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Book: Process Risk and Reliability Management |
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Reviews
This unique book is to safety what Perry's is to Chemical Engineering. Fully of practical facts and advice and invaluable to the novice or seasoned professional;
and a comprehensive reference. Since acquiring my copy I have used it frequently and it has provided the answers I needed. I highly recommend it.
Clive Wilby
In my opinion, the author has produced an excellent book, replete with much useful and practical information, figures, and tables. Many of the references are also very recent (some as late as 2009 and 2010). It is a practical guide and roadmap to making the shift from Process Safety Management programs to Operational Integrity regimes that focus on increasing performance not just in safety, but also in environmental compliance, quality control, and overall profitability. Stanley Grossel Ian provides comprehensive guidance on the development, implementation and evaluation of process risk and process safety programs. Charles Gillard Overview
This book helps executives, managers and technical professionals achieve not only their current PSM goals, but also to make the transition to a broader operational integrity strategy. The book focuses on the energy and process industries- from refineries, to pipelines, chemical plants, transportation, alternative energy and offshore facilities. The techniques described in the book can also be applied to a wide range of non-process industries. The book is both thorough and practical. It discusses theoretical principles in a wide variety of areas such as management of change, risk analysis and incident investigation, and then goes on to show how these principles work in practice, either in the design office or in an operating facility. Techniques and principles are illustrated with numerous examples from chemical plants, refineries, transportation, pipelines and offshore oil and gas. ContentsThe book has 16 chapters. The Tables of Contents for each chapter are listed below; follow the bookmark link to learn more.
1.
Operational Integrity Management
sample pages top of page Introduction Operational Integrity / Excellence Process Safety Management Major Events Examples Example 1 - Facility Design Example 2 - Process Flow Example 3 - Heat Exchanger Example 4 - Risk Management Workflow External Standard Guidance Risk Analysis Plan and Implement Audit / Deltas Success / Continuous Improvement Fundamentals of PSM Safe Limits Set Point Values Operating, Safe and Emergency Limits Non-Prescriptive Performance / Risk Based Process - Not Occupational - Safety Measurement Strategies Involvement and Thoroughness Holistic Definition of Process Safety Management Trends Health, Safety & Environmental Programs Environmental / Sustainability Health Safety Quality Management Statistical Process Control ISO 9000 / 14001 Six Sigma Risk Hazards Consequence / Likelihood Bow-Tie Method Presence of Persons Single Contingency Events Economies of Scale Subjective Nature of Risk Degree of Control Familiarity with the Hazard Direct Benefit Personal Impact Natural vs. Man-Made Risks Recency of Events Perception of the Consequence Term Comprehension Time Quantification of Risk Frequency Predicted Frequency Probability Likelihood and Failure Rate Error / Statistical Significance Confidence Failure / Fault Independence and Randomness Acceptable Risk As Low as Reasonably Practical - ALARP De Minimis Risk Citations / "Case Law" RAGAGEP Indexing Methods Risk Matrices Consequence Matrix Worker Safety Public Safety and Health Environmental Impact Economic Loss Frequency Matrix Risk Matrix Chapter 2 - Culture and Employee Involvement sample pages top of page Introduction Elements of Culture On-Going and Consistent Words and Actions External Evaluation Learning from Incidents Attention to Basics Historical Development 1. Safety as a Value 2. Codes and Standards 3. Workers Compensation 4. Occupational Safety 5. Systems Analysis 6. Regulations 7. Management Systems 8. Behavior-Based Safety 9. Safety Culture Warning Flags over Your Organization Flag One - Unrealistic Stretch Goals Production Creep Production Records Initiative Overload Flag Two - Excessive Cost Reduction Reduction of "Non-Essentials" Reductions in Work Force The "Big Crew Change" Flattened Organizations Aging Infrastructure Out-Sourcing Not Enough Time for Detailed Work Project Cutbacks Flag Three - Belief That "It Cannot Happen Here" Lack of Direct Experience Good Occupational Safety Performance Lack of Imaginative Thinking Failure to Learn from Near-Misses Failure to Draw on Experience Elsewhere Flag Four - Excessive Belief in Rule Compliance Flag Five - Ineffective Information Flow Critical Safety Information Is Buried, Lost or Diluted Team Player Culture Fear of Litigation Mergers, Acquisitions and Divestitures Flag Six - Ineffective Audit Process Softened News to Senior Managers Failure to Identify Root Causes Inadequate Follow Up Developing a Strong Culture Mission Statement Guiding Tenets Detailed Program Workforce and Stakeholder Involvement Workforce Involvement Safety Committees Involvement in OIM Elements Difficulties with Workforce Involvement Inefficiencies Unwillingness to Accept Change Labor / Management Relations Stakeholder Outreach Contractors Types of Contractor Selection of a Contract Company Contractor Training Safety Meetings Post-Contract Evaluation Chapter 3 - Hazards Identification sample pages top of page Introduction Hazards Management Process Step 1. Identify the Hazards Creative / Imaginative Techniques Experience-Based Logical / Rational Step 2. Risk Rank Step 3. Eliminate or Substitute the Hazard Step 4. Remove the People Step 5. Reduce the Consequence Step 6. Reduce the Likelihood Step 7. Install Safeguards Organization of a Hazards Analysis Charge / Scope Letter Abandoned Equipment Preparations Logistics Meeting Protocol Location of the Meeting Projection of Notes Documentation Requirements Security of the Information Time Required Kick-Off and Close-Out Meetings HAZID / Major Hazards Screening The Team Leader / Facilitator Process Knowledge Stimulate Thinking Creative Thinking Casual Remarks "If We Had Unlimited Money" Generalizations Team Management Knowledge of Actual Incidents Lawyer-Like Behavior Persona Personal Preparation Engineering Standards The Scribe Operations / Maintenance Expert Process and Instrument Experts Specialists Use of Sophisticated Language The One-Minute Engineering Department Results of the Analysis Findings Recommendations Action Items Risk Register Finding Number and Date Hazard Source Consequence(s) / Likelihood / Risk Follow-Up The Hazards Analysis Report Completeness of the Notes Cross-Reference Anonymity Findings Terminology Completeness "Non-Findings" Appearance Pictures Report Distribution Communication with the Public Table of Contents 1. Disclaimer 2. Executive Summary 3. Objectives of the Analysis 4. Summary of Findings 5. Method Used 6. Risk Ranking 7. The Team 8. Regulations 9. Attachments 10. Meeting Notes Development of the Report Step 1. Notes Clean-Up Step 2. Team Review Step 3. Draft Report Step 4. Client Review Step 5. Final Report Step 6. Risk Register Legal Issues Need to Act on Findings Informal Notes Internal Communication Special Types of Hazards Analysis Temporary and Transient Operations Non-Process Applications Decommissioning / Demolition Revalidation Hazards Analyses Benefits and Limitations of Hazard Analyses Strengths Providing Time to Think Challenging Conventional Thinking Cross-Discipline Communication Education Development of Technical Information Economic Payoff Limitations and Concerns Imprecision in Defining Terms Multiple Contingencies Complexities and Subtle Interactions Dynamic Conditions Common Cause Events Knowledge of Safe Operating Limits Lack of Quantification Team Quality Personal Experience Boredom Confusion with Design Reviews False Confidence Equipment Orientation Interfaces Human Error The Hazard and Operability Method (HAZOP) Step 1. Node Selection and Purpose Selection of Nodes Pressure Breaks Step 2. Process Guideword / Safe Limits Step 3. Identification of Hazards and their Causes Step 4. "Announcement" of the Hazard Step 5. Consequences Step 6. Identification of Safeguards Step 7. Predicted Frequency of the Hazard Step 8. Risk Rank Step 9. Findings Step 10. Next Process Guideword / Node Checklists Checklist Categories Guidewords Structure of a Checklist The What-If Method Node / Functional Area Review Equipment and Function Review Utility Systems Batch Processes Operating Procedures Layout Reviews What-If / Checklist Method Failure Modes & Effects Analysis TRIZ Indexing Methods Interface Hazards Analysis Hazards Analysis on Projects Common Hazards Process Hazards High Flow Low / No Flow Reverse Flow Misdirected Flow High Pressure High Temperature Blocked-In Pump Polymerization External Fire Low Pressure Low Temperature High Level Wrong Composition Corrosion Chemical Embrittlement Static Electricity Hazards of Utilities Common Cause Failure Process Contamination Electrical Power Failure Nitrogen Reverse Flow to a Utility Header Use of Hoses Survivability of Utilities Hazards of Water Water in Hydrocarbon Tanks Water in Very Hot Liquid Static Electricity Water and Firefighting Hazards of Steam Steaming Vessels during Turnaround Reboiler Leak Wet Steam Hazards of Ice Line Freezing Hydrates Hazards of Compressed Gas Gas Cylinders Pigging Incident Hazards of Air Flammable Mixture Blowing a Line Clear Hazards of External Events Flooding Lightning Earthquakes Hazards of Equipment and Instruments Furnace Firing Fired Heater Burnout Multiple Uses of Equipment Distributed Control Systems Hazards of Piping, Valves and Hoses Piping Pipe Class Transition Hydraulic Hammer Pig Launchers and Receivers Pressure in Relief Headers Overload of Overhead Vacuum Lines Underground Piping Vents and Bleeders Hoses Hoses and Truck Pull-Away Hose Run Over Hose Failure Backflow Preventor Valves Blocked-In Pressure Relief Valve Vents and Bleeders Fail-Safe Control Valves Critical Control Valves in Manual Shared Relief Valve Block Valves below Relief Valves SDV Bypass Human Error Errors of Intent Errors of Action Mistakes Slips Fixation Error in an Emergency Chapter 4 - Consequence and Likelihood Analysis sample pages top of page Introduction Consequence Analysis Safety Health Environmental Economic Effect of a Release Fires Flammable Range Ignition Temperature / Energy Spontaneous Combustion Ignition Sources Vacuum Trucks Radiant Heat Static Electricity Lightning Pyrophorics / Iron Sulfide Flammability Hazard Ranking Passive Fire Protection / Fireproofing Explosions Physical Explosions Vapor Cloud Explosions Deflagrations and Detonations Blast Effects BLEVEs Dust Explosions Toxic Gas Releases Gas Release Modeling Effect of Toxic Gases Probit Equations Short-Term Exposure Limits Emergency Response Planning Guidelines (ERPGs) Immediately Dangerous to Life and Health Permissible Exposure Limits (PEL) Threshold Limit Values (TLV) Short Term Exposure Limit (STEL) Levels of Concern (EPA) Acutely Toxic Concentration / Levels (New Jersey/Delaware) Substance Hazards Index Hazardous Chemicals Carbon Monoxide (CO) Nitrogen (N2) Sulfur Dioxide (SO2) Hydrogen Sulfide (H2S) Chlorine (Cl2) Frequency Analysis The Pareto Principle Importance Ranking Fault Tree Analysis Gates OR Gate AND Gate VOTING Gate Events Top Event Intermediate Events Base Events House Event Top-Down Development of a Fault Tree 1. Define the Top Event 2. Build the Tree 3. Identify the Cut Sets 4. Eliminate Repeat Sets 5. Eliminate Repeat Events in a Set 6. Eliminate Redundant Events 7. Quantify the Risk Mathematics of an OR Gate Mathematics of an AND Gate Mathematics of a Voting Gate Cut Set Quantification 8. Risk Rank Event Contribution Important Few Unimportant Many Power of the AND Gate Importance Equalization Cost-Benefit Analysis Importance Ranking Using Cut Sets Birnbaum Factor Method Fussel-Vesely Method Perturbation Method Common Cause Events Utility Failure Instruments on Manual Instrument Pluggage Vibration External Events Maintenance Availability Human Error / Untrained Personnel Generic Fault Trees Generic Safety Fault Tree Generic Reliability Fault Tree Discussion of the Fault Tree Method Qualitative Fault Tree Analysis Event Tree Analysis Quantification of an Event Tree Scope of Event Combining Event Trees and Fault Trees Short Sequence of Events Many Events Partial Success Discrete Event Analysis Non-Linearities and Complexities Conveying Statistical Uncertainty Monte Carlo Simulation Random Number Generators Seed Numbers Speeding the Simulation Markov Models Importance Ranking Top-Down / Bottom-Up Approach Top-Down Bottom-Up Qualitative Insights Limitations to Quantification Mathematical Understanding Value-Laden Assumptions Lack of Exhaustivity Human Behavior Data Quality Safeguards Safeguard Level 1: Normal Operations Safeguard Level 2: Procedural Safeguards Safeguard Level 3: Safety Instrumented Systems Safeguard Level 4: Mechanical Safeguards Safeguard Level 5: Passive Safeguards Safeguard Level 6: Emergency Response Layer of Protection Analysis The LOPA Process Single Scenarios IPLs Specific Independent Dependable Auditable Human Response Implementing LOPA Team Makeup Timing Tools Procedures and Inspections Risk Criteria PFDs Failure Rate Data Chapter 5 - Technical Information and Industry Standards sample pages top of page Introduction Technical Information: Table of Contents Process Description Material Safety Data Sheets (MSDS) The Safety Diamond Engineering Information Block Flow Diagrams Process Flow Diagrams Piping & Instrument Diagrams Materials of Construction Table Industry Standards Types of Standard Regulations Codes and Industry Standards Development of a Standard National Fire Protection Association (NFPA) American Petroleum Institute American Chemistry Council / Responsible Care(TM) Center for Chemical Process Safety American Society of Mechanical Engineers American National Standards Institute (ANSI) International Organization for Standardization (ISO) Company Standards Industry Information Open Literature RAGAGEP Chapter 6 - Asset Integrity sample pages top of page Introduction Siting and Layout Blocks and Roads Equipment Layout and Spacing Pumps Utilities Piping and Valves Drainage Buildings Area Classification Electrical Equipment Ground Fault Circuit Interrupters Fireproofing Pressure Vessels Maximum Allowable Working Pressure Effect of Temperature Reflux Vessels Small Pipe Connections and Isolation Pressure Tests Tightness Tests Strength Tests Test Media Testing Procedures Storage Tanks Operation Vapor Recovery Systems Pumps Protective Instrumentation Pump Casing Seals and Packing Minimum Flow Bypass Pump Isolation Compressors Liquid Knockout on the Compressor Suction Relief Valves Compressor Isolation Shutdown and Alarm Systems Heat Exchangers Shell and Tube Heat Exchangers Air-Cooled Exchangers Cooling Towers Air Preheaters Boilers Piping and Valves Materials Insulation Gaskets Threaded Piping Thermal Expansion Identification and Labeling of Pipes Valves Trapped Liquids Plugs Valve Seat Material Self-Closing Valves Check Valves Emergency Isolation Valves Testing and Inspection Pressure Relief Devices Pressure Safety Relief Valves Shared Relief Valves Venting from Relief Valves Block Valves below Relief Valves Testing and Inspection Thermal Relief Valves Rupture Disks Hatches / Doors Flame Arrestors Thermal Flame Arrestors Water Seal-Type Flame Arrestors Velocity-Type Flame Arrestors Detonation Arrestors Flares Instrumentation and Control Systems Alarms Alarm Management Interlocks and Trips Safety Instrumented Systems Design Issues Fire Protection Quantitative Analysis Testing and Inspection Internal Combustion Engines Starter Systems Intake, Exhaust and Fuel Systems Buildings Process Buildings Temporary Buildings Control Buildings Control Building Laboratories Warehouses Inside Storage Inspection Programs Inspection Frequency Inspection Records Quality Control Risk-Based Inspection Analyze Risk Determine Costs Allocate Resources Chapter 7 - Reliability, Availability and Maintainability sample pages top of page Introduction Benefits of a RAM Program Reliability and Safety Definitions Reliability Availability Effectiveness Maintainability Failure Modes Equipment Description Primary, Secondary and Command Failures Catastrophic, Degraded and Incipient Failures Real Failures / Necessary Replacements Failure Rates Constant / Exponential Distribution Lognormal Distribution Bathtub Curve Early Failures Constant Failure Rate Wear-Out Failures Reliability Block Diagrams Active / Standby Redundancy Quantification of Block Diagrams Failure Rate Data Conditional Probability / Bayes' Theorem Evaluation of Tests Sequential Observations Combining Data Sources Chapter 8 - Operations, Maintenance and Safety sample pages top of page Introduction Safe Work Practices Housekeeping Minimizing Contact with Air Tank Filling and Emptying Catching Samples Flame Propagation through Drains Spills and Overflows Hot Taps Unplugging a Line NORM (Naturally Occurring Radioactive Material) Machinery Safety Machine Guards Lifting Stairways and Ladders Stairways and Railings Fixed Ladders Behavior Based Safety Observed Hazard Card Five by Five Policy Lone Worker Policy Energy Control Procedures Removal of the Hazard Positive Isolation Temporary Plugs Isolation Techniques Level 1 - Closed Valve Level 2 - Closed Valve with Open Bleeder Level 3 - Double Block and Bleed Level 4 - Block and Bleed with Line Break Level 5 - Block, Bleed and Spectacle Blind Level 6 - Double Block and Bleed with Blind Level 7 - Double Block and Bleed with Line Break Electrical Isolation First Break Policy Lockout / Tagout Group Lockout Car Seals Padlocks Tags Administrative Controls Work Permits General Work Permits Issuance of Permits Changes in Conditions Multiple Work Permits Hot Work Permits Confined Space Entry Preparation Drain Liquids Purge and Ventilate Steam Air Test The Entry Permit Personnel Entrant Supervisor Manway Attendant Gas Tester Maintenance Repair Condition-Based Maintenance Scheduled Maintenance Reliability Centered Maintenance Tie-Ins Maintenance Task Organization Step 1 - Plan the Work Step 2 - Conduct a Job Hazards Analysis Step 3 - Issue a Work Permit Step 4 - Shutdown and Isolate Equipment Step 5 - Perform the Work Step 6 - Close Out the Work Signs Prohibition Mandatory Action Warning Safe Condition Fire Safety Color Coding For Exposed Piping Personal Protective Equipment (PPE) Head Protection Hand Protection Clothing Fire Resistant Clothing Impervious Clothing Foot Protection Eye Protection Respiratory Protection Air-Purifying Respirators Supplied Air Respirators Chemical Canister Rebreathers Portable Gas Detectors Office Safety Outside Operations Outside Storage Coal and Coke Storage Drum Storage Drainage Fire Protection and Prevention Cylinders Loading Racks Drum Storage Emergency Showers and Eyewashes Components of an Emergency Shower Freeze Protection Heat Protection Visibility and Accessibility Alarms Inspection Commissioning and Start-Up Construction Complete Commissioning Operational Readiness Review Types of Review Review Not Required Small Projects / Engineering Changes Medium Size Projects Large Projects Restart Reviews Organizational Responsibility Time Required Team Structure Using the Elements of OIM Knowledge Management Operating Procedures Asset Integrity / Reliability Training / Performance Chapter 9 - Operating Procedures sample pages top of page Introduction Definition of Operating Procedures Operations Written Instructions Design or Operating Intent Definition of Maintenance Procedures Terminology Engineering the Solution Quick Assessment of Operating Procedures The Users Experienced Technicians Less Experienced Technicians Engineering / Management DCS / SCADA Programmers Auditors, Regulators and Inspectors Translators Elements of OIM Workforce Involvement Knowledge Management Hazard Identification and Risk Management Management of Change Operational Readiness Emergency Management Information Manual Types of Operating Procedure Steady-State Operating Procedures Types of Steady-State Procedure Shift Change Start-Up Procedures Shutdown Procedures Levels of Shutdown Stand-By Unit Shutdown Process Shutdown Emergency Shutdown Turnaround Trouble Shooting Procedures Elements of Troubleshooting Procedures Guidance - Not Instructions Structure of Troubleshooting Procedures Temporary Operating Procedures Batch Procedures Standard Operating Procedures Maintenance Procedures Job Safe Practices The Operating Manual Software Analogy Modular Design Connecting the Modules If / Then / Else Instructions Modular Operating Manual Data Base Structure Top-Down Development Prototyping Limitations of Modularity Design of an Operating Manual Adding and Removing Modules Numbering the Modules Module Design The Title Block Procedure Name Module Number Purpose of the Procedure Revision Number Date of Revision Covered Persons Company / Facility Safe Upper and Lower Limits Special Safety Items Equipment Information Training The Operating Task Instructions Step Number Column Person Action Discussion / Illustration The Authorization Block Written By Approval - Superintendent Approval - Manager Authorization Sheet Overall Module Links to Other Procedures and Manuals Links to Technical Information Training Two-Page Modules Content Development Level of Detail Level 1 - Overview / Checklists Level 2 - Equipment Description Level 3 - Valve Detail Sources of Information Existing Procedures Technician Interviews Engineering Information Vendor Manuals Process Hazards Analyses The Procedures-Writing Team Writing and Publishing Project Organization 1. Define the Scope of Work Physical Area / Equipment Covered Users Types of Procedure Job Task Analysis Design of the Manual Regulations / Standards Writer's Guide 2. Create the Team Steering Committee Project Manager Project Lead Technicians Technology Expert Interviewer-Writers Publisher / Webmaster 3. Develop a Detailed Plan Schedule and Progress Metric Budget Prepare the SOPs 4. Collect Information Operator Interviews Existing Procedures / Vendor Manuals Logbooks 5. Write the Procedures Draft Releases Plan to Throw One Away - You Will Anyway 6. Review and Sign 7. Publish Potential Difficulties Poorly Defined Goals Too Many People Extended Review Cycle Lack of Signatures Maintaining the Procedures Procedures Modification Process Organization Writing Guidelines Vigorous Writing Minimalist Writing Short, Pithy Instructions Avoid Repetition of Instructions Omit Needless Words Omit Adverbs Short and Old Words Avoid Wordy Phrases and Padded Syllables Writing Style Imperative Tense Active Voice Reading Grade Level List Instructions Singly Implied Instructions Bulleted Lists Conditional Instructions Positive / Negative Instructions Vocabulary Identification of Equipment Consistency Should / Would / Could The Word "You" The Word "This" Tautologies Arabic Numerals Adverbs and Adjectives Articles Humor Spelling Latinate Abbreviations Apostrophes Ambiguous Words Cobblestone Writing Repetition of Messages Danger, Warning, Caution, Note Proofreader Marks Illustrations Photographs P&IDs Iconic Flow Diagrams Maps / Plot Plans Publishing Color White Space Fonts Paragraph Formatting Emphasis Techniques Heading Page Numbering Single-Sided versus Double-Sided Printing Indexing Glossary The Binder Multiple Languages Chapter 10 - Training and Competence sample pages top of page Introduction Elements of a Training Program Orientation Initial / Basic Training Site Training Abnormal Situation Management Refresher Training Procedures and Training Management of a Training Program Training Matrix Budget Allocation Measuring Progress Economics of Training Process Simulators and Emulators Testing and Certification Chapter 11 - Emergency Management and Security sample pages top of page Introduction Human Response Human Error Rate Fixation Heroism and Buddy Loyalty Trouble Shooting Levels of Emergency Cause of Emergency Emergency Operations Local Emergency Response General Emergency Response Recovery Operations Investigation and Follow Up Emergency Planning Organization and Personnel Emergency Response Manual Emergency Procedures Emergency Response Training Communications Fire and Gas Detection Fire Detection Fire Eyes / Flame Detectors Smoke Detectors Heat Detectors Fusible Links Low Oxygen Detectors Combustible Gas Detectors Manual Call Points Toxic Gas Releases Fire Fighting Single Fire Concept Deluge Systems Fire Zones Fire Water Water Capacity and Rates Sources of Fire Water Testing Fire Water Pumps and Drivers Jockey Pumps Main Fire Pumps Fixed Water Spray Systems Automatic Sprinkler Systems Fire Water Monitors Fire Water Distribution System Materials of Construction Layout Valves Hydrants Other Fire Fighting Media Halon Steam Foam Systems Carbon Dioxide Systems Heavy Equipment Portable Fire Extinguishers Location Types Water Extinguishers Carbon Dioxide Extinguishers Dry Chemical Extinguishers Personnel Protective Equipment Bunker Gear / Turnout Clothing Proximity Suits Breathing Apparatus Security Members of the Public Vandalism Theft Activists Sabotage Terrorism Visible Security Population Density High Profile Chemicals Security Vulnerability Analyses Rings of Protection Improving Security Culture Inherent Safety Access Security Personnel Screening Equipment Modifications Response to a Threatening Call Chapter 12 - Incident Investigation and Root Cause Analysis sample pages top of page Introduction Management Level Line Supervision Facility Management Executive Management Industry Regulations and Standards Incident Investigation and Analysis Philosophy Trust and Candor Listen to the Facts Cause and Effect Technical Expertise Root Cause Analysis Project Management Blame and Fault-Finding Management Trust Early Reporting of Bad News Management Pressure No Good Deed Goes Unpunished Communications Definitions Incident Accident Near Miss / Hit Potential Incident High Potential Incident Six-Step Investigation and Analysis Process Step 1 - Initial Investigation Step 2 - Evaluation and Team Formation Step 3 - Information Gathering Step 4 - Timeline Development Step 5 - Root Cause Analysis Step 6 - Report and Recommendations 1. Initial Investigation The "Go Team" Drug and Alcohol Testing Incident Report Form First Management Report 2. Evaluation and Team Formation Evaluation Team Formation Outside Investigators Corporate Support Team Members Charter / Terms of Reference Team Member Qualifications 3. Information Gathering Interviews Interview Guidelines Regulatory / Legal Interviews Witness Interviews Interviewer Attributes Documentation Engineering Information Operating Information Vendor Data Field Information Damage Assessment Photographs and DVDs Closed Circuit Television Instrument Records Testing / Lab Analysis 4. Timeline Development Timeline Steps Timeline Construction Conditions Multiple Timelines Timeline Table Background Information 5. Root Cause Analysis Levels of Root Cause Types of Root Cause Analysis Argument by Analogy: Story Telling Safeguards Categorization System Analysis Why Trees Fault Tree Analysis Linkage of Fault Trees to the Timeline Common Cause Events 6. Report and Recommendations Levels of Recommendation Report Structure Issuing the Report Information Security and Chain of Custody Record Retention Removing Evidence File Systems Incident / Risk Register Feedback Incident Data Bases National Response Center (NRC) Accidental Release Information Program (ARIP) Database CFOI (Census of Fatal Occupational Injuries) Major Accident Reporting System (MARS) Marsh & McLennan Reviews Annual Loss Prevention Symposia Process Safety Beacon Government Agencies Chapter 13 - Management of Change sample pages top of page Introduction Benefits of Management of Change Increased Production, Productivity and Quality Maintenance Expense and Safety Environmental Performance Personal Reputation Definition of MOC Deviation beyond Limits Impact on other Process Safety Elements Critical Changes In-Kind / Not-In-Kind Change Same Specification Same Service and Materials of Construction Same Storage and Handling Process Procedural Replacement Process Chemistry Instrumentation and Control Systems Types of Change Initiated Equipment Change Large and Small Changes Turnarounds Field Change Non-Initiated Equipment Change Overt Change Covert Change Temporary Changes Emergency Changes Organizational Change Reorganization Management by Contractors Informal Aspects of MOC The Management of Change Process Section A - Initiator Request Initiator Sponsor Request Process Management of Change Form - Section A Section B - First Review In-Kind / Not-In-Kind Change Selecting the First Reviewers Management of Change Form - Section B Section C - Detailed Evaluation Review Process MOC Coordinator Review Team Builders Project Team Software Reviewers Qualifications Recommendations Management of Change Form - Section C Section D - Formal Approval Management of Change Committee Process Hazards Analysis Variance Procedures Section E - New Limits / Process Safety Update Section F - Notification Section G - Implementation Section H - Follow-Up Chapter 14 - Audits and Assessments sample pages top of page Introduction Formal Audits Reasons for Audits Accident Follow-Up Regulatory / Standards Compliance Voluntary Check Insurance and Business Security Audit Standards Regulations Industry Standards Internal Standards Audit Personnel Outside Auditors Internal Auditors Team Composition Auditor Attributes Interview Skills Technical Knowledge Writing Skills Demeanor The Host Company First Impressions Employees Planning the Audit Goals Determine the Audit Standard Scope Budget Schedule One-Point Contact Pre-Audit Activities Audit Forms Conducting the Audit Auditor Preparation Kick Off Meeting Plant Tour Information Collection Interviews On-Site Inspection Close-Out Meeting Report Letter of Certification Audit Verification Findings Follow Up Unannounced Audits Lagging and Leading Indicators Lagging Indicators Leading Indicators Limitations Quality of Reporting Management Elements Reviews and Expert Assessments Review Issues Management Systems Effectiveness Workforce Involvement Real World Usefulness "Learned to Live with It" Problems Lessons Learned Reviewer Attributes Management Elements Assessment Level 1 - Risk Management Level 2 - Management Element Spreadsheet Level 3 - Detailed Questions Scoring Template Guidance Benefits of the Elements Assessment Approach Independent of Events Handling Abstraction Smoothing of Results Objectivity Chapter 15 - Process Safety Management Compliance sample pages top of page Introduction Regulations, Standards and Guidance Rules and Regulations Rule-Based Approach Goal-Driven Approach Codes and Standards Guidance Analysis United States Federal Regulations The Regulatory Process Code of Federal Regulations General Duty Clauses The Tenth Amendment to the United States Constitution The Environmental Protection Agency (EPA) The Occupational Safety & Health Administration (OSHA) OSHA Inspections Variances Enforcement The Entry Process Reasons for Entry Fatality / Catastrophe Programmed Inspections Complaints Citations Willful Serious Other-than-Serious Repeat and Failure-to-Abate OSHA Standards Part 29 Subparts of Part 29 Sections of Subparts Interpretations and Guidance The EPA Risk Management Program - 40 CFR 68 Tiering / Program Levels Covered Chemicals Formal Management System Worst Case Release Emergency Plan Five-Year Accident History State Regulations New Jersey Toxic Catastrophe Prevention Act Delaware/Nevada Chemical Safety and Hazard Investigation Board Minerals Management Service (MMS) The Safety Case Regime Elements of a Safety Case Duty-Holder Responsibility Responsibility of the Auditor / Assessor Risk Management System Management Systems Living Document Structure of a Safety Case 1. Facility Description 2. Safety Management System 3. Formal Safety Assessment Preparation and Implementation Assessment Performance Measurement International Agencies The OSHA PSM Standard Covered Processes Other Standards Audit Guidelines Elements of PSM 1. Employee Participation Written Plan of Action Consultation Access to Information 2. Process Safety Information 3. Process Hazards Analysis Initial Hazard Analysis Methodology Issues to Address Team Revalidation 4. Operating Procedures Written Down Initial Start-Up Temporary and Emergency Operations Certification 5. Training 6. Contractors Application Employer Responsibilities 7. Prestartup Safety Review (PSSR) Process Safety Information Construction and Equipment Procedures New / Modified Facilities 8. Mechanical Integrity Application Written Procedures Training Inspection and Testing Deficiencies Quality Assurance 9. Hot Work 10. Management of Change Employer Responsibility Written Down Replacement In-Kind Factors that Affect Change Training and Participation / Accountability Information Base Operating Procedures Making the Change Training / PSI / Operating Procedures 11. Incident Investigation Investigation Timing Team Report Follow Up Participation 12. Emergency Planning and Response 13. Compliance Audits Certification Technical Qualifications Report Response Retention of Reports 14. Trade Secrets Chapter 16 - Managing a Risk and Reliability Program sample pages top of page Introduction Clients / Customers Senior Management Facility Managers Project Managers and Design Engineers Regulators / Auditors Program Organization Step 1 - Determine the Objectives Step 2 - Set Up an Organization Management Steering Committee Coordinator Sub-Committees Operating Binders Step 3 - Create the Metrics and Baseline Step 4 - Develop a Plan Goals Resources Needed Develop a Schedule Reviews and Signatures Step 5 - Implement the Plan Step 6 - Audit / Improve Risk Management on Projects Phase I - Concept Selection Phase II - Preliminary Engineering Philosophies Hazards Analysis Phase III - Detailed Engineering Phase IV - Fabrication and Construction Phase V - Commissioning and Start-Up The Risk Management Professional Education and Certification Technical Knowledge Personal Attributes Holistic Eclectic Numerate Communication Skills Experience Knowledge of Past Events "Who You Know" The Resume / CV Consultants True Expertise The Consultant as Outsider Consultants - Not Doers Quick Study Role of the Client Communication Presentations Meetings Report Writing Draft Report Language of the Report Completeness / Thoroughness Personal Information Anecdotes Writing Style Non-Emotional Language Minimalist Writing - Make Every Word Tell Omit Needless Words Short, Simple Words Minimize "Soft" Materials Eschew Obfuscation Develop a Theme Modifiers No Typos Date Format Active/Passive Voice He / She You / I Choice of Words Use of Humor Copyright Responsible Document Creation Litigation Support Types of Litigation The Discovery Process Depositions Witnesses to Fact The Expert Witness Acceptance by the Court Prior Testimony Timeline / Story Line The Report Attributes of an Expert Witness To Thine Own Self Be True Be Prepared Be a True Expert Be a Teacher Marketing Privilege |
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