Safety Flash
Serious injury caused by energy isolation failure
Serious injury caused by energy isolation failure
- IMCA
- Safety Flash
- IMCA SF 18/18
- IsolationLine of FireManagement of ChangeSimultaneous Operations
- Line of fireRisk management
- Energy and process isolationManagement of changeRisk assessmentSimultaneous operations coordination
Summary
A yard worker sustained a serious forearm injury when another worker lowered a hydraulic pipe stand during debris cleaning. The flash identifies absent energy isolation routines, inadequately assessed simultaneous operations and equipment modification, and insufficient task planning. Lessons address risk assessment, coordinated permit and isolation controls, and management of change.
Classifications: Line of fire; struck-by hazards.
Classifications: Risk management; risk evaluation.
Classifications: Energy and process isolation; isolation; energy isolation.
Classifications: Management of change; MOC; change management.
Classifications: Risk assessment; hazard assessment.
Classifications: Simultaneous operations coordination; SIMOPS; simultaneous operations.
Summary
A worker’s forearm was crushed when a hydraulically operated pipe stand moved during poorly controlled simultaneous work and equipment modification.
IMCA SF 18/18. Themes: isolation, line of fire, management of change, simultaneous operations.