For this assignment you will conduct an incident investigation and put together a report outlining the Cause, factors that lead to the incident and corrective actions going forward in order for this not to happen again. Scenario: An employee was standing in front of a heat exchanger that had just had the bundle removed for some hydro blasting in order to remove the scale that had built up over the years. After the bundle was removed from the shell there were still some Koch scale left in the shell that was extremely hot 135 degrees(pyrophoric situation, Pyrophoric materials are compounds that have the ability to ignite spontaneously in the air. Technically, they are defined as materials that will ignite at temperatures below 54.5 degrees celsius (130 degrees fahrenheit), as many chemicals will burn at a high enough temperature. They may also ignite on contact with water and moisture. Handling such materials without following proper safety procedures can result in serious damage to property and possible injury.) and there was a presence of oil as well(hydro carbons). As the employee stood in front of the shell he used a 20k pump to shoot water into the extremely hot shell with the hot scale and oil still inside. Once the water came into contact with the scale a flash fire ignited and shot out of the shell causing 2nd degree burns on the employee standing in front shooting water from a 20k pump inside. What were the factors causing this flash fire and what can be done to prevent it from happening again. Foam was not initially used to deplete the oxygen.
Hide
