Holistic Approach In Human Error Management

2021 ◽  
Author(s):  
Kishan Prasad Shetty ◽  
Subramanian T.S ◽  
Ibrahim Al Awadhi
Keyword(s):  
Human Error ◽  
Structural Integrity ◽  
Oil And Gas ◽  
Work Force ◽  
Holistic Approach ◽  
Operating Conditions ◽  
Process Safety ◽  
Safety Measures ◽  
Root Cause ◽  
Extent Of Damage

Abstract Despite all safety measures taken in oil and gas plants, serious vehicular accidents happen during maintenance/ shutdown activities, due to human errors such as inadequate planning, improper decision making/ behaviour etc. affecting structural integrity/ process safety, resulting in catastrophic events. In most of such incidents, swift safety measures need to be undertaken to control the extent of damage and limit additional risks cascading from the main event. This paper presents the case study of a vehicle impact incident on an existing main piperack located in the process plant, its root causes and immediate actions adopted in controlling major hazard and ensuring uninterrupted plant operation by maintaining structural integrity. Prime factors considered while arriving solutions to structural damages due to the vehicular impact include, incident cause, extent of damages, availability of restoration material, execution feasibility under plant operating conditions and skillsets of work force that carries out the restoration activities. Due to various constraints, solution arrived are temporary, averting multiple structural failures/ major accident. Further investigation and studies were required to identify root cause of the incident and enhance the implemented solution that would reaffirm long-term integrity of the piperack structure. The vehicular impact loads are generally not accounted in general structural design, since necessary safety measures are considered while finalizing the plant layout. Such unanticipated vehicular impacts on the structural system can result in local/ global structural damages such as failure of critical pipe supports, consequential damage to adjacent pipes, other structural components etc. In this case, although there was a warning signboard (installed on the pipe rack) indicating maximum permissible height, contractor tried to drive the container vehicle having height more than the stipulated height. Since the vehicle passed through first obstruction (beam) located at much higher level, driver negligently moved the vehicle further ahead hitting internal beam located slightly above the limiting height thereby damaging structural beam supporting critical piping. In this incident, site surveys to inspect the damage, data review, structural assessment and details of material in stock are some of the common steps followed for swift restoration of structural integrity. Based on the same, temporary support to prevent further structural damages and restoring operational integrity was designed and implemented in a short time. Other main activities followed were, Walk through the incident to derive the root cause Review work instructions and communication protocol Human factors pertaining to the incident Review the application of management and administrative control Permanent solution for structural restoration Ensuring safety of critical assets is the top most priority for the asset owner. Further, any accident related to safety shall be dealt swiftly to control major hazard, maintain asset integrity and ensure process safety. Such incidents could happen in any industrial facility, oil and gas or other industries. The lessons learnt from this accident and fit for purpose swift actions employed for restoration can be shared with the industry professionals to ensure 100% HSE in projects, operations and maintenance activities.

Development and Experimental Calibration of Numerical Model Based on Beam Theory to Estimate the Collapse Pressure of Flexible Pipes

2015 ◽  
Author(s):  
Jefferson Lacerda ◽  
Marcelo I. Lourenço ◽  
Theodoro A. Netto
Keyword(s):  
Structural Integrity ◽  
Oil And Gas ◽  
Numerical Models ◽  
Beam Theory ◽  
Gas Production ◽  
Operating Conditions ◽  
Flexible Pipe ◽  
Experimental Calibration ◽  
Collapse Pressure ◽  
Flexible Pipes

The constant advance of offshore oil and gas production in deeper waters worldwide led to increasing operational loads on flexible pipes, making mechanical failures more susceptible. Therefore, it is important to develop more reliable numerical tools used in the design phase or during the lifetime to ensure the structural integrity of flexible pipes under specific operating conditions. This paper presents a methodology to develop simple finite element models capable of reproducing the behavior of structural layers of flexible pipes under external hydrostatic pressure up to collapse. These models use beam elements and, in multi-layer analyses, include nonlinear contact between layers. Because of the material anisotropy induced by the manufacturing process, an alternative method was carried out to estimate the average stress-strain curves of the metallic layers used in the numerical simulations. The simulations are performed for two different configurations: one where the flexible pipe is composed only of the interlocked armor, and another considering interlocked armor and pressure armor. The adequacy of the numerical models is finally evaluated in light of experimental tests on flexible pipes with nominal internal diameters of 4 and 6 in.

Catastrophic Events and Human Error: A Few Rotten Apples or Organizational Dysfunction?

2021 ◽  
Author(s):  
Peter Vincent Bridle
Keyword(s):  
Human Error ◽  
Oil And Gas ◽  
Wide Spectrum ◽  
Oil And Gas Industry ◽  
Operating Conditions ◽  
Oil Field ◽  
Gas Industry ◽  
Oil And Gas Producers ◽  
The North ◽  
The Uk

Abstract In July 2021, commemorations will be held to mark the 33 years since the 1988 Piper Alpha tragedy in the UK sector of the North Sea where 167 oil field workers lost their lives. Without question, the incident was a watershed event for the international oil and gas industry not simply because of the immediate toll in human lives lost, but also in terms of the devasting aftermath endured by countless friends, families and loved ones whose lives were forever changed. The tragedy also served to illustrate just how poorly the oil and gas industry really understood and managed those operating risks that possessed the potential for catastrophic loss, both in terms of business cost and overall reputational impact. In the wake of the public enquiry that followed and chaired by Lord Cullen of Whitekirk, one of the principal recommendations required that the international oil and gas industry do a much better job in determining both its major hazards (i.e. major operating risks) and also in creating the necessary operating conditions to demonstrate that such things were being well managed. The objective being to provide tangible assurance that the likelihood of the industry ever incurring such a calamitous event again in the future had been reduced to as low as reasonably practicable (ALARP). In taking its responsibilities very seriously, the international oil and gas industry responded by raising the profile of the management of Health, Safety and the Environment (HSE) across the wide spectrum of its global operations. By the mid-nineties, the industry had implemented comprehensive and structured systems of work within the framework of purposely built HSE Management Systems using templates designed and developed for the industry via the International Oil and Gas Producers (IOGP)*.

Catastrophic Events and Human Error: A Few Rotten Apples or Organizational Dysfunction?

2021 ◽  
Author(s):  
Peter Bridle
Keyword(s):  
Human Error ◽  
Oil And Gas ◽  
Wide Spectrum ◽  
Oil And Gas Industry ◽  
Operating Conditions ◽  
Oil Field ◽  
Gas Industry ◽  
Oil And Gas Producers ◽  
The North ◽  
The Uk

Abstract By July of 2021, it would have been 33 years since the 1988 Piper Alpha tragedy in the UK sector of the North Sea where 167 oil field workers lost their lives. Without question, the incident was a watershed event for the international oil and gas industry. And not simply because of the immediate toll in human lives lost, but also in terms of the devasting aftermath endured by countless friends, families and loved ones whose lives were forever changed on that fateful day. The tragedy also served to illustrate how much work would be needed by the oil and gas industry to fully understand and better manage those operating risks that possessed the potential for catastrophic loss in terms of business cost and reputational impact. In the wake of the public enquiry that followed and chaired by Lord Cullen of Whitekirk, one of the principal recommendations resulting from the disaster required that the international oil and gas industry do a much better job in determining both its major hazards (i.e. major operating risks) and in creating the necessary operating conditions to demonstrate that such things were being well managed. The objective being to provide tangible assurance that the likelihood of the industry ever incurring such a calamitous event again in the future had been reduced to as low as reasonably practicable (ALARP). In taking its responsibilities very seriously, the international oil and gas industry responded by raising the profile of the management of Health, Safety, and the Environment (HSE) across the wide spectrum of its global operations. By the mid-nineties, the industry had implemented comprehensive and structured systems of work within the framework of purposely built HSE Management Systems using templates designed and developed for the industry via the International Oil and Gas Producers (IOGP)*.

New Methodologies for Human Factors in Process Safety

2014 ◽  
Author(s):  
B.. James
Keyword(s):  
Human Factors ◽  
Human Factor ◽  
Oil And Gas ◽  
Organisational Culture ◽  
System Thinking ◽  
Process Safety ◽  
Major Focus ◽  
Cause Analysis ◽  
Root Cause ◽  
New Methodologies

Abstract Process Safety has been a major focus for the Oil and Gas and Petrochemical industries since the Flixborough disaster of 1974. Through the efforts of leaders in Safety there have been a number of key methodologies that has assisted Process Safety professionals in identifying “what went wrong” and how do we learn from disasters to prevent similar incidents from occurring again. Industry professional Dr. Trevor Kletz has gone as far as saying “Organisations have no Memory” Kletz (1993). However, over the last few decades, the industry seems to be making the same mistakes every few years. Research, insight and well-structured root cause analysis has highlighted that Human Factors and Organisational Culture is an area that must be considered in understanding Process Safety related incidents. Organisations such as the Centre for Chemical and Process Safety has included Human Factors as one of the elements in the Management System for Process Safety. System thinking and system dynamics has been identified a way of thinking about and analysing Process Safety related incidents to understand the Human Factor and its role in process related incidents.

Pseudo-Dynamic Fault Isolation Technique Using Backside Emission Microscopy – Case Study, Where All Other Methods Fail

2002 ◽  
Author(s):  
Yoav Weizman ◽  
Ezra Baruch ◽  
Michael Zimin
Keyword(s):  
Failure Analysis ◽  
Process Variations ◽  
Fault Isolation ◽  
Operating Conditions ◽  
Detection Sensitivity ◽  
Isolation Technique ◽  
Root Cause ◽  
Emission Microscopy ◽  
Failure Location ◽  
Noisy Background

Abstract Emission microscopy is usually implemented for static operating conditions of the DUT. Under dynamic operation it is nearly impossible to identify a failure out of the noisy background. In this paper we describe a simple technique that could be used in cases where the temporal location of the failure was identified however the physical location is not known or partially known. The technique was originally introduced to investigate IDDq failures (1) in order to investigate timing related issues with automated tester equipment. Ishii et al (2) improved the technique and coupled an emission microscope to the tester for functional failure analysis of DRAMs and logic LSIs. Using consecutive step-by-step tester halting coupled to a sensitive emission microscope, one is able detect the failure while it occurs. We will describe a failure analysis case in which marginal design and process variations combined to create contention at certain logic states. Since the failure occurred arbitrarily, the use of the traditional LVP, that requires a stable failure, misled the analysts. Furthermore, even if we used advanced tools as PICA, which was actually designed to locate such failures, we believe that there would have been little chance of observing the failure since the failure appeared only below 1.3V where the PICA tool has diminished photon detection sensitivity. For this case the step-by-step halting technique helped to isolate the failure location after a short round of measurements. With the use of logic simulations, the root cause of the failure was clear once the failing gate was known.

scholarly journals Mode I Crack Propagation Experimental Analysis of Adhesive Bonded Joints Comprising Glass Fibre Composite Material under Impact and Constant Amplitude Fatigue Loading

Materials ◽  
2021 ◽  
Vol 14 (16) ◽  
pp. 4380
Author(s):  
Alirio Andres Bautista Villamil ◽  
Juan Pablo Casas Rodriguez ◽  
Alicia Porras Holguin ◽  
Maribel Silva Barrera
Keyword(s):  
Crack Propagation ◽  
Structural Integrity ◽  
Crack Propagation Rate ◽  
Fatigue Loading ◽  
Propagation Rate ◽  
Operating Conditions ◽  
Impact Testing ◽  
Mode I ◽  
Mode I Crack ◽  
Constant Amplitude

The T-90 Calima is a low-wing monoplane aircraft. Its structure is mainly composed of different components of composite materials, which are mainly bonded by using adhesive joints of different thicknesses. The T-90 Calima is a trainer aircraft; thus, adverse operating conditions such as hard landings, which cause impact loads, may affect the structural integrity of aircrafts. As a result, in this study, the mode I crack propagation rate of a typical adhesive joint of the aircraft is estimated under impact and constant amplitude fatigue loading. To this end, effects of adhesive thickness on the mechanical performance of the joint under quasistatic loading conditions, impact and constant amplitude fatigue in double cantilever beam (DCB) specimens are experimentally investigated. Cyclic impact is induced using a drop-weight impact testing machine to obtain the crack propagation rate (da/dN) as a function of the maximum strain energy release rate (GImax) diagram; likewise, this diagram is also obtained under constant amplitude fatigue, and both diagrams are compared to determine the effect of each type of loading on the structural integrity of the joint. Results reveal that the crack propagation rate under impact fatigue is three orders of magnitude greater than that under constant amplitude fatigue.

A Comparison of Rule-Based and Machine Learning Models for Classification of Human Factors Aviation Safety Event Reports

2020 ◽  
Vol 64 (1) ◽  
pp. 129-133
Author(s):  
Katherine Darveau ◽  
Daniel Hannon ◽  
Chad Foster
Keyword(s):  
Machine Learning ◽  
Human Factors ◽  
Human Error ◽  
Data Science ◽  
Aircraft Engine ◽  
Rule Based ◽  
Root Cause ◽  
Textual Data ◽  
Safety Event

There is growing interest in the study and practice of applying data science (DS) and machine learning (ML) to automate decision making in safety-critical industries. As an alternative or augmentation to human review, there are opportunities to explore these methods for classifying aviation operational events by root cause. This study seeks to apply a thoughtful approach to design, compare, and combine rule-based and ML techniques to classify events caused by human error in aircraft/engine assembly, maintenance or operation. Event reports contain a combination of continuous parameters, unstructured text entries, and categorical selections. A Human Factors approach to classifier development prioritizes the evaluation of distinct data features and entry methods to improve modeling. Findings, including the performance of tested models, led to recommendations for the design of textual data collection systems and classification approaches.

A Holistic Approach for Mitigation of H2S from Crude Oil and Gas in an Offshore/Remote Environment

2019 ◽  
Author(s):  
M K Gupta ◽  
J N Sukanandan ◽  
V K Singh ◽  
A S Pawar ◽  
BUDHIN Deuri
Keyword(s):  
Crude Oil ◽  
Oil And Gas ◽  
Holistic Approach ◽  
Remote Environment

A Transient 3D CFD Model of a Progressive Cavity Pump

2016 ◽  
Author(s):  
K. R. Mrinal ◽  
Md. Hamid Siddique ◽  
Abdus Samad
Keyword(s):  
Oil And Gas ◽  
Complex Geometry ◽  
Transient Behavior ◽  
Oil And Gas Industry ◽  
High Viscosity ◽  
Solid Content ◽  
Operating Conditions ◽  
Cfd Model ◽  
Ansys Fluent ◽  
Flow Variables

A progressive cavity pump (PCP) is a positive displacement pump and has been used as an artificial lift method in the oil and gas industry for pumping fluid with solid content and high viscosity. In a PCP, a single-lobe rotor rotates inside a double-lobe stator. Articles on computational works for flows through a PCP are limited because of transient behavior of flow, complex geometry and moving boundaries. In this paper, a 3D CFD model has been developed to predict the flow variables at different operating conditions. The flow is considered as incompressible, single phase, transient, and turbulent. The dynamic mesh model in Ansys-Fluent for the rotor mesh movement is used, and a user defined function (UDF) written in C language defines the rotor’s hypocycloid path. The mesh deformation is done with spring based smoothing and local remeshing technique. The computational results are compared with the experiment results available in the literature. Thepump gives maximum flowrate at zero differential pressure.

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