
example, similar to a brainstorming session to develop new applications for a common house
brick. New and interesting applications will continue to surface.

Kletz emphasized an extra effort to generate three levels of recommendations for preventing
and mitigating accidents:

First layer: immediate technical recommendations,

Second layer: recommendations to avoid the hazards,
Third layer: recommendations to improve the management system.

To fully utilize this layered technique, the investigation process is conducted with an open
mind. Facts about the accident that support conclusions at all three levels are accumulated.

Investigation Process
Different investigators use different approaches to accident investigations. One approach that
can be used for most accidents is described here and shown in Table; it is an adaptation of a
process recommended by A. D. Craven.

The accident investigation report is the major result of the investigation. In general, the
format should be flexible and designed specifically to best explain the accident. The format
may include the following sections: (1) introduction, (2) process description (equipment and
chemistry), (3) incident description, (4) investigation results, (5) discussion, (6) conclusions,
and (7) layered recommendations.

The accident investigation report is written using the principles of technical documentation.
Items 1-4 are objective and should not include the authors opinions. Items 5-7 appropriately
contain the opinions of the authors (investigation team). This technical style allows readers to
develop their own independent conclusions and recommendations. As a result of these
criteria, the accident investigation report is a learning tool, which is the major purpose of the
investigation.

lnvestigation Summary
The previously described accident investigation report is a logical and necessary result of an
investigation. It includes comprehensive details that are of particular interest to specialists.
These details, however, are too focused for an average inquirer.

Kletz used a report format that summarizes the events and recommendations in a diagram.
This type of summary is shown in Figure. It emphasizes underlying causes and layered
recommendations. The illustrated format is similar to the one used by Kletz.

The third-layer recommendations shown in Figure emphasize the importance of management

systems for preventing accidents. Management systems are designed to continuously, and on
a long-term basis, either prevent the accident or eliminate the hazardous conditions, that is, to
break the link in the chain of events that led to the accident. Examples may be (1) a quar terly
audit program to ensure that recommendations are understood and used, (2) a semiannual
orientation program to review and study accident reports, or (3) a checklist that is initiated by
management and checked by operations on a daily basis.

Layered events and recommendations are developed primarily by experienced personnel. For
this reason some experienced personnel are always assigned to investigation teams.
Inexperienced team members learn from the experienced personnel, and often they also make
significant contributions through an open and probing discussion.