Alert
  • Published: 25 May 2012
  • Incident ID: 3430

Breakdown in Control of Work - Near Miss

Cause & Consequence

  • Other
Incident Consequence
Hydrocarbon release

Incident Location

Fixed Installation

Incident Activity

Maintenance

Incident Info Source

PFM

Lessons Identified

Area Authority and Performing Authority are key players within the safe system of work and MUST ensure we provide a safe place to work prior to releasing equipment to maintenance.

Site visits should be performed before and during ongoing maintenance work is a key step in the provision of maintaining a safe place to work.

Ensure a consistent and thorough use of “tools” within the safe system of work is crucial, including hazard recognition and toolbox talk cards, risk assessments, toolbox talks and STOP cards.

Communications – as always, positive & active communications are critical – communications are the essential link between all the different components of a successful task, including: initiation, preparation, delivery and close out.

Incident Recommendations

Safe isolation and reinstatement of plant standards to be ammended to include an equipment handover checklist form. Reinvigorate permit to work awareness.At the time of this incident, Petrofac was in the process of developing a control of work training and awareness programme to increase all permit to work users knowledge of their responsibilities and accountabilities in all operations.Petrofac is also in the final stages of developing a computer based training package for roll out to all permit to work users to complete this item due for launch in Q2 2012.

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