Factors in offshore planning that affect the risk for major accidents

The purpose of this paper is to systematically analyse a typical planning process in the offshore industry from the perspective of causes of major accidents, with the ultimate aim of identifying factors that affect the risk for major accidents occurring. We first study and describe a typical planning process for offshore oil and gas operations in Norway. Then we analyse a number of theories of major accidents, to see how the different theories and their explanations of causes and contributing factors can be of relevance for future plans and planning processes. Finally, we review accident investigations to search for evidence of how weaknesses in planning processes can contribute to major accidents through the above identified factors. Also, we try to identify any additional factors that have not been recognised through the theoretical review. This provides empirical support for the theoretical basis. Thirteen factors which directly or indirectly can influence the planning process causing a major accident potential are identified. These are exemplified through a review of investigation reports. The paper suggests that planning process should focus more on increasing quality in the plans at an early phase, with examples from incidents, and illustrate the relation between planning quality and potential for major accidents.     

建筑施工起重机械事故一线作业人员不安全动作规律研究

为有效预防建筑施工起重机械事故,笔者将建筑起重机械一线作业人员按工种分为设备驾驶员、现场施工人员、安拆维修工和信号司索工4种。以行为安全“2-4”模型作为分析工具,对70起建筑施工起重机械事故样本中各类人员不安全动作进行分析。结果表明:建筑施工起重机械事故一线作业人员发出不安全动作196次,其中设备驾驶员发出不安全动作29次,占比41.43%,安拆维修工、信号司索工、现场施工人员分别发出不安全动作18、14和9次,占比分别为25.71%、20%和12.86%。一线作业人员常见的不安全动作是擅自拆除或起吊、未佩戴劳动防护用品、作业现场环境误判断、违反安全操作规程、资质不足作业,其中资质不足作业、违反安全操作规程和作业现场环境误判断发生频次最高。     

A safety barrier-based accident model for offshore drilling blowouts

Blowout is one of the most serious accidents in the offshore oil and gas industry. Accident records show that most of the offshore blowouts have occurred in the drilling phase. Efficient measures to prevent, mitigate, and control offshore drilling blowouts are important for the entire offshore oil and gas industry. This article proposes a new barrier-based accident model for drilling blowouts. The model is based on the three-level well control theory, and primary and secondary well control barriers and an extra well monitoring barrier are established between the reservoir and the blowout event. The three barriers are illustrated in a graphical model that is similar to the well-known Swiss cheese model. Five additional barriers are established to mitigate and control the blowout accident, and event tree analysis is used to analyze the possible consequence chains. Based on statistical data and literature reviews, failures of each barrier are presented. These failures can be used as guidance for offshore drilling operators to become aware of the vulnerabilities of the safety barrier system, and to assess the risk related to these barriers. The Macondo accident is used as a case study to show how the new model can be used to understand the development of the events leading to the accident. The model can also be used as an aid to prevent future blowouts or to stop the escalation of events.     

基于STAMP模型的丰城坍塌事故原因分析

为了系统地分析建筑施工事故原因、有效预防同类事故,运用STAMP模型从控制角度详细分析了一起特别重大坍塌事故,分别从物理过程及环境因素、基层操作原因以及管理层原因3方面分析了导致事故的控制缺陷,并且根据分析结果,提出事故控制措施及建议。结果表明:STAMP模型不仅可以分析各个层级的原因,还可以找出层级之间以及层级内不同组织之间的交互影响原因;建设方、施工方、监理方以及承包方对项目管理内容交叉与重叠,且沟通与协调缺失是导致错误决策和不恰当控制动作产生的主要因素;基层不安全控制动作直接导致事故发生,但取决于管理因素,管理层的原因是预防同类事故的重点。     

海洋石油轮班作业风险定量分析方法研究

长期以来,海洋石油领域风险研究主要集中在对设施的潜在失效概率和后果研究方面,而对于人员可靠性及风险管理方面的研究较弱。然而,据统计资料显示,海上设施在其生命周期内的设计、建造和生产作业等各个阶段中发生的事故大多与人为错误和组织错误（HOE）有关联。在海洋工程领域,开展人员可靠性分析（HRA）的研究工作具有重要意义。根据海上作业的特殊性及轮班制度的特点,推导出轮班风险的定量分析公式,据此计算出每个工作日轮班风险的相对大小,然后结合我国海上作业的实际情况,对影响轮班风险的可变因素进行了敏感性分析,为风险控制与管理提供参考。     

Determination of human error probabilities for offshore platform musters

The focus of this work is on prediction of human error probabilities during the process of emergency musters on offshore oil and gas production platforms. Due to a lack of human error databases, and in particular human error data for offshore platform musters, an expert judgment technique, the Success Likelihood Index Methodology (SLIM), was adopted as a vehicle to predict human error probabilities. Three muster scenarios of varying severity (man overboard, gas release, and fire and explosion) were studied in detail. A panel of 24 judges active in the offshore oil and gas industry provided data for both the weighting and rating of six performance shaping factors. These data were subsequently processed by means of SLIM to calculate the probability of success for 18 muster actions ranging from point of muster initiator to the final actions in the temporary safe refuge (TSR). The six performance shaping factors considered in this work were stress, complexity, training, experience, event factors and atmospheric factors.     

A conceptual offshore oil and gas process accident model

The purpose of this paper is to present and discuss an accident prevention model for offshore oil and gas processing environments. The accidents that are considered in this work relate specifically to hydrocarbon release scenarios and any escalating events that follow. Using reported industry data, the elements to prevent an accident scenario are identified and placed within a conceptual model to depict the accident progression. The proposed accident model elements are represented as safety barriers designed to prevent the accident scenario from developing. The accident model is intended to be a tool for highlighting vulnerabilities of oil and gas processing operations and to provide guidance on how to minimize their hazards. These vulnerabilities are discussed by applying the 1988 Piper Alpha and the 2005 BP Texas City disaster scenarios to the model.     

Fatal workplace accidents in outsourced operations in the manufacturing industry

Several studies have indicated that outsourcing increases the risk of accidents and presented some explanations for this phenomenon. For example, higher accident proneness of external employees has been presented, but the common causes of accidents have not been reviewed in depth. This paper provides information about typical accidents, the contributing factors, and preventive measures of fatal occupational accidents that occurred in outsourced manufacturing tasks. This paper also compares whether these factors differ from accidents that occurred when tasks were performed in-house in the manufacturing industry. The focus is on operations executed in the factory area for or by an organization operating in the manufacturing business. The accident analysis is based on information gathered from accident reports for fatal workplace accidents that occurred in Finland during 1999–2008. At outsourced operations in manufacturing, accidents occur most commonly when installations or work preparations are being performed. According to the reports, dangerous work practices and insufficient hazard identification most frequently contributed to accidents. In order to prevent typical accidents, e.g., occupational instructional and guidance, hazard identification, work practices, supervision, and task planning should be improved. Statistical differences between outsourced and in-house operations were also found, mainly within the contributing factors. Therefore, the safety of outsourced manufacturing operations should be considered in detail in order to prevent accidents and ensure occupational safety also when operated with other performers.     

基于动态风险平衡的海洋平台事故连锁风险研究

针对海洋平台事故风险特点,提出动态风险平衡概念,以此建立事故动力模型,并将该模型运用到墨西哥湾"深水地平线"井喷事故。动态风险平衡表征事故动力与事故阻力之间的动态平衡状态,具有动态性和暂时稳定性。事故动力模型以海洋平台可能发生的重大事故为研究对象,从工艺、技术和管理等角度分析事故可能致因和事故发展可能影响因素。该模型首先分析对象的初始事故动力,建立事故连锁风险图,然后计算初始动力发生情况下,传递动力和传递阻力的概率分布,最后提出相应风险控制措施。实例分析表明,基于动态风险平衡建立的事故动力模型能有效分析海洋平台事故连锁风险。     

A study of maintenance-related major accident cases in the 21st century

This paper is based on a review of 183 detailed, major accident investigation and analysis reports related to the handling, processing and storage of hydrocarbons and hazardous chemicals over a decade from 2000 to 2011. The reports cover technical, human and organizational factors. In this paper, the Work and Accident Process (WAP) classification scheme is applied to the accident reports with the intention of investigating to what extent maintenance has been a cause of major accidents and what maintenance-related causes have been the most frequent.The main objectives are: (1) to present more current overall statistics of maintenance-related major accidents, (2) to investigate the trend of maintenance-related major accidents over time, and (3) to investigate which maintenance-related major accident causes are the most frequent, requiring the most attention in the drive for improvement.The paper presents statistical analysis and interpretation of maintenance-related major accidents’ moving averages as well as data related to the types of facility, hazardous substances, major accidents and causes. This is based on a thorough review of accident investigation reports.It is found that out of 183 major accidents in the US and Europe, maintenance was linked to 80 (44%) and that the accident trend is decreasing. The results also show that “lack of barrier maintenance” (50%), “deficient design, organization and resource management” (85%) and “deficient planning/scheduling/fault diagnosis” (69%) are the most frequent causes in terms of the active accident process, the latent accident process and the work process respectively.     

油库火灾原因分析

油库火灾爆炸事故除易造成人员中毒、伤亡、经济损失巨大外,还会导致环境污染严重。近十年来油罐单罐面积越来越大,油库火灾爆炸发生的次数和损失与2000年以前相比急剧增长,特别是对环境的污染日益引起人们的重视。通过对23起油库火灾爆炸事故案例进行分析,发现静电是引发油库火灾爆炸几率最大的火源,输、卸油是最易引发油库火灾的操作工艺,人为的操作失误是油库发生火灾爆炸事故的主要原因。探索油库火灾爆炸事故发生的原因,对减少、避免同类事故的发生具有重要价值和意义。     

Accident investigation in the Norwegian petroleum industry - Common features and future challenges

In their regulations, the Petroleum Safety Authority Norway (PSA) states that the companies responsible for oil and gas exploration and production activities in Norway shall record and investigate accidents and serious incidents. This paper introduces a general model for the accident investigation process in the Norwegian petroleum industry, and presents some results derived from a comparative study of causal factors identified in offshore accident investigation reports from 2002 to 2006. The paper also offers a discussion of the improvement potential in the use of investigation methods. Finally, a discussion of future challenges in accident investigations is provided.     

基于“2-4模型”的化工生产事故原因分析

为进一步研究化工生产事故发生的原因,运用“2-4模型”对从安全管理网等网站收集的125起化工生产安全事故进行分析,结果表明对于事故的直接原因方面,作业人员的不安全动作主要表现在违规操作和无证上岗,管理人员的不安全动作主要表现在其工作不认真等方面,不安全物态最主要的是设备年久失修。对于事故的间接原因,主要表现在安全意识不够、安全知识不足、安全习惯不佳3方面。事故的根本原因则主要表现在缺乏安全培训等方面。为制定化工生产事故预防措施提供了依据。     

Offshore oil and gas occupational accidents—What is important?

Occupational accidents continue to present a problem to industry in general and the offshore oil and gas business in particular. To address this concern, a quantitative model capable of predicting occupational accident frequency in the offshore petroleum industry is being developed. The model offers a means to optimise safety spending, thereby maximising benefits to personnel and the organisation. As input to the development of the model, industry safety experts were polled with respect to the relative importance of a series of influencing factors. These included elements directly affecting accidents, organisational issues, and external factors. A questionnaire was the chosen method to consolidate industry opinion. The results of the questionnaire are presented here, together with a discussion, interpretation, and conclusions.     

海上平台事故应急演练评估方法研究

针对目前我国海上平台事故应急演练缺乏有效评估体系的现状,结合海上平台事故应急演练典型示例,运用“事故应急指挥系统（ICS）”基本理念,对整个应急演练过程进行系统分析,从人员安全、资产保护、环境保护、企业声誉等4个方面搭建应急演练评估框架。采用层次分析法构建计算模型,合理设置评估指标权重,最终建立了1套具有海洋石油行业特点的应急演练评估指标体系,并选取国内1个海上平台事故应急演练进行了应用分析。研究结果表明:构建的演练评估指标体系及评估方法能较好地应用于海上平台事故应急演练过程,进而在演练评估结果的基础上,实现应急演练的持续改进。     

基于鱼骨图和层次分析法的石油静电事故影响因素分析

针对石油静电事故影响因素的复杂性、多层次性和不确定性的特点,采用鱼骨图分析法,找出了引发石油静电事故的影响因素,确定出6个主因素、25个子因素的石油静电事故评价指标体系。应用层次分析法确定了各个影响因素的重要程度,分析出导致石油静电事故的重要因素。结果表明,6个主因素中,隶属于生产操作工艺和安全生产管理的操作错误、人体静电和接地故障3个主因素权重之和高达0.792,是引发石油静电事故的主导因素;子因素中预防的重点应放在喷溅式装卸油、化纤品与人体摩擦和接地线损坏方面。鱼骨图分析法和层次分析法的联合应用,合理地解决了石油静电事故影响因素分析难题,具有一定的推广应用价值。     

Analysis of equipment failures as contributors to chemical process accidents

A database study of chemical process accident cases was carried out. The objective of the study is was to identify the reasons for equipment based accidents. The most frequent accident causing equipment were piping (25%), reactors and storage tanks (both 14%) and process vessels (10% of equipment accidents). The six most accident-prone equipment is process related involve nearly 80% of accidents.78% of equipment accident contributors are technically oriented including design and human/technical interface faults. Purely human and organizational reasons are the most common accident contributors for storage tanks (33%), piping (18%) and heat transfer equipment (16% of causes). For other equipment the technical accident causes are most common.The accident contributors were divided to main and sub-contributors. On average process equipment failures have 2.2 contributors. The contributors, which frequent and act often as main contributors, should be focused. These risky contributors were identified for several equipment types. Also a deeper analysis of the accident causes and their interconnections was made. Based on the analysis a checklist of main risk factors was created for hazard identification on different types of equipment.     

高大模板支撑体系坍塌事故不安全行为原因分析

为预防高大模板支撑体系建筑施工坍塌事故的发生,选取2000-2016年间的31起高大模板支撑体系建筑施工坍塌事故案例,运用事故统计与分析方法,以行为安全“2-4”模型为理论依据,对31起事故中的不安全动作及其规律进行研究。研究表明:出现频次最高的事故等级为较大事故。一线作业人员因安全知识不足“不知道是否应该设置剪刀撑”引发不安全动作“剪刀撑数量不足或未设置剪刀撑”的发生率为71.43%,因安全意识缺乏“没意识到杆件距离过大给施工带来的危险”引发不安全动作“立杆间距和横杆步距过大”的发生率为78.57%;管理人员因安全意识缺乏“没意识到按规定进行安全交底的重要性”引发不安全动作“未进行安全技术交底”的发生率为78.57%,因不佳安全习惯“按照以前的方案习惯施工”引发不安全动作“未制定专项施工方案”的发生率为83.33%。因此,减少不安全动作的首要任务是加强一线作业人员违规操作的管理,企业在制定对策措施时,应从加强一线作业人员与管理人员的安全知识、安全意识和安全习惯入手,预防不安全动作的发生,进而有效预防事故。     

Worker safety and injury severity analysis of earthmoving equipment accidents

Introduction: Research on construction worker safety associated with construction equipment has mostly focused on accident type rather than injury severity and the embedded factor relationships. Significant variables and their effects on the degree of injury are examined for earthmoving equipment using data from OSHA. Four types of equipment, backhoe, bulldozer, excavator, and scraper are included in the study. Accidents involving on-foot workers and equipment operators are investigated collectively, as well as separately. Methods: Cross tabulation analysis was conducted to establish the associations between selected categorical variables, using degree of injury as a dichotomous dependent variable (fatal vs. nonfatal) and a number of independent variables having different values. Odds ratios were calculated to determine how much a certain variable/factor increases the odds of fatality in an accident, and the odds ratios were ranked to determine the relative impact of a given factor. Results: It was found that twelve variables were significantly associated with injury severity. Rankings based on odds ratios showed that inadequate safety training (2.54), missing equipment protective system (2.38), being a non-union worker (2.26), being an equipment operator (1.93), and being on or around inadequately maintained equipment (1.58) produced higher odds for fatality. Conclusion: A majority of the earthmoving equipment accidents resulted in fatality. Backhoes were the most common equipment involved in accidents and fatalities. Struck-by accidents were the most prevalent and most fatal. Non-OSHA compliant safety training, missing seatbelt, operator not using seatbelt, malfunctioning back-up alarms, and poorly maintained equipment were factors contributing to accidents and fatalities. On-foot workers experienced a higher number of accidents than operators, while fatality odds were higher for the operators. Practical applications: Safety professionals should benefit from our findings in planning and delivering training and providing oversight to workers in earthmoving equipment operations.     

基于灰色系统理论的煤矿人因事故关键因素分析

通过对煤矿人因失误事故致因因素进行分析,统计出相关的关键影响因素,运用灰色系统关联理论,根据国家安监局近十年煤矿事故统计数据,对煤矿人因失误事故影响类型进行了分析。以煤矿事故发生起数和事故死亡人数作为参考指标,计算和分析行为失误致因、个人违章、组织管理失误等十项主要与煤矿人因事故相关的灰色关联度,进而推算出这些因素的灰色关联序,确定出导致煤矿人因失误事故的关键因素,最终得到煤矿人因事故与关键影响因素之间的定量化分析结果。采用灰色关联理论对煤矿人因失误影响因素进行分析,能够很好地说明人因失误与各关键影响因素之间的权重关系,对煤矿人因事故主致因机理有更加深刻的理解,为煤矿事故的预防和控制提供重要的参考依据。