OSHA Accident Investigation · Summary #14559744
BURN,BUTANE,FLAMMABLE VAPORS,WORK RULES,FIRE,GAS LEAK,COMMUNICATION
Event description
One employee dies and one injured in fire caused by gas leak
Investigation abstract
At the shift change, employees reported a butane leak that had started approxima #2 was hospitalized for burns. tely 10 minutes before shift change. The shift foreman had initiated an approxim ately three-hour shut down for the unit, including the F3 drum. At the time of t he accident, supervisors were communicating end of shift information. Employee # 1, who was starting his regular shift in the area of the leak, was independently trying to hook up a relief line to attempt to divert some of the pressure to th e flare line. Employee #2 (who was not assigned to the area) came to assist him. While they were finding fittings and preparing to hook up the diversion line, t he butane ignited, causing an intense fire. Employee #1 was killed and Employee
Victims (2)
-
#1 Fatality Age 33 M
- Nature of injury
- 4
- Part of body
- 31
- Event type
- 2
- Source
- 16
- Occupation code
- 999
- Human factor
- 1
- Environmental factor
- 7
- Hazardous substance
- 0420
- Task assigned
- 1
-
#2 Hospitalized Age 31 M
- Nature of injury
- 4
- Part of body
- 9
- Event type
- 14
- Source
- 16
- Occupation code
- 999
- Human factor
- 1
- Environmental factor
- 7
- Hazardous substance
- 0420
- Task assigned
- 2
Codes shown verbatim from OSHA's accident-investigation database. A human-readable decoder is coming in a future release once the accident_lookup2 dictionary is loaded.