1. Oil Field Contractor Fatality Case Study
Presented by Dan Klimek
Loss Control and Safety Manager
Sisk and Company
The information in this study is based on a report issued by the US Chemical Safety & Hazard Investigation Board.
Report No I-MS

2. Overview of accident
On June 5, 2006, three employees were killed and a fourth suffered serious injuries when they were connecting a series of tanks.
During the process of welding the connections between tanks 3 & 4, a fire flashed back into tank 2 causing an explosion.

3. Sequence of Events & Arrangement of facility
Pass out copies of page 2 of report

4. Unsafe Work Practices
The crew used a ladder as scaffold plank between tanks 3 & 4.
Welder used a lit torch to check for flammable atmospheres by “flashing” the space – this is extremely dangerous.
Open pipe on adjacent tank was not capped or isolated.
All tanks were interconnected and tanks 2 & 3 had flammable contents.

7. Tank lids were blown off

8. Key Findings – Hot Work Safety
Contractor was not using a “hot work procedure”
Tanks 2 & 3 not isolated from tank 4
Tanks 2 & 3 contained flammable vapors
Flammable gas detector was not used to ensure the work area was free of flammable vapors

9. Key Findings – Makeshift Work Platform
Contractor crew used a ladder laid flat that cantilevered from tank 3.
2 workers stood on top of tank 3 to hold ladder stable while the welder worked at the end of the ladder to weld on tank 4
Two fatalities could have been avoided if they were not standing on top of tank 3

10. Hot Work Safety Guidelines
Isolate the work area from flammable and combustible materials
Remove flammables/combustibles from tanks and piping
Test for gases / vapors with meter
Issue written hot work permits

11. Hot Work Safe Practices
Work performed by trained personnel who understand the hazards
Use extreme caution when working on tanks and piping that contained flammable/combustible materials
Everyone involved needs to understand the hazards of hot work

12. Written Safety Program – a formal program helps planning
Safety equipment
Safety and work tasks (JSA)
Regulatory compliance plans
Safety orientation plan
Claims management
Safety Policy
Injury and illness rates
Experience of workers
Safety staffing
Safety training
Emergency response

13. How does your safety program compare?
Could an accident like this happen to your work crews?
Questions?