OSHA Accident Investigation · Summary #565291
BURN,ALCOHOL,PRESSURE VESSEL,WORK RULES,FIRE,EXPLOSION,HIGH PRESSURE,PROCESS SAFETY,HIGH TEMPERATURE
Event description
EMPLOYEE BURNED IN CHEMICAL PRESSURE VESSEL EXPLOSION
Investigation abstract
EMPLOYEE #1 WAS BADLY BURNED WHEN A PRESSURE VESSEL CONTAINING 15,000 POUNDS OF KNOWN. IT IS POSSIBLE THAT EXCESS TEMPERATURE RESULTED IN DECOMPOSITION AND AN E XOTHERMIC REACTION. METHYL THIOTINACOLONE (MTPO) EXPLODED, DESTROYING THE VESSEL, THE BUILDING, AND IGNITING THE ALCOHOL AT THE LOCATION. THE RESULTING FIRE DESTROYED ALL INDICATOR S, READINGS, AND LOGS FOR THIS PROCESS. A DETAILED EXAMINATION WAS NOT PERMITTED BECAUSE THE STRUCTURE HAD BEEN WEAKENED TO SUCH A GREAT EXTENT. EMPLOYEE #1 REF USED TO BE INTERVIEWED; HOWEVER, THERE ARE INDICATIONS THAT HE ACKNOWLEDGED AN A LARM DURING THE PROCESS AND TURNED IT OFF. OPERATOR ERROR APPEARS TO BE A FACTOR IN THIS ACCIDENT. IN ADDITION, THE MIX BEING PROCESSED WAS A 3-BATCH RATHER THA N THE CUSTOMARY 4-BATCH MIX; WHETHER THE NECESSARY MODIFICATIONS WERE MADE IS UN
Victim
-
#1 Hospitalized Age 32 M
- Nature of injury
- 4
- Part of body
- 4
- Event type
- 1
- Source
- 9
- Occupation code
- 999
- Human factor
- 1
- Environmental factor
- 9
- Task assigned
- 1
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.