OSHA Accident Investigation · Summary #733741
RESPIRATORY,HYDROGEN SULFIDE,WORK RULES,INHALATION,TOXIC FUMES,INATTENTION,RESPIRATOR
Event description
EMPLOYEES EXPOSED TO HYDROGEN SULFIDE GAS
Investigation abstract
THE PRESSURE RELIEF VALVE BETWEEN THE ISO STRIPPER AND THE BLOWDOWN LINE FAILED G THEIR AIR MASKS. WHEN THE EMPLOYEES WERE FOUND AFTER THE ACCIDENT, EMPLOYEE #2 HAD HIS MASK PARTIALLY ON AND WAS LOCATED APPROXIMATELY 8 FEET NORTH OF THE WOR K AREA. EMPLOYEE #1 WAS ON THE RECEIVER, APPROXIMATELY 15 FEET NORTHWEST OF THE WORK AREA, AND WAS NOT WEARING AN AIR MASK. THE TEMPERATURE ON DAY OF THE ACCIDE NT WAS 13 DEGREES F. THERE WAS NO SPOTTER ASSIGNED TO ASSIST THE EMPLOYEES IN TH E EVENT OF AN EMERGENCY. ON SUNDAY, DECEMBER 16. THE FAILED VALVE WAS REMOVED ON THE FOLLOWING TUESDAY. T HE BLOWDOWN LINE ON THE ISO STRIPPER SIDE WAS TO BE CLOSED OFF WITH A BLOCK VALV E UNTIL THE RELIEF VALVE COULD BE REPLACED. THERE WAS A POWER OUTAGE AT THE PLAT FORMER UNIT WHICH CAUSED THE SULFER UNIT TO SHUT DOWN. A BLOCK VALVE AT THE PLAT FORMER WAS OPENED, CAUSING HYDROGEN SULFIDE TO VENT INTO THE BLOWDOWN LINE. HYDR OGEN SULFIDE VENTED FROM THE OPEN END OF THE BLOWDOWN LINE AT THE ISO STRIPPER B ECAUSE THE BLOCK VALVE HAD NOT BEEN CORRECTLY INSTALLED (NO BLIND WAS INSTALLED) . THE LAST TIME THE TWO EMPLOYEES WERE SEEN BEFORE THE ACCIDENT THEY WERE WEARIN
Victims (2)
-
#1 Fatality Age 36 M
- Nature of injury
- 2
- Part of body
- 31
- Event type
- 8
- Source
- 19
- Occupation code
- 585
- Human factor
- 1
- Environmental factor
- 7
- Hazardous substance
- 1480
- Task assigned
- 1
-
#2 Hospitalized Age 36 M
- Nature of injury
- 2
- Part of body
- 31
- Event type
- 8
- Source
- 19
- Occupation code
- 585
- Human factor
- 1
- Environmental factor
- 7
- Hazardous substance
- 1480
- 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.