HCR from body cavity bleed port on emergency shutdown valve

Cause & Consequence

• Uncontrolled release of a flammable gas or liquid

Incident Location

Fixed Installation

Incident Activity

Production operations

Specific Incident Equipment

Emergency shutdown valve

Lessons Identified

• The bleed port on the valve was found to be hand tight and two turns from seated. The valve body had been painted, including the bleed port, in this position.
• During factory testing by a 3rd party, the valve was successfully pressure tested in the open and closed positions so the above was not identified.
• During the remote opening of the valve the bleed port was subject to pressure and the gas escaped due to the bleed port being hand tight.

Incident Recommendations

• Ensure valves are tested in all positions where valve integrity may be compromised to ensure that they have full integrity.