Lessons Learned from Safety Events...

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Lessons Learned from Safety Events “H2Incidents.org” Steven C. Weiner and Linda L. Fassbender presented to the International Conference on Hydrogen Safety San Francisco, CA September 14, 2011 PNNL-SA-82561

Transcript of Lessons Learned from Safety Events...

Page 1: Lessons Learned from Safety Events “H2Incidents.org”conference.ing.unipi.it/ichs2011/presentations/139FinalSlides.pdf · Database-driven website launched in 2006 to store information

Lessons Learned from Safety Events“H2Incidents.org”

Steven C. Weiner and Linda L. Fassbenderpresented to the

International Conference on Hydrogen SafetySan Francisco, CA

September 14, 2011

PNNL-SA-82561

Page 2: Lessons Learned from Safety Events “H2Incidents.org”conference.ing.unipi.it/ichs2011/presentations/139FinalSlides.pdf · Database-driven website launched in 2006 to store information

From Pisa to San Francisco

Presentations and discussions at first ICHS (2005) set the context for developing “H2Incidents.org” as a voluntary, publicly-accessible database Hydrogen Safety Panel emphasized

Importance of reporting and analyzing incidents and near-misses as part of an organization’s safety cultureSharing lessons learned will benefit and encourage others, particularly “incident owners”

International collaboration has become integral to creating value in “H2Incidents.org”The “Lessons Learned Corner” highlights one means for additional knowledge sharing around sets of safety events.

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What is H2Incidents.org?

Database-driven website launched in 2006 to store information and analysis of hydrogen-related safety events“H2Incidents.org” facilitates sharing of lessons learned from actual experiences with hydrogen in order to prevent similar events from happening in the future.Targeted website users are those who work with or around hydrogenPNNL sends e-mail notifications to an international distribution list when new safety event records are posted on the website.

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Capturing Safety Event Information

Each safety event record contains:DescriptionSeverity (Was hydrogen released? Was there ignition?)SettingEquipmentCharacteristics (High pressure? Low temperature?)Damage and InjuriesProbable Cause(s)Contributing FactorsLessons Learned/Suggestions for Avoidance/Mitigation Steps TakenSome records include photos

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Tube Trailer Rollover

Gas Chromatograph Piping Leak and Explosion

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Developing New Incident and Near-Miss Records

An easy-to-use, online form is provided for self-submittal of records.Self-submittal is encouraged, but only ~10% of the records have been self-submitted.Multiple approaches are used to seek out new safety records.Working with incident owners and other submitters is an important aspect of this work.

Discuss, encourage and reach agreement for the submittal of a safety event record.Discuss, clarify and edit the description, information and lessons learned.Obtain organizational approval for posting.

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Linking to “H2BestPractices.org” Enhances the Value of Both

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Expanding Knowledge SharingThe Lessons Learned Corner

Helps focus attention on key safety themes and what has been learned utilizing safety event recordsPublished quarterlyThemes covered to date:

Management of ChangeWorking with Reactive Metal Hydrides in the LaboratoryThe Importance of Purging Hydrogen Piping and EquipmentHydrogen Use in Anaerobic ChambersAdequate Ventilation of Battery Charging FacilitiesLearning from Burst Disk Failures

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Presenter
Presentation Notes
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Lessons Learned CornerManagement of Change

MOC is the process used to review all proposed changes to materials, technology, equipment, procedures, personnel, and facility operation to determine their potential effects on safety vulnerabilities.At least 25 records in “H2Incidents.org” refer to MOC.Hydrogen Safety Panel suggests that MOC principles should be applied more systematically to elevate the importance of safety in the research environment.MOC usually applies to permanent changes, but temporary changes (e.g., deviations from standard operating conditions, untrained personnel filling in during an absence) have also contributed to catastrophic events.

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Lessons Learned CornerWorking with Reactive Metal Hydrides

Scientists and engineers are trying to develop safe and cost-effective energy storage systems using metal hydrides.At least 10 records in “H2Incidents.org” deal with metal hydrides.Materials must quickly and efficiently absorb hydrogen during fueling process and release it during duty cycle.Metal hydrides are very reactive and must be handled in a robust inert gas environment (i.e., laboratory glove box) to protect personnel and equipment.Lessons learned relate to handling, storing, and shipping metal hydrides, as well as laboratory procedures and equipment issues.

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Getting Feedback from UsersAn insurance company reprinted an incident record for use in their customer intranet.A power plant engineer used incident information for a slide presentation on safety.The U.S. Nuclear Regulatory Commission used some incident records and photos for their power plant engineering training course to communicate lessons learned in working with hydrogen.An international company duplicated our HTML structure and interface to create a lessons learned database for global oil and gas services.The International Association of Fire Chiefs used some photos for their new online training course for first responders.A student used the content of one incident record for a school paper on hydrogen production.The National Institute of Standards and Technology added a link to “H2Incidents.org” from their Weights and Measures website.

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International Collaborations Enhance “H2Incidents.org”

Conducted a one-day workshop at DNV (Hoevik, Norway) in 2008 to discuss current efforts on “H2Incidents.org” and the HySafe Hydrogen Incident and Accident Database (HIAD)An initiative captures safety event records and learnings from members of the IEA Hydrogen Implementing Agreement Task 19 (Canada, France, Germany, Greece, Italy, Japan, Netherlands, Norway, Switzerland, U.K., U.S.)Collaboration with HIAD, JRC, IA HySafe integrated with work plan for new IEA HIA Task 31.Safety event records have been exchanged with HIAD.

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Concluding ThoughtsSafety knowledge tools such as “H2Incidents.org” provide a powerful resource for conveying data, information and knowledge as a means to share, discuss and learn from the experience of others.The issues associated with sharing safety information and data in a publicly-accessed database are understood and solvable.Such information from hydrogen fuel cell R&D, demonstration and deployment projects and commercial operation can serve as a rich resource if systematically collected, analyzed and used for several purposes:

To identify lessons learned from safety eventsTo develop quantitative risk assessment methodologies and modelsTo identify gaps in applicable codes and standards that can be addressed by R&D and further analysis

Progress is being made but there is more to be done!

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Acknowledging…

U.S. Department of Energy Fuel Cell Technologies Program (Sunita Satyapal, Program Manger; Antonio Ruiz, Safety, Codes and Standards lead)

Colleagues at PNNL, the Hydrogen Safety Panel, other collaborators and “incident owners”You, the audience and the ICHS

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“I believe your site is an invaluable safety reference resource for a range of people experimenting and working in the alternative energy sector. Providing information about and scrutiny of hydrogen accidents and mishaps in the way your site does is a great idea!”

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--- A website user from Australia