Helping HSE Team in Learning from Accident by Using the Management Oversight and Risk Tree Analysis Method

Introduction: The effects of accidents vary from minor injuries to fatalities and from insignificant damage to severe damage to the environment and property. In order to prevent accidents in the work place, the root causes of and events should be identified using a systematic method and the results should be published. The current study aims to investigate the given causes of an accident in order to implement preventive actions in accidents and similar organizations. Materials and Methods: In this case study, after choosing the main event; to analyze the accidents, at first a set of questions in Management Oversight and Risk Tree (MORT) were answered. By answering the questions, the final events, and the inappropriate management risks (color-coded red) followed by the leading causes of the accident were identified. Results: After analyzing the given accident, 22 inappropriate final events (color-coded red) and 4 assumed risks were identified. Of the total 12 identified basic causes, about 75 % were classified as the management policies and decision makings group, 17 % as the individual factors, and 18 % as the environmental factors group. Conclusion: The analysis using MORT method helped the organization with learning lessons from the accident especially at the management level. In order to prevent the similar and dissimilar accidents, the inappropriate informational network within the organization, inappropriate operational readiness, lack of proper implementation of work permit, the inappropriate and lack of updated technical information systems regarding equipments and working process, and the inappropriate barriers should be considered in a special way

Identification of hazardous and risk assessment of energy sources for Kavir Steel Complex using ETBA method in 2015

Introduction: The steel industry is known as the most important consumer of energy and fuel. In doing so, ensuring safety of energy sources of a country needs to expect the risks analysis in order to select a comprehensive approach. This study aimed to identify the energy consumption and control measures available in the Hot Rolling Kavir Steel Complex and to conduct risk assessment by Energy Tracking and Barrier Analysis method (ETBA). Materials and methods: In this study, initially a team of experts identified mobilized energies and risks of the system and control measures using ETBA sheet that result of a standard MILSTD-882B. Then, the initial risk assessment was carried out using ETBA method. Finally, the control strategies were proposed and the secondary risk level was calculated. Results: Using ETBA, in total 19 energy types and 74 risk types were successfully identified so that in the first stage, 19 risks were unacceptable, 50 risks were unfavorable and 5 risks were acceptable for which the corrective strategies were required Then, the corrective revisions were proposed to reduce the risk level and calculate RAC2. Conclusion: Corrective controlling measures including safety, health and environmental training, continual monitoring and ongoing visit are effective using the safety equipment and personal protective equipment for reducing the unacceptable risks