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The document discusses the importance of control of work (CoW) systems for safety management. It summarizes a study that found CoW factors were involved in 90% of fatal industrial accidents. The three key CoW factors are planning of work, work rules/procedures, and management/leadership. Two incidents are described where failures in CoW systems led to disasters: an explosion at a chemical plant that killed one due to improper hot work permitting, and the Piper Alpha offshore platform explosion that killed 167 due to a breakdown in work permitting during maintenance. The document outlines BP's 12-element CoW standard for safely managing construction, maintenance and other high-risk activities.

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102 views

01 PDF

The document discusses the importance of control of work (CoW) systems for safety management. It summarizes a study that found CoW factors were involved in 90% of fatal industrial accidents. The three key CoW factors are planning of work, work rules/procedures, and management/leadership. Two incidents are described where failures in CoW systems led to disasters: an explosion at a chemical plant that killed one due to improper hot work permitting, and the Piper Alpha offshore platform explosion that killed 167 due to a breakdown in work permitting during maintenance. The document outlines BP's 12-element CoW standard for safely managing construction, maintenance and other high-risk activities.

Uploaded by

newnse2008
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CONTROL OF WORK

1
Introduction

1.1 Introduction
In large facilities where multiple tasks are performed
simultaneously, the management of work is essential to
ensure that these tasks are accomplished safely. Poor
control of work has resulted in many accidents and
fatalities over the years.
According to a study performed by a major oil company, factors relating to
Control of Work have had direct influences on many of their fatal accidents. In
fact, Control of Work factors are the primary causes of fatality after fatalities
related to vehicles and driving. A consistent methodology was used to
investigate the root causes of the fatal accidents, which includes three factors
that relate directly to Control of Work.
The study reviewed fatal industrial accidents over a five-year period and found
that all three factors were highlighted in 30% of the accident investigations. At
least two out of three were present in 71%, while at least one of the three was
a contributory factor in 90% of the accidents.
Since only 10% of the fatal industrial accidents are found to have no
association with the Control of Work, it becomes apparent that a good Control
of Work system is essential to prevent incidents.

Percentage of fatal industrial accidents relating to Control of Work

Not related to
Control of Work
10%
All 3 elements
1 out of 3 30%
elements
19%

The three factors relating to


Control of Work
2 out of 3
1. Planning of work
elements
2. Work rules, policies,
41%
standards or procedures
3. Management, supervision, or
leadership

1
CONTROL OF WORK

A robust Control of Work process could have helped in preventing the following
incidents.

INCIDENT Inadequate control of work results in fatality!!!


An explosion occurred in a sulphuric acid storage tank when a spark from hot
work being performed in the vicinity ignited the flammable vapour in the tank.
The tank exploded with the roof and shell separating from its floor,
instantaneously releasing its entire content of sulphuric acid. Other tanks in
the common bund were affected by the fire and also released their contents.
The acid spill reached the nearby river resulting in significant damage to
aquatic life.

Contractors were repairing the grating on the catwalk at the time of the incident.
They were issued a hot work permit although it was known that there were
holes in the roofs of the nearby tanks. Instead of adhering to the ‘absolute spark
control’ requirement stated on the hot work permit, the contractors changed
from oxy-acetylene cutting to air carbon arc gouging, which threw large
amounts of molten metal over a wide area. A spark apparently came into
contact with the flammable atmosphere within the tank through the holes
causing the explosion, which killed one and injured eight others.
(continued )

2
CONTROL OF WORK

There was inadequate control of the Hot Work Permit System that allowed
cutting and welding close to tanks containing flammable atmospheres without
extensive safeguards, such as continuous flammable gas monitoring and
providing flameproof barriers/blankets to contain sparks. Further, no action had
been taken when the hot work permit was denied on two previous occasions
for the repair work. The presence of holes in the roofs of the tanks should have
been recognized as a significant hazard and effectively communicated to the
contractors so that those performing the work could understand the situation
better and prevented actions that compromised their safety.
The company pleaded no contest to criminally negligent homicide for failure
to maintain the spent sulphuric acid storage tank which exploded, killing
one employee.
Aside from the compensation fines to be paid to the victims totalling nearly
$37 million, the company was fined a further $10 million for discharging
pollutants into the nearby river, and negligently releasing sulphuric acid into
the air.

3
CONTROL OF WORK

INCIDENT Disaster on Piper Alpha!!!


On 6 July 1988, an explosion occurred on the
Piper Alpha offshore platform. It set off a chain
of fires and explosions, one of which blew
down a firewall containing the process facility.
As a result, large quantities of stored oil
burned out of control. The fire spread to the
gas risers causing them to fail catastrophi-
cally. The resulting release of fuel from the
risers increased the size of the fire into a
towering inferno. Flames reached a height of
300 to 400 feet (91–121 m) and the heat could be felt over a mile
(1.6 km) away.

The surviving platform crew congregated in the accommodation area, which


was farthest from the blaze and seemed the least dangerous. They waited for
helicopters to rescue them there, but the helicopters could not land because
of the fire. Smoke began to seep into the accommodation area because it
was not smoke-proof and a lack of training and awareness meant that crew
members kept opening and shutting doors, allowing more smoke to enter.
Soon it became apparent to some crew members that to survive, they had to
leave the accommodation area and escape by lifeboat. However, they found
that all routes to lifeboats were blocked by smoke and flames. Through lack
of any other instructions, they jumped into the sea, hoping to be rescued by
boat. Sixty-one men survived by jumping. Most of the 167 who died had
waited in vain in the accommodation area and were overcome by carbon
monoxide and smoke.

Investigations found that the immediate cause of the accident was failure of
the Work Permit system to control maintenance and inspection work on the
platform, although it was noted that audit findings never showed a sign that
the permit system was not working well. A Work Permit had been issued to
allow for the maintenance of a condensate standby pump on a hydrocarbon
liquids line. The pump’s discharge pressure relief valve, located out of sight of
the pump, was removed for inspection at the platform workshop, to be
reinstalled at a later date.

When the maintenance work was complete for the day, the maintenance
supervisor returned the Work Permit to the control room. As the process
supervisors and operators were in deep discussion, he left the Work Permit
on the desk without any verbal or written handover. This resulted in vital
information being overlooked and the next shift commencing without knowing
the true conditions of the standby condensate pump. This pump was
subsequently started without the pressure relief valve in place and within
seconds, large quantities of condensate and gas escaped from the blanked
flange fitted to the pipe from where the relief valve had been removed. This
release started the whole chain of catastrophic events.

4
CONTROL OF WORK

For more details on these two and other major incidents, refer to BP Process
Safety Series Integrity Management: Lessons from Past Major Industrial Incidents.

1.2 Control of Work Standard


The Control of Work (CoW) Standard is a formal approach to manage work
risk. It is a procedural form of control, consisting of the following 12 elements.

This Standard, developed by BP, covers the means of safely controlling


activities such as construction, maintenance, demolition, re-mediation and
others. Its purpose is to reduce the risk to which workers in the oil and chemical
industry are exposed. It also serves to decrease the potential for harm to third
parties. However, the Control of Work Standard does not apply to activities for

5
CONTROL OF WORK

which adequately risk-assessed operating procedures exist for normal


operation of plant and equipment.
It is strongly recommended that this Standard, or a similar form of control be
adopted. The 12 elements of the Control of Work Standard are further
elaborated in the next chapter.

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