Case study of Lockout tagout6

Case study of Lockout tagout6

Sep 21, 2019

Case 6

Accident description: a worker needs to conduct energy isolation on the valve next to the flammable liquid pipeline of a chemical plant. He cut off the power and shut the valve, but it wasn't locked because he couldn't find the right size lock. He saw no one around the pipeline and left temporarily. When reading the meter, the meter reader saw that the pressure on the meter was 0. He did not know that there was a repairman repairing the pipeline, so he restarted the pipeline.

Maintenance workers are working on the steam pipe. He covered a small section of steam pipe with insulation and opened the flammable liquid pipe. When the meter reader opens the valve, flammable liquid flows out of the pipe and drips onto the steam pipe. When it catches fire, the maintenance worker dies.

Cause of accident: the pipe is being repaired, but the worker did not Lockout the valve to inform others; There was no prior communication between the relevant departments. The meter reader did not know that the pipeline was being repaired, so he opened the valve. The liquid in the flammable pipe is not emptied or properly isolated; The repairman's insulation covers only a small section of the heat pipe, making him unsafe.

Improvement: when isolating power source, the valve must be locked after closing; Release the contents of the repaired pipeline, and make sure that the pipeline is installed with sealing fastening valve to ensure no leakage; Heat insulation insulation layer must be installed near the maintenance area to prevent dripping liquid from causing fire; Before performing repairs on complex equipment, distribute memos and brief communication sessions to the relevant departments to let everyone know about the Lockout tagout procedure.