Scenario

01. Poor Value Perception
02. Poor Safety Awareness
03. Insufficient Safety Measure
04. Carelessness
05. Insufficient Precaution
06. Carelessness of Operator
07. Ignorance of Procedure
08. Disregard of Procedure
09. Disregard of Operation Procedure
10. Planning and Design
11. Poor Planning
12. Wrong Structure of Sequence
13. Malicious Act
14. Rule Violation
15. Safety Rule Violation
16. Secondary Damage
17. External Damage
18. Leakage/Fire

Fire caused due to incorrect opening of valves during sampling operation at a polypropylene manufacturing plant
Case Details

Knowledge Comment:
At the solid sampling from the mixture of solid and gas, the valve's open and close was mistaken and resulted fire.

Field Chemicals and Plants
Author ARAI, Mitsuru (Environmental Science Center, The University of Tokyo)
TAMURA, Masamitsu (Center for Risk Management and Safety Sciences, Yokohama National University)