Worker Death: Place Blame Where It Really Belongs

Readers suggest the actual culprits behind a welder's death.

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Calculations showed that monomer wasn't in the flammable range? Calculations are under ideal conditions, with good mixing, and assume pure components. But that's not always the real world. The torch heat on the metal could have made a local flammable mixture. Or, there could have been decomposed material on the inside, another component in the tank or "lights" were present.

Operating the other connected vessels made the lockout procedure a sham. Could this have been done safely? Possibly. Fully isolating the tank would have been the first choice. Even if there were no valves in the vent line, a pancake blind between flanges would have done the job. If that wasn't feasible (and "why not?" should be answered), they could have erected a barrier with ventilation to blow any fumes from the mixer opening away from the torch area, with continuous monitoring on the welder's side. Or they could have used a wet cutoff wheel, or water jet cutter, to avoid any heat or sparks. Or they could have temporarily blocked the opening with rags (with a place for the tank to breathe elsewhere, of course).

And the greatest insult is blaming the welder. Did the welder do the vapor pressure calculations, or sign off on the hot work order, or develop the lockout procedure? This is the kind of incident that gives the industry a self-inflicted black eye.
 Alex Smith, process platform lead
M+W Group U.S., Boston, Mass.

Forget about flogging the dead welder, fire the maintenance manager, then fire the safety manager who blamed the welder! Welders do as they are told. They rely on us, those with college degrees, to get them home safe. There are so many things wrong with this work process it's hard to begin.

First, no work should ever be permitted, covered process or not, that deviates from a well-critiqued plan. Ad hoc plans should not be allowed! The foreman overseeing the work should have foreseen what would happen if the bolts were frozen. There are safer ways to cut a bolt loose that don't involve open flame. Even a grinder would have been a safer choice, though not as fast.

Second, where was the fire watch? A good fire watch moves around the work site looking for potential problems. A fire watch could have seen where the sparks were going, especially if they fell into the vessel through the agitator shaft hole.

Third, couldn't somebody find a way to slip a spectacle blind behind a tank flange? Although this maneuver is dangerous in its own right, operators equipped with respirators could manage it. Another idea would be to flow purge nitrogen into the vapor space of the adjoining tank to force the vapor down into the liquid.

Fourth, did anyone verify that the monomer temperature was, in fact, normal? Perhaps the temperatures were hot. If they were, then maybe it would have been possible to cool the tank liquid or the gases above the tank. Another option would have been to use spark-resistant blowers to pull the vapors out of a manway door and not allow them to accumulate above the liquid.

And, lastly, the vapor content was "calculated." I see too much reliance on simulations in place of laboratory tests or measurements. Who can say the composition is as expected in a simulation?
Dirk Willard, lead process engineer
Fluor Global Services, Inver Grove Heights, Minn.

The horizontal counter-current-flow induced-draft finned air condenser on our debutanizer column can't keep up in the summer whenever the air temperature rises above 105°F. Instead of an outlet temperature of 115°F, which would ensure the exiting liquefied petroleum gas (LPG) is a saturated liquid, we get 125°F and the LPG leaves as a mixed gas/liquid. We're looking for ways to limp through until the next turnaround. We must get as much as possible out of the condenser because we are limited by space and load on top of the column. The column takes a feed from the fluid catalytic cracker at about 260°F. Naphtha is withdrawn from the bottom at about 360°F. The LPG — a mixture of propylene, propane, butanes, butenes and trace C5+ — leaves the top of the tower as a saturated gas at 155 psig and 142°F and goes to the air condenser. Under design conditions, the condenser should provide condensed liquid at 120°F to a water cooler, which then should discharge the condensate at 90°F. Our water cooler is designed for liquid LPG and is stressed at high temperature. Do you have any ideas on how we can improve the performance of this condenser?

Send us your comments, suggestions or solutions for this question by November 9, 2012. We'll include as many of them as possible in the December 2012 issue and all on Send visuals — a sketch is fine. E-mail us at or mail to Process Puzzler, Chemical Processing, 555 W. Pierce Road, Suite 301, Itasca, IL 60143. Fax: (630) 467-1120. Please include your name, title, location and company affiliation in the response.

And, of course, if you have a process problem you'd like to pose to our readers, send it along and we'll be pleased to consider it for publication.

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  • I'm sorry for the loss of the welder. I am also sorry for the cintinuedmanagement mistake all the way to the top for not addressing these and other issues that may take a life of a human being. I have investigated many issues in operating plants, not neccisarily in a chemical plant, but in industrial works. It is the same all over, management puts little effort into ALL workers training, understanding of what goes on in any plant, pre-employment instruction, adequate supervision, adequate and continued classes on the entire plant and works, operations and maintenance. Most of the time even the plant manager is ignorant of what is happening at any given time in the plant. Before a plant is commissioned, planning and execution must take place, with a full complement of personnel on all aspects of the plant, the works, the equipment, what is going through every pipe, valve, pump and compressor. Every operating pressure and temperature, all characteristics of all liquids and gases, all safety issues of everything must be reviewed. During construction and placing of each component and piece of hardware must be reviewed and inspected by anyone to become involved and especially operations and maintenance should be involved in the at least observation and perhaps the setting and pre-operational testing of each piece of equipment, pressure testing, etc, with direct supervision to teach and answer any inquiries as they progress and again by doing everyone will potentially become profficient in what is going on and what should be touched and what not. Labels are the most prevalent piece of knowledge that can be used for identification in a plant. In addition, an engineering group in the plant can very well make flow sheets to be installed in every area of a plant which should include all aspects of the process and warnings and safety issues. I recommend that all plant personnel should participate in every aspect of construction, pre-operational engineering, checkout and setting, systems startup and then full operations. this can also save small fortunes in future, faster startups, better trained people and more pride in knowledge and production. During operations and maintenance shutdowns I also recommend operations personnel participate in project and task supervision with any report information to complete the tasks. As far as this incident is concerned, blame is always a preferred avenue but better is an understanding of how it will never ocurr again, an admittance that the company will favor suggestions from every body to be reviewed by a committee and management to implement changes required. Thomas J Coyne jr President T.C.Inc., an international engineering and consulting firm Emai:


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