Modern Safety Management System & Risk Assessmentrisk Assessment Mix

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Handal Wira Mandiri Consult ing, Training & Services

Website:http://www.handal.co.id & www.handalconsulting.com

En h a n c in g y o u r

p e r f o r m a n ce

MODERN SAFETYMODERN SAFETYMANAGEMENT SYSTEM &MANAGEMENT SYSTEM &

RISK ASSESSMENTRISK ASSESSMENT

Ir. Alfino Alwie MScIr. Alfino Alwie MScIr. Alfino Alwie MSc

MULIAMULIA--HOTEL, JakartaHOTEL, Jakarta

1717--19 December 200719 December 2007

Public TrainingPublic Training



2Handal Consult ing & Training A.A

• Latar Belakang Safety Management System

- Key Learning Points

- General Methodology

• Assessing Risks- Risk Definition

- ALARP region

- Risk Tools

• Protecting Our Environment

AGENDA AGENDA




I. INTRODUCTIONI. INTRODUCTION

Safety Management System is vital to the success of losscontrol system. The term of “Safety Analysis” is generic value

for study of the system, identification of dangerous aspects ofthe system, and correction them. It is a compilation ofengineering analyses and management practices that controldangerous situation, especially in identify hazard in a system,

determine the underlying causes of those hazards and developengineering or management controls to either eliminate thehazards or mitigate their consequences.



Handal Consult ing & Training A.A

I.1. Accident in IndustryI.1. Accident in Industry

Mainly, Accident are caused by human element and human error. Research into healthand safety at work should be directed towards mistakes and failings on the part of

workers in order to advance understanding about the causes human factor in accidents

in order that they can be better prevented.

Pipeline LeakagePipeline LeakagePiper Alpha

28 April 1988 Aloha

Accident, Killing FA &

Injuring 8 peoples

Railway Accident




ANGKA KECELAKAAN KERJA MASIH TINGGI

Data Jamsostek tahun 2002 : 66.367 kasus, jumlah kematian 4.142

orang, luka berat/cacat 20.970 orang, 87.390 orang tidak mampubekerja lagi. Tahun 2003 : 7 kematian setiap hari dari 400 kasuskecelakaan kerja (PERSI, 2005).

Triwulan I 2004: angka kecelakaan kerja nasional sebanyak 20.937

kasus (setiap hari rata-rata 349 kasus). Dari kasus tersebut 2.133mengalami cacat/lebih 35 orang cacat setiap hari (Depnakertrans,2005).

PENYEBAB KECELAKAAN

88% faktor manusia (unsafe act), 10% kondisi kerja tidak aman(unsafe condition), 2% faktor lainnya .

PERAN PERILAKU DALAM KESELAMATAN KERJABerkembang pendekatan behavioral base safety

I.2. DATAI.2. DATA--DATA K3DATA K3




• What are your responsibilities as a manager?

-A serious accident happening in your organization

-Injured workers-Company Reputation

I.4. Why is it important to control SAFETY?I.4. Why is it important to control SAFETY?




I.5. Layer of protection analysis (LOPA)I.5. Layer of protection analysis (LOPA)

SIS= safety interlocked system

ESD= emergency Shutdown system




Examples Of Identifying & Managing Safety and Health RiskExamples Of Identifying & Managing Safety and Health Risk

Next few slides….

Identify

Assess

Control

Recovery




Safeguards (IndependentProtective Layers)

Emergency preparedness




I.5. 2. Management StandardsI.5. 2. Management Standards

• “ Management system” refers to what the organization does to manage itsprocesses, or activities

• What requirement your quality system must meet not HOW they should be

met in your organization- Generic Standard: ISO, OSHAS, etc

“A house divided against itselfcannot stand”

==Abraham Lincoln==




I.5.3. Preliminary Hazard AnalysisI.5.3. Preliminary Hazard Analysis

• Identify TARGETS to be protected

-Personnel - Product - Environment

-Equipment - Productivity - Others

• Recognize Risk Tolerance Limits

(Risk Matrix Boundaries)

• “SCOPE” system as to: (a) physical boundaries; (b) operating phases (e.g.,

shakedown, startup, standard run, emergency stop, maintenance); and (c) other

assumptions made (e.q., as-is, as-designed)




I.5.6.I.5.6. RegulationRegulation

Risk management and consultation>hazard identification>risk assessments>risk controls>OHS Committees

Work premises>general duties of controllers of premises>fall prevention>electricity>asbestos

Use of places of work>lighting>heat and cold>noise management>atmosphere

>fire and explosion>confined spaces




Plant

cranes, forklifts, boilers

Hazardous Substances carcinogens, sensitisers, toxics

Dangerous Goods

dry ice, ammonium nitrate

Hazardous Processeswelding, spray painting

Construction Work

I.5.7.I.5.7. RegulationRegulation




I.5.8. Chemistry of FireI.5.8. Chemistry of Fire

Fire Tetrahedron

In order for fire to occur four things must be

present, Oxygen, Fuel, Heat, and a ChemicalChain Reaction. This is represented by the Fire

Tetrahedron.

When any of the four items are removed, the

fire will go out.

Fire extinguishers function by removing one of

the four components of the Fire Tetrahedron.






•• Maximum corridor dead end length: 20 ft.Maximum corridor dead end length: 20 ft.

-- (absence of sprinkler system)(absence of sprinkler system)

•• Preliminary floor plan violates requirement.Preliminary floor plan violates requirement.

•• Now let us illustrate why this is an issue.Now let us illustrate why this is an issue.

Fire EventFire Event

Too much time wasted traveling in theToo much time wasted traveling in thewrong direction (away from an exit)wrong direction (away from an exit)

Life Safety IssueLife Safety Issue




I.5.12. Real life risk assessmentI.5.12. Real life risk assessment

Crossing a roadCrossing a road




1. What is the activity? 2. Who is at risk?

I.5.13.Real life risk assessmentI.5.13.Real life risk assessment





3. What is the hazard? 4. What is the risk?

I.5.14. Real life risk assessmentI.5.14. Real life risk assessment



















II. Assessing RisksII. Assessing RisksII. Assessing Risks




What is a hazard and What is a risk? What is a hazard and What is a risk? What is a hazard and What is a risk?

A hazard is an inherent physical or chemical characteristic thathas the potential for causing harm to people, property or the

environment

Risk is usually defined as the combination of the severity andprobability of an event. In the other words, how often can it

happen and how bad is it when it does? Risk can evaluated

qualitatively or quantitatively

II. Assessing Risks?II. Assessing Risks?




II.1 BEBERAPA PERTANYAANII.1 BEBERAPA PERTANYAAN

Catastrophic; any event that may cause death or serious personnel injury, or

loss of system (e.g., anhydrous ammonia tanker truck overturns, resulting in a

major spill)

Critical-any event that may cause severe injury, or loss of mission – criticalhardware or high-dollar-value equipment (e.g., regulator fails open and over

pressurizes a remote hydraulic line, damaging equipment and bringing the

system

Minor – any event that may cause minor injury or minor system damage , butdoes not significantly impact the mission (e.g., pressure control valve fails

open, causing pressure drops and increased caustic levels)

Negligible – any event that does not result in injury or system damage and

does not affect the mission (e.g., lose commercial power, causing shutdownof plant cafeteria)

HOW SAFE IS SAFE ENOUGH?• WHAT CONSTITUTES A CATASTROPIC ACCIDENT?

• WHAT CONSITUTES A CRITICAL ACCIDENT?• IS THE COST OF PREVENTING THE ACCIDENT ACCEPTABLE?




System Definition

Hazard

Identification

Probability

Consequence

Risk Level

II.2.Risk AnalysisII.2.Risk Analysis

II 2 1 Ri k M P




II.2.1.Risk Management ProcessII.2.1.Risk Management Process

Environment

&

Strategy

Monitoring

&

Continuous Improvement

Risk

Identification

Information

&

Communication

Risk Identification

&

Evaluation

Risk Mitigation

&

Control Activities

II 3 Ri k B d A h M h d l




II.3. Risk Based Approach MethodologyII.3. Risk Based Approach Methodology

• Qualitative Approach assess each plant item with aposition in 5 x 5 risk matrix (EXAMPLE)

• A likelihood of failure is determined from the sum of six

weighted factors;o Amount of Equipment

o Damage Mechanism

o Usefulness of inspection

o Current of equipment condition

o Nature of process

o Safety Design and mechanism

i (C )




Generally, the quantitative analysis is to establish details onthe process, the equipment and other pertinent information.

Risk can be calculated as the product of each consequence

and likelihood for each damage scenario.

Risks = Cs x Fs

S = Scenario

Cs = Consequence of scenario

Fs = Failure frequency of scenario

Risk item = Σ Risks Ref: DNV

Risk Based Approach Methodology (Risk Based Approach Methodology (ContCont’’ndnd))

II 3 1 Ri k M t M th d lII 3 1 Ri k M t M th d l




Describing and quantifying a specific risk andthe magnitude of the risk usually requires some

modeling. Typical tools use in risk analysis are

Network analysis

Life cycle analysis

Probability analysis

Estimating relationships

WBS

Logic Analysis

Technology use

II.3.1. Risk Management MethodologyII.3.1. Risk Management Methodology

Ri k A l i A hRi k A l i A h




• Qualitative Approach

Faster in time, Need Engineering Judgments

from experts

• Quantitative Approach

More Detail and Accurate

• Semi-Quantitative Approach

Combination of Qualitative and Quantitativeapproaches

Risk Analysis Approach:Risk Analysis Approach:

II 3 2 Qualitative ApproachII 3 2 Qualitative Approach




A qualitative analysis of risk based approach procedures have threefunctions, there are:

Screening the level of analysis needed and to ascertain the

benefit of further analysis (Quantitative Approach or some other technique).

Rating the degree of risk within the units in order to assigning theminto a position within a risk matrix

Identifying areas of potential concern at the plant that may meritenhanced inspection programs

II.3.2. Qualitative ApproachII.3.2. Qualitative Approach

II 4 QUALITATIVE APRROACHII 4 QUALITATIVE APRROACH




The RBA program has condensed these effects into four basic risk categories ;

a. Flammable events

b. Toxic releases

c. Environmental risks

d. Business interruption

II.4. QUALITATIVE APRROACHII.4. QUALITATIVE APRROACH

II 4 QUALITATIVE APRROACH (II 4 QUALITATIVE APRROACH (CntnCntn’’dd))




LIKELIHOOD CATEGORY :LIKELIHOOD CATEGORY :

There are six factors should be considered in term of thelikelihood of large leak. The following Each factor is weightedand their combination results in the likelihood factor;

• Amount of Equipment

• Damage Mechanisms

• Appropriateness of Inspection

• Current Equipment Condition

• Nature of the process• Equipment Design

II.4. QUALITATIVE APRROACH (II.4. QUALITATIVE APRROACH (CntnCntn’dd))

II 3 3 Risk MatrixII 3 3 Risk Matrix




II.3.3. Risk MatrixII.3.3. Risk Matrix

ExtremelyUnlikely VeryUnlikely Unlikely

Catastrophic

Significant

Major

Severe

Minor

Improbable

6

5

4

3

2

7 8 9

6 7 8

5

4

3

6 7

5

4

6

5

10

9

8

7

6

Probable

Ref; Control of Major Accident Hazard Regulation 1999 (COMAH)

II 3 3 Risk Matrix (2)II 3 3 Risk Matrix (2)




II.3.3. Risk Matrix (2)II.3.3. Risk Matrix (2)

Ref; ISO 17776

Severity

RankingSafety Environment Business

Very Low

(< 1x10-5)

Low (<

1x10-4)

Medium

(< 1x10-3)

High (<

1x10-2)

Very High

(> 1x10-2)

0 Zero Injury Zero EffectZero

Damage

1 Slight Injury Slight EffectSlight

Damage

2 Minor Injury Minor EffectMinor

Damage

3 Major Injury Local EffectLocal

Damage

4Single

FatalityMajor Effect

Major

Damage

5Multiple

FatalityMassive Effect

Extensive

DamageHigh Risk Area

Consequence Probability of Failure

Low Risk Area

Medium Risk Area

II 3 4 FAILURE CONSEQUENCESII 3 4 FAILURE CONSEQUENCES




II.3.4. FAILURE CONSEQUENCESII.3.4. FAILURE CONSEQUENCES

Question of Risk

10-7

10-6

10-5

10-4

I believe I haveComplete control(driving car)

I believe I Havesome control andchoice aboutExposing mySelf (at work)

I believe I Have noControl but IDon’t have toExpose myself (aircraft pax)

I have no Control and noChoice about Exposing myself (off-site exposureTo industrial accident)

II 5 Risk Acceptance CriteriaII.5. Risk Acceptance Criteria




II.5. Risk Acceptance CriteriaII.5. Risk Acceptance Criteria

Risk acceptance criteria are the limits of the risk tolerance. These criteria must be defined for each type of risk to be

assessed.

The risk acceptance criteria are used to derive theinspection interval that to be scheduled before exceeding

those acceptance limits. This would allow either the

reassessment of the risk level based upon betterinformation, detailed evaluation of any damage, or the

timely repair or replacement of the degraded component.

Illustration of ALARP RegionIllustration of ALARP Region




Acceptable

Region

Tolerable

Region

Intolerable

Region10-3

10-6

Tolerable only if

Risk reduction is

impractical

Tolerable if cost

of reduction would

exceed the

improvement gainedl

Necessary to maintain

assurance that risk

remains at this level

Risk can not be

justified except

in extraordinary

circumstances

A L A R

P

(one fatality in

1.000 manyrs)

(one fatality in

1.000.000 manyrs)

Illustration of ALARP RegionIllustration of ALARP Region

Risk Acceptance CriteriaRisk Acceptance Criteria




Risk Acceptance CriteriaRisk Acceptance Criteria

There are 3 regions of risk acceptance criteria :

- Intolerable region

- Tolerable region- Acceptable region

Example : COMPANY GOAL / TARGETExample : COMPANY GOAL / TARGET




Example : COMPANY GOAL / TARGETExample : COMPANY GOAL / TARGET

(in term of risk to personnel)(in term of risk to personnel)-Individual risk of fatality of personnel who are

operating, maintaining or attending the facilities

shall not exceed 1x10-3 per manyears-IRPA < 1x10-3

(less than one fatality in 1.000 man years).




Acceptable

Region

TolerableRegion

Intolerable

Region

10-3

10-6

IRPA Acceptance Criteria

Tolerable only if

Risk reduction is

impractical

Tolerable if cost

of reduction would

exceed the

improvement gainedl


assurance that risk


Risk can not be

justified except

in extraordinary

circumstances

(one fatality in

1.000 man

yrs)

(one fatality in

1.000.000 manyrs)




Acceptable

Region

TolerableRegion

Intolerable

Region

1x10-3

1x10-6

IRPA Acceptance Criteria

(one fatality in

1.000 man

years)

(one fatality in

1.000.000 man

year)

Tolerable only if

Risk reduction is

impractical

Tolerable if cost

of reduction would

exceed the

improvement gained


assurance that risk


Risk can not be

justified except

in extraordinary

circumstances

= 0,001 = 0,1%

= 0,000001 = 0,0001%

Illustration of Risk Acceptance CriteriaIllustration of Risk Acceptance Criteria




Acceptable

Region

TolerableRegion

Intolerable

Region

10-3

10-6

Tolerable only if

Risk reduction is

impractical

Tolerable if cost

of reduction would

exceed the

improvement gained


assurance that risk


Risk can not be

justified except

in extraordinary

circumstances

(one fatality in

1.000 man

years)

(one fatality in

1.000.000 man

years)

pp




Individual Risk Criteria from other countries forpeople working at plants

10-3

10-8

10-5

10-6

10-7

10-4

Australia

(New Plant)

(COPI - Belanak

FPSO)

I n

d i n i v i d u a l

f a t a l i t y p e r

y e a r

10-6

10-7

10-6

10-5

10-3

10-5

Netherland

(New Plant)




Individual Risk Criteria fromother countries for people working at plants

10-3

10-8

10

-5

10-4

10-6

10-7 Australia

(New Plant)

(COPI - Belanak

WHP-A)

a t

a l i t y p e r y e a r

10-6

10-7

10-610-6

10-3

10-5

Netherland

(New Plant)

I n d i n i v i d u a l f

10-3

Is there any Risk Acceptance Criteria withinIs there any Risk Acceptance Criteria within

I d i R l tIndonesian Regulatory




Acceptable

Region

Tolerable

Region

Intolerable

Region

?

?

Indonesian RegulatoryIndonesian Regulatory

Tolerable only if

Risk reduction is

impractical

Tolerable if cost

of reduction would

exceed theimprovement gained


assurance that risk


Risk can not be

justified except

in extraordinarycircumstances

How to achieve ALARP condition ?




• ALARP = As low as Reasonably Practicable

• ALA RP

Regulasi / Peraturan

Recommended Practice

=

R

e a s o n a b l y

P r a c t i c a b l e

Rp (Cost & Benefit Analysis)

RP = Reliable Parts

RP = Rules and Procedures

How to achieve ALARP condition ?(How to get the risk level as low as possible with the prevention and

mitigation measures are reasonably practicable ?)

Industrial Risk related studies MappingIndustrial Risk related studies Mapping




F o r m a l S a f e t y A s s e s s m

e n t

Q u a n t i t a t i v e R i s k A s s e s s m e n t

C o m

p a n y V a l u e s

S o c i e t a l V a l u

e s

I n c r e

a s i n g C o m p l e x i t y a n

d H a z a r d s o f D e v e l o p m e n t

C o d e s a n d S t a n d a r d s

G

o o d P r a c t i c e

E n g i n e e r i n g J u d g e m

e n t

Typical Developments

1

Exploration drilling

activities

Simple wellhead platform

Simple subsea development

Simple production platform

Large production platform or FPSO

Large complex multi-product

production platform or FPSO

Large complex petrochemical facility

2

UKOOA Industry Guidelines on Framework For Risk Related Decision support

II.6. Generic Steps in Risk Analysis:II.6. Generic Steps in Risk Analysis:




1. Identification of accident scenarios / hazard2. Identification of potential deterioration mechanisms and modes of

failure3. Assessment of the probability of failure on each mechanism/mode4. Assessment of the consequences resulting from equipment failure5. Determination of risks from equipment failure6. Determine risk mitigation

7. Risk ranking and categorization

p yp y




Risk Assessment = Risk Analysis + Mitigation

Risk Analysis

Risk Level :

Menentukan tingkat resiko pada pekerja,

masyarakat di sekeliling, lingkungan hidupdan asset

ALARP Demontration :

Mendemonstrasikan bahwa

usaha-usaha untuk mengurangi

resiko ada dalam kondisi ALARP

Mitigasi :

Usaha-usaha untuk mengurangi resiko

Risk Assessment =Risk Assessment =

+ + +

RISK BASED GOALSRISK BASED GOALS




DEFINED RISK BASED GOALSDEFINED RISK BASED GOALS

PERSONNELPERSONNEL< 1 x 10< 1 x 10--33/year /year

ENVIRONMENTENVIRONMENT

< 1 x 10< 1 x 10--3/year3/year

CAPITAL ASSETCAPITAL ASSET

< 1 x 10< 1 x 10--2/year2/year

US$ 5 MillionUS$ 5 MillionReputationReputation

< 0.6%< 0.6%

UnavailabilityUnavailabilityHSE Interface

Identification of SCE within the designIdentification of SCE within the design

Define PS for the aboveDefine PS for the above

HSE Interface to Assist DisciplineHSE Interface to Assist Discipline

Mech.Mech. Elec.Elec.

Inst.Inst.

Building/ Building/ StructStruct..

HVACHVAC

Power PlantPower Plant

MedicalMedical SupprtSupprt EquipEquip




Hazards P r e

v e n t i o n

o f h a z a r

d s

f o r c a

u s i n g

b i g g e r

h a z a r d s

MAH

Detection &

Controlling

Prevention /

Isolation

TR EER P r o b a

b i l i t y o

f

M A H

t a k i n g

p l a c e

C o n s e q

u e n c e

o f M A H

t o f a t a

l i t y

P r e v e n t i o n

o f M A

H o c c u

r r i n g

M i t i g a

t i o n o f

M A H c

o n s e q u

e n c e

Each of Identified HazardsEach of Identified Hazards




Consequences

People Assets Environment Reputation

No

Injury

No

Damage

No

Effect

No

Impact

Slight

Injury

Slight

Damage

Slight

Effect

Single

Impact

Minor

Injury

Minor

Damage

Minor

Effect

Limited

Impact

Major

Injury

Localised

Damage

Localised

Effect

Considerable

Impact

SingleFatality MajorDamage MajorEffect NationalImpact

Multiple

Fatality

Extensive

Damage

Massive

Effect

International

Impact

Never heard of in oil & gas industry

Has occured

in oil & gasindustry

Has been experienced

bymost operators

Happens several

times per yearper operator

Happens several

times per yearper facility

Qualitative Risk MatrixQualitative Risk Matrix

Risk Level

R i s k s i n

t o l e r a b l

e R i s k

s t o l e r a b l e

i f A L A R P

R i s k s a c c e p t a

b l e i f m

a n a g e d

f o r

R i s k s a c c e p t a

b l e i f m

a n a g e d

f o r

c o n t i n o

u s c o n

t i n o u s i m

p r o v e m e n t

i m p r o v e m e

n t

FSA : (FERA,TGRA, DORA, SCRA)

Quantitative Risk AssessmentQuantitative Risk Assessment

FSA( SGIA, EERA, ESRAA, TRIA)

II. 7. Formal Safety Assessment MethodologyII. 7. Formal Safety Assessment Methodology




Objectives Process

Hazard

Identification

Hazard & RiskAnalyses

Assessment of

Results

Risk Reduction

Measures

Apply ALARP

Principles

* Overall FSA Process

* Safety Goal Criteria

* Hazard Listing

* Hazard Ranking

* Consequence Studies

* Risk Assessment Studies

* Sensitivity Studies

Hazard

Documentation:

MAE’s

* Major Risk Contributor

* Potential Risk Reduction Measure

Access Acceptability

Against Criteria

* Risk Reduction Method Adopted







MULIAMULIA--HOTEL, JakartaHOTEL, Jakarta1717--19 December 200719 December 2007

MODERN SAFETYMODERN SAFETYMANAGEMENT SYSTEM &MANAGEMENT SYSTEM &RISK ASSESSMENTRISK ASSESSMENT

Ir. Alfino Alwie MScIr. Alfino Alwie MScPublic TrainingPublic Training

II.8. RISK TOOLSII.8. RISK TOOLS




• Failure Mode and Effect Analysis adalah Failure Analysis tool yang dilakukan dengan melibatkannara sumber yang dianggap ahli danberpengalaman di bidang masing-masing

• FMEA merupakan prosedur untuk melakukanevaluasi yang sistematis dari potensi-potensimodus kegagalan dan dampak yang diakibatkanoleh gagalnya suatu sistem terhadap sistem

integrasinya.• FMEA sudah memiliki format standar yang telah

dibakukan sehingga tinggal mengisi format bakutersebut

Failure Mode Effect Analysis (FMEA)Failure Mode Effect Analysis (FMEA)

TYPICAL FMEA FORMTYPICAL FMEA FORM




Funct ion :

Fun ct ional Fai lure :

Item N am e Item N o Loca l E ffe c t E nd E ffec t

P ro jec t : D a te :S ys tem : P repa red by :

S ub sys tem : C hecked by :

Issued : A pp roved by :

S hee t : o f

F A IL U R E M O D E A N D E F F E C T A N A L Y S IS

( F M E A )

I tem Ident i f icat ionF a ilu re M ode C aused by

Fai lure Ef fectS eve rity D e tec tion R em ark



FAILUREFAILURE CONSEQUENCESCONSEQUENCES




HIDDEN AND EVIDENTHIDDEN AND EVIDENT

Categories of Evident Failure Consequences• safety and environmental consequences

- Injure or kill someone- Breach of environmental standard• operational consequences

- Affect production or operation

• non-operational consequences- non safety and operational- Direct cost of repair

FAILURE CONSEQUENCESFAILURE CONSEQUENCESSAFETY AND PROACTIVESAFETY AND PROACTIVE




SAFETY AND PROACTIVESAFETY AND PROACTIVE

Does the failure mode

Cause a loss of functionWhich could injure or killsomeone

Proactive is worth doing

If it reduces the risk of The failure to tolerableLow level

If proactive task can not be found, redesign is compulsory

No

Does the FM could breach

Any known environmentalstandard

yes yesNo

(see nextChapter)

For an FM with safety or environmental

consequences, a proactive task is only worth

doing if it reduces the probability of the failure toa tolerable low level

FAILURE CONSEQUENCESFAILURE CONSEQUENCESOPERATIONAL CONSEQUENCESOPERATIONAL CONSEQUENCES




A failure has operational consequences if it has a direct

adverse effect on operational capabilityFailure affect operation in four ways :• they affect total output• they affect product quality

• they affect customer service• increase operating cost in addition to the direct cost of

repair

OPERATIONAL CONSEQUENCESOPERATIONAL CONSEQUENCES

FAILURE CONSEQUENCESFAILURE CONSEQUENCESHIDDEN FAILURE CONSEQUENCESHIDDEN FAILURE CONSEQUENCES




Hidden Failure and Protective Device

• fail-safe protective device

- “a fail safe protective device is one whose failure on its own will

become evident to the operating crew under normal circumstances”

- A system which includes a fail-safe protective device, there are three

(3) possible states

> Neither device failed

> Protected function fails before the protective device> Protective device fails before the protected function

HIDDEN FAILURE CONSEQUENCESHIDDEN FAILURE CONSEQUENCES

FAILURE CONSEQUENCESFAILURE CONSEQUENCESHIDDEN FAILURE CONSEQUENCESHIDDEN FAILURE CONSEQUENCES




HIDDEN FAILURE CONSEQUENCESHIDDEN FAILURE CONSEQUENCES

Hidden Failure and Protective Device

• non fail-safe protective device

- The fact that the device is unable to fulfill its intended function is not

evident under normal circumstances

- A system which includes a non fail-safe protective device, there are

four (4) possible states

> Neither device failed

> Protected function fails while the protective device is still

functioning

> Protective device fails while the protected function is still

functioning

> The protective device fails then protected function fails while theprotective device is in failed state (multiple)



CONTOH FMEA OUTPUTCONTOH FMEA OUTPUT




Function : 1. Mengolah ref ormed gas menjadi reformed gas dengan komposisi CH4 < 0.41% dengan T pada range 340 – 370 oC

Functional Failure : 1.1 Gagal Mengolah reformed gas menjadi reformed gas dengan komposisi CH4 < 0.41% dengan T pada range 340 – 370 oC

Item Name Item No Local Effect End Effect

Secondary Reformer D-1002 Vessel fail Creep Major Visual

Castable rontok TI

Burner tip fail Crack Cut rate Moderate TI

Kotor

Alumina ball fail Pecah Performance turun Plant Shutdow n Major PI

Deposit

Katalis fail Sintering Performance turun Plant Shutdow n Major PI, AR

Poisoning TI

Dusting

Dome katalis fail patah Plant Shutdow n Major PI

Project Pabrik Ammonia Date :

System : Reforming Prepared by :

Sub system : Secondary Reforming Checked by :

Issued : NE Approved by :

Sheet : of

FAILURE MODE AND EFFECT ANALYSIS

(FMEA)

Item IdentificationFailure Mode Caused by

Failure EffectSeverity Detection Remark

Secondary Reformertidak berfungsi

Katalis jatuh, outletbuntu

Secondary Reformer

tidak berfungsi

Safety/Plant

Shutdown

Jika terjadi leak,

kandungan gasproses memiliki sifat

f lammable

Pembakaran tidak

sempurna

Kerusakan biasanya

baru teridentifikasi

pada saat TA

Jika rusak,

penggantian sekitar

10 - 14 hari

Jika rusak,

penggantian sekitar

10 - 14 hari



Functional Block Diagram (FBD)Functional Block Diagram (FBD)

IN Interfaces




te aces

• Natural Gas – from SKG• Fuel Gas – from Utility Plant (KO Drum)• MP Steam – from Steam Header MP• Process Air – from Air Compression• Power Supply – from Utilitas (P-xxxx-1; P-xxxx-3; P-xxxx-2)• H2 – from HRU & Back End (Syn gas Compressor 1st discharge)

• Boiler Feed Water – from Utilitas (G-xxxx)• Boiler Water – from Utilitas (F-xxxx)• Sea Water Supply – from Utility Plant• Cooling Water Supply – from Utility Plant• Instrument Air – from Utility Plant

Work BreakDown Structure





OUT Interfaces

• Reformed Gas – to Shift Conversion.

• Flue Gas – to Atmosfer

• HP Steam Superheated – to Steam Header

• Boiler Feed Water – to E-xxxx & E-xxxx

• Boiler Water – to Utilitas System ( F-xxxx )• Cooling Water Return – to Utility Plant

• Sea Water Return – to Outfall





Internal OUT Interfaces

• Natural Gas – from D-xxxx to E-xxxx• Reformed Gas – from C-xxxx to D-xxxx

• Process Air – from E-xxxx to D-xxxx



Functional FailureFunctional Failure




1 Gagal mengolah reformed gas menjadi reformed gas

dengan komposisi CH4 < 0.41% dengan T pada range 340

– 370 oC

2 Gagal memanfaatkan panas reformed gas

Functional FailureFunctional Failure




1.1 Gagal mengontrol temperature

1.2 Gagal mengontrol pressure

1.3 Gagal memproteksi temperature

1.4 Gagal memproteksi tekanan

II.10. FUNCTIONAL BLOCK DIAGRAMII.10. FUNCTIONAL BLOCK DIAGRAM




II.11. REMAINING LIFE ASSESSMENTII.11. REMAINING LIFE ASSESSMENT




XY

Z

10688.

10188.

9689.

9189.

8689.

8190.

7690.

7190.

6691.

6191.

5691.

5192.

4692.

4192.

3693.

3193.

2693.

V5

L1

C1

G16

Output Set: MSC/NASTRANCase 1

Contour: Plate TopVonMises Stress

(Intangible, Difficult or

Impossible to Measure)

HIDDEN FAILURE

(Intangible, Difficult or

Impossible to Measure)

HIDDEN FAILURE

R alistic(Realistik)

Simple ( Singkat/jelas)

Measurable ( Terukur )

Achievable( Dapat dicapai)

Time frame(Batas waktu)

MaterialsDimensions

Load

MaterialsDimensions

Load

Review Service Conditions

• Stress

• Temperature

• Environment

• Etc

Review Service Conditions

• Stress

• Temperature

• Environment

• Etc

RISER PIPELINE CORROSIONRISER PIPELINE CORROSION




CORROSION On PRESSURE VESSELCORROSION On PRESSURE VESSEL




II.12. Risk Facility ProfileII.12. Risk Facility Profile




The individual risk per annum (IRPA) is calculated basedupon the number of people died per annum for each

worker;

maintenance staff secondary breaker

sealing operator

supervisor others

What are Needed for ensuring safety ? What are Needed for ensuring safety ?




• For a Simple Facility (e.g. WHP, Buoy,Pipeline, drilling rig, etc)

• Use recognised Codes and Standards.

• Good Practice.• Engineering Judgement• Standard Equipment• Qualitative Risk Assessment

• For a Complex Facility (e.g. FPSO)• As for a simple facility PLUS• Formal Safety Assessment (FSA)

• Quantitative Risk Assessment(QRA)

Some Questions in Design PhaseSome Questions in Design Phase




HOW DO WE KNOW A DESIGN IS SAFE?HOW DO WE KNOW A DESIGN IS SAFE?

HOW ARE WE SHOWING OUR DESIGN IS SAFE?HOW ARE WE SHOWING OUR DESIGN IS SAFE?

WHY DO WE WANT A SAFETY CASE?WHY DO WE WANT A SAFETY CASE?

WHAT IS IN THE SAFETY CASE?WHAT IS IN THE SAFETY CASE?

WHAT ACTIVITIES ARE THE PROJECT CARRYING OUTWHAT ACTIVITIES ARE THE PROJECT CARRYING OUT

TO SUPPORT THE SAFETY CASE?TO SUPPORT THE SAFETY CASE?

Hazard Severity CategoriesHazard Severity Categories




Description Category Definition

Catastrophic

Critical

Marginal

Negligible

I

II

III

IV

Death, system loss, or severeenvironmental damage

Severe injury, severe occupational illness,

major system or environmental damage

Minor injury, minor occupational illness, or minor system or environmental damage

Less than minor injury, occupational

illness, or less than minor system or

environmental damage

Source: U.S Department of Defense 1993, “System Safety Program Requirements” MIL-STD-882C

Qualitative Hazard Probability LevelsQualitative Hazard Probability Levels

Source: U.S Department of Defense 1993,Source: U.S Department of Defense 1993, “ “ System SafetySystem Safety




Program Requirements Program Requirements” ” MIL MIL--STDSTD--882C 882C

Level

A

B

C

D

Description

Frequent

Probable

Occasional

Remote

Improbable E

Fleet or Inventory

Continuously experienced

Will occur frequently

Will occur several time

Specific Individual Item

Likely to occur frequently

Will occur several times in the life

of an item

Likely to occur some time inThe life of an item

Unlikely but possible to occur in

the life of an item

So unlikely that it can be assumed

Occurrence may not be experienced

Unlikely but reasonably be

Expected to occur

Unlikely to occur, but

possible

PRELIMINARY HAZARD ANALYSISPRELIMINARY HAZARD ANALYSIS




PHA FORMPHA FORM




THE TERMINOLOGY for RISK STUDIES:THE TERMINOLOGY for RISK STUDIES:

1 Ri k l i th ti ti f i k f th b i




1. Risk analysis - the estimation of risk from the basicactivity “as is”.

2. Risk assessment - a review as to acceptability of risk

based on comparison with risk standards or criteria,and the trial of various risk reduction measures.

3. Risk management - the process of selecting appropriate

risk reduction measures and implementing them in the

on-going management of the activity

II.10. Reliability Block Diagram AnalysisII.10. Reliability Block Diagram Analysis




• RBD adalah salah satu metoda reliability modeling, yang bertujuanuntuk menanalisa dan mengambarkan kehandalan sistem secarakeseluruhan

• RBD dapat menggambarkan secara grafis tentang hubungan /

interaksi antar komponen dalam suatu integrated system dimanapengaruh kehandalan setiap komponen individu dapat dilihatdampaknya terhadap kehandalan integrated system.

• Komponen-komponen tersebut disusun berdasarkan blok-blok, dan

terhubungkan dengan suatu logical gate system

ContohContoh Reliability Block Diagram (RBD)Reliability Block Diagram (RBD)




DD

AA

BB

A,B,..: Components

Numbers: availability

II.11. Fault Tree Analysis (FTA)II.11. Fault Tree Analysis (FTA)




• FTA juga merupakan suatu metoda dalam melakukan Reliability

Modeling

• FTA mendefinisikan suatu top event, yang diikuti oleh

penidentifikasian komponen-komponen dari sistem itu yang dapat

berkontribusi pada terjadinya top event

• Setiap komponen ini dihubungkan dalam suatu symbolic logic

diagram with AND/OR gates

CONTOH: PIPELINE OUTAGE FTACONTOH: PIPELINE OUTAGE FTA




Advanced MethodAdvanced Method

II.12 Root Causes Analysis (RCA)II.12 Root Causes Analysis (RCA)




Failure

Events

Failure

Events

• Principal Analyst

Required

• Involves All Levels

• Part Time/Full Time

• Root Cause Analysis

• Extremely Disciplined/High

Attention to Detail

Significant Few LossesSignificant Few Losses

• Hourly/Supervisory

Level

• Part Time

• Problem Analysis &

Problem Solving Skills

• Less Attention to Detail

Matters Of Consequence

100% Coverage

RCA

Methods

Basic

Failure

AnalysisBasic Failure Analysis

Is Sporadic Failure is more costly than Chronic Events?

Don’t Unresolved Chronic issues lead to those Catastrophic, Sporadic Events

D il P d tiD il P d ti




Daily ProductionDaily Production

100,000

50,000

Time

Status Quo

}

Sporadic Failures

Reactive

Chronic Failures

Proactive

Opportunities

JUST WHAT WILL RCA DO FOR YOU AND JUST WHAT WILL RCA DO FOR YOU AND

YOUR COMPANY? YOUR COMPANY?

MinimizeMinimizess Consequences of Events to CriticalConsequences of Events to CriticalE i t




MinimizeMinimizess Consequences of Events to CriticalConsequences of Events to CriticalEquipmentEquipment

ReducesReduces thethe Cost of Poor QualityCost of Poor Quality

ReducesReduces thethe Defects inDefects in thethe Final ProductFinal Product

ArrivesArrives atat Opportunities for ImprovementOpportunities for ImprovementFocusFocuseses on Priority Issues Using GAP andon Priority Issues Using GAP and

Opportunity AnalysisOpportunity Analysis

EliminatesEliminates thethe Risk of Problem/Event RecurrenceRisk of Problem/Event Recurrence

CAN YOU IDENTIFY EVERY CHRONIC EVENT INCAN YOU IDENTIFY EVERY CHRONIC EVENT IN

YOUR OPERATIONS? YOUR OPERATIONS?

CAN YOU PUT A DOLLAR FIGURE TO THEM?CAN YOU PUT A DOLLAR FIGURE TO THEM?

Advanced Advanced RCARCA forfor MajorMajor EventsEvents




1. Describe the Failure Event

2. Describe the Failure Modes

3. Hypothesize

4. Verify the Hypotheses

5. Determine Physical Rootsand Verify

6. Determine Human Roots

and Verify

7. Determine Latent Roots

and Verify

Impact

First

EffortSecond

Chronic Conveyor

Roller Problems

Thus avoiding Trial and Error on the Front LineBasicBasic FailureFailure Analysis Analysis forfor MinorMinor EventsEvents




IMPACT

E F F O R T

LOW

1

MEDIUM

3

HIGH

5

Hard

5

Moderate

3

Easy

1

1 - 5 3 - 5 5 - 5

1 - 3 3 - 3 5 - 3

1 - 1 3 - 1 5 - 1 Is it either this,

or that?

Recommendations

Step 1

Generate a list of problems/events and

slot them into the priority matrix

Step 2Define your problem/event usingthe TOP BOX

Step 4

Make recommendations thatstate the problem/event, its

impact and your solution to theproblem/event based on youranalysis.

Step 3

Formulate a hypothesis for each leg

of the tree using the either/ortechnique and verify.

Have you seen

this happen

before?

Bearing

LeakageCorrosion Blown

SealsMaterial

Buildup

Heavy Objects

Fall On RollersHot

Bearings



3 RISK ASSESSMENT &





3. RISK ASSESSMENT &MITIGATION

3.13.1 FOREWORDFOREWORD

Adapted from ‘Risk

Risk Assessment Element

Risk UnderstandingRisk Understanding




Assessment Method’, ABS

GeneratorTurbine

Production

WellGeothermal Zone

Injection Well

Air andWater Vapor

Air Air

Water

Waste Brine

Steam Steam

Direct Heat Uses

Risk UnderstandingRisk Understanding

What can go wrong?What can go wrong?How likely is it?How likely is it? What are the impacts?What are the impacts?

HistoricalHistorical

Experience?Experience?

Foundation for Risk Assessment

Analytical Analytical

MethodMethod

KnowledgeKnowledge

JudgmentJudgment

Ri k A t M th dRisk Assessment Methods

3.23.2 RISK ASSESSMENT METHODSRISK ASSESSMENT METHODS




Risk Assessment MethodsRisk Assessment Methods

HazzardHazzard

IdentificationIdentification

MethodsMethods

FrequencyFrequency

AssessmentAssessment

MethodsMethods

ConsequenceConsequence

AssessmentAssessment

MethodsMethods

RiskRisk

EvaluationEvaluation

MethodsMethods

Literaturature

Search

What If Review

Safety Audit

Walk Through

Checklist

Brainstorming

HAZOP

FMEA

HAZID

Historical

Records

Fault Tree

Analysis

Even Tree

Analysis

Human

Reliability

Analisis

Common Cause

Failure Analysis

Source Term

Models

Atmospheric

Dispersion

Models

Blast And

Thermal

Radiation Models

Aquatic

Transport

ModelsEffect Models

Mitigation

Models

Risk Matrix

F - N Curve

Risk ProfileRisk Isopleth

Risk Density

Curve

Risk Index

3.3. Redundancy in Critical Systems3.3. Redundancy in Critical Systems

If a hazard analysis identifies accidents that can be causedby the failure of a single component redundant componentsIf a hazard analysis identifies accidents that can be causedby the failure of a single component redundant components




yby the failure of a single component, redundant components

should be installed

Examples of critical components:

Flow-regulators, valves, exhaust fans, pumps,

compressors.

Redundant systems must be completely independent

Examine conditions which may adversely affect a given layer

of defense at the same time that they produce a safety

challenge to that layer

(Such conditions in complex systems can be studied with

Fault Tree Analysis)

yby the failure of a single component, redundant components

should be installed

Examples of critical components:

Flow-regulators, valves, exhaust fans, pumps,

compressors.

Redundant systems must be completely independent

Examine conditions which may adversely affect a given layer

of defense at the same time that they produce a safety

challenge to that layer

(Such conditions in complex systems can be studied with

Fault Tree Analysis)

Redundancy in Critical Systems




> If a hazard analysis identifies accidents that can be caused by the failure of a

single component, redundant components should be installed

> Examples of critical components:

Flow-regulators, valves, exhaust fans, pumps, compressors.> Redundant systems must be completely independent

> Examine conditions which may adversely affect a given layer of defense at the

same time that they produce a safety challenge to that layer

(Such conditions in complex systems can be studied with Fault Tree Analysis)

3.4 Hazard Reduction (Design Phase)3.4 Hazard Reduction (Design Phase)

NASA (1993) mengembangkan hirarki dari hazard reductionyang antara lain;




( ) g gyang antara lain;

o Design out the hazard

o Safety Devices

o Warning Devices

Hazard Reduction (Design Phase, (contn’d))

o Safety Devices




o Safety Devices

• Berdasarkan Design Philosophy (Fails safe)

• Pada chemical plant umumnya concern pada temperatur (Valve, fail open)

o Warning Devices

• Smoke Detector, ---- alarm

• Gas detector, i.e, ammonia, hydrocarbon

fuels, hydrogen, methane, etc

• buzzer --- ammonia, siren --- nitrogen

StandardsStandards

• ProductM t i l Ch i l /P l /M t l




• Materials; Chemicals/Polymer/Metals• Process• Management system standards

• Prescriptive• Performance

HUMAN FACTORSHUMAN FACTORS




MODELS:

♠ Accuracy

♠ Consistency

♠ Usefulness

♠ Resources

HEART (Human Error Assessment & Reduction Technique)

Developed by J.C Williams during early 1980s

Task Probability of error

Totally unfamiliar, perform at speed, no idea of outcome 0.55

HUMAN FACTORSHUMAN FACTORS




Restore system to new or original on a single attempt 0.26

without supervision or procedure checks

Complex task requiring high level of comprehension and 0.16

skill

Fairly simple task performed rapidly or given scant 0.09

attention

Routine highly practised, rapid task involving relatively 0.02

low level of skill

Restore system to new state following procedure checks 0.003

Totally familiar task, performed several times per hour, 0.0004

well motivated, highly trained staff, time to correct errors

Respond correctly when there is augmented supervisory 0.00002

system providing interpretation 0.03

Miscellaneous task - no description available

3.3 AN ILLUSTRATION EXAMPLE:

THE PROPELLANT TANK




Adapted from ‘Probabilistic Risk Assessment’, NASA

3.6 ELEMENTS OF PROBABILISTIC3.6 ELEMENTS OF PROBABILISTIC

RISK ASSESSMENTRISK ASSESSMENT1. Setting the scenarios:





ELEMENTS OF PROBABILISTIC RISK ASSESSMENT

(Cntn’d)Application of Event Trees





EVENT TREE MODEL

Example of Event Tree on Hydrazine leak:





4. Modeling of Pivotal Events

FAULT TREE MODEL





Quantification of Basic Event.

Basic events corresponding to component failure may be quantified using reliability models. A simple andid l d d l i th ti l di t ib ti th t i b d th ti f t t ti t f il


(Cntn’d)




widely used model is the exponential distribution that is based on the assumption of constant time-to-failure

Exponential Distribution Model ( Prf (t) = 1− exp(−λt) for λ=0.001 per hour))


5. Quantification POF of Basic Events.


(Cntn’d)




6. Uncertainty Analysis


(Cntn’d)




Example Illustration on Application of Bayes Theorem


Example Illustration Results on All Probabilities Being Quantified:






MODERN SAFETYMODERN SAFETYMANAGEMENT SYSTEM &MANAGEMENT SYSTEM &








Protect Your EnvironmentProtect Your Environment

RISK ASSESSMENTRISK ASSESSMENT

Ir. Alfino Alwie MScIr. Alfino Alwie MScIr. Alfino Alwie MSc

• What the impact of industry on the environment?

• How can we control pollution and waste?

4.1 How can you answer the following Questions?4.1 How can you answer the following Questions?




• How can we control pollution and waste?

• What are the main elements of an environmental management system

• Air quality

• Water quality

4.2. Five Issues4.2. Five Issues




Water quality

• Waste reduction & management

• Energy consumption

• Protection of natural areas & corridors

• It can be a condition of getting a license to operate

• It enables effective cost control

4.3. Some Key Benefits of an EMS for your Organization4.3. Some Key Benefits of an EMS for your Organization




It enables effective cost control

• It gives better access to product and capital markets

• It improves relations with general public

Coincident or Not ?Coincident or Not ?

If,A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Equals,




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Then,

K + N + O + W + L + E + D + G + E11 + 14 + 15 + 23 + 12 + 5 + 4 + 7 + 5 = 96%

H + A + R + D + W + O + R + K8 + 1 + 18 + 4 + 23 + 15 + 18 + 11 = 98%

Both are important, but the total falls just short of 100%

But, A + T + T + I + T + U + D + E1 + 20 + 20 + 9 + 20 + 21 + 4 + 5 = 100%

Safety really is about attitude. Make 100% Safe Behavior your choice

both ON and OFF the job



CASE STUDY:Risk Analysis of Heat ExchangerRisk Analysis of Heat Exchanger





Risk Analysis of Heat Exchanger Risk Analysis of Heat Exchanger




GOALSGOALS

• To predict the heat exchanger risk, based on its life data analysis

• To manage the risk heat exchanger at low level by constituting the




g g y g

inspection interval

HEAT EXCHANGER DATAHEAT EXCHANGER DATA

P d




• Processed Gas: Frigorif NH3

• Coolant: Seawater

• Date of Manufactured: 1975

• Design Temp (o

C) / Pressure (kg/cm2

):- Shell side: 72/20

- Tube Side: 67/45

Seawater

ProcessedGas

ASSUMPTIONS AND FACTS ASSUMPTIONS AND FACTS

• Historical failure follows Weibull Distribution• Turn Around (TA) is scheduled every 2 years• Suspected failure modes:




p- Fouling- Tube leak due to local / pitting corrosion

- Tube leak due to crack• Mechanical Cleaning is conducted every TA due to Fouling• The minimum remaining tube thickness, is judged, should be 60% of the initial thickness

due to the heat transfer effectiveness

HISTORICAL FAILURE DATA

Tubing Failures:

Start: 1993

# of Tubes 3260




Tube Failure of HX

0

106122

0

44

68

0

20

40

60

80

100

120

140

Aug-95 Jul-97 Sep-98 May-01 Mar-03 Mar-05

In-service Time

# o

f T u b e s

Date of Failure Failure Mode

Aug-95 OK

Jul-97Tube buntu dan penipisan

tube total 106, di plug

Sep-98

1 bocor pada lasan tube. 122

ea plug dari 3260 atau

3.7% di plug

May-01 Tidak ada Bocor, OK

Mar-03

Utara 44 ea, ptm 9 ea, plug

lama 137 ea. Status

terakhir retubing 37tube, total plug 153 ea.

Mar-05

Utara 68 ea, ptm 9 ea, plug

lama 148 ea. Status

terakhir retubing 77

tube, total plug 148 ea.

RISK CRITERIARISK CRITERIA

< 10-5 10-5-10-4 10-4-10-3 10-3-10-2 >10-2

Insignificant

•

No safety or environmental

consequences•

Process capability not impacted.

(<US$10.000)

Mi di l t t t fi t Mi l f d ti it

Severity

Level

Safety and Environmental

Aspect CriteriaBusiness Aspect Criteria

Acceptable PoF(per year)




•

Minor medical treatment or first

aid for Plant personnel•

Minor loss of production capacity

(<10%) for short term (<48 hours),

(US$10.000 – US$100.000)

•

Non reportable environtment

incident

• Medical treatment for personnel • Loss production capacity (10 –

50%) for short term (< 48 hours)

•

Minor reportable environmental

incident• Minor Loss of production

capacity (<10%) for long term (>48

hours)

•

Financial impact at a unit level

(US$100.000 – US$1.000.000)

•

Death of one company orassociated person

• Signifcant loss productioncapacity (50–100%) for short term

(< 48 hours)

•

Severe injury or illness of

multiple plant personnel, Limited

impact on public safety

•

Loss of production capacity (<1

–50%) for long term (>48 hours)

•

Major reportable environmental

incident• Financial impact at a facility level

(US$1.000.000 – US$10.000.000)

•

Multiple fatalities of companyor associated personnel

•

Major production loss

•

Severe injury, illness, or

fatalities of one or more members

of the community, serious impact

on public safety

• Financial impact at corporate

level (US$10.000.000 –

US$100.000.000)

•

Catastrophic environmental

Catastrophic

Minor

Moderate

Major

CONSEQUENCE ASSESSMENT OFCONSEQUENCE ASSESSMENT OF TUBE FAILURETUBE FAILURE

• This equipment has become the plant shutdown item, i.e. whenever the problemoccurs in this equipment, it may cause to stop production

f f




• There is no safety and minor environmental issues on the equipment failure,Only business issues become the concern

• The shutdown duration depends on the type of failure mode occurred• Tube leaks is estimated to cause 5-day shutdown period, and it was defined asMajor Consequences (Production Loss > 2 Days)

POF ANALYSISPOF ANALYSIS

• Equipment Failure follows the Weibull Distribution




⎥⎥⎦

⎤

⎢⎢⎣

⎡

⎟⎟ ⎠

⎞

⎜⎜⎝

⎛

−−=

β

η

t

t F exp1)(

)()( t T Pt F <= Shape factorScale factor

Need to bedefined!

Cumulative Probability Distribution Function

POF ANALYSIS (CONTINUED)POF ANALYSIS (CONTINUED)

Weibull Line Fit Plot

Time of Failure

(Months)

45

59




-1.5

-1

-0.5

0

0.5

1

5.2 5.4 5.6 5.8 6

Cycles

R a n k

⎥

⎥

⎦

⎤

⎢

⎢

⎣

⎡

⎟⎟

⎠

⎞⎜⎜

⎝

⎛ −−=

β

η

t t F exp1)(

LN(1/(1-F(t))) = (t/η)β

LN(LN(1/1-F(t))) = β.LN(t) – β.LN(η)

Y = β.X + α

123

147

PoFPoF Analysis (Continued) Analysis (Continued)

SUMMARY OUTPUT

Regression Statistics

Multiple R 0.959343016

R Square 0.920339023




Adjusted R Square 0.880508534

Standard Error 0.348343886

Observations 4

ANOVA

df SS MS F Significance F

Regression 1 2.803810033 2.803810033 23.10639543 0.040656984

Residual 2 0.242686926 0.121343463

Total 3 3.046496959

Coefficients Standard Error t Stat P-value Lower 95% Upper 95% Lower 95.0% Upper 95.0%

Intercept -7.985080357 1.571457943 -5.081319797 0.036615972 -14.74652287 -1.223637841 -14.74652287 -1.223637841

X Variable 1 1.697833705 0.353206795 4.806911215 0.040656984 0.178106465 3.217560945 0.178106465 3.217560945

Shape Factor, β: 1.697833705

Scale Factor, η: 110.2884504

RESIDUAL OUTPUT

Observation Predicted Y Residuals

1 -1.522000478 -0.230893796

2 -1.062099851 0.345382602

3 0.185208437 -0.235474585

4 0.487844292 0.12098578

PoFPoF Analysis (Continued) Analysis (Continued)

Shape Factor, β: 1.70

Scale Factor, η: 110.29 Cumulative PoF of HX Tube Failure




⎥⎥

⎦

⎤

⎢⎢

⎣

⎡

⎟⎟ ⎠

⎞⎜⎜⎝

⎛ −−=

β

η

t t F exp1)(

)()( t T Pt F <=

0.00E+00

2.00E-01

4.00E-01

6.00E-01

8.00E-01

1.00E+00

1.20E+00

0 50 100 150 200 250 300

In-service time, in Months

P r o b a b i l i t y ,

i n %

Equipment Risk MatrixEquipment Risk Matrix

Severity Level: Major

PoF Target: 1x10-4

– 1x10-3

/th




< 10-5 10-5-10-4 10-4-10-3 10-3-10-2 >10-2

Insignificant

•

No safety or environmental

consequences•

Process capability not impacted.

(<US$10.000)

•

Minor medical treatment or first

aid for Plant personnel•

Minor loss of production capacity

(<10%) for short term (<48 hours),

(US$10.000 – US$100.000)

•

Non reportable environtment

incident

• Medical treatment for personnel • Loss production capacity (10 –

50%) for short term (< 48 hours)

•

Minor reportable environmental

incident• Minor Loss of production

capacity (<10%) for long term (>48

hours)

•

Financial impact at a unit level

(US$100.000 – US$1.000.000)

•

Death of one company or

associated person• Signifcant loss production

capacity (50–100%) for short term

(< 48 hours)

•

Severe injury or illness of

multiple plant personnel, Limited

impact on public safety

•

Loss of production capacity (<1

–50%) for long term (>48 hours)

•

Major reportable environmental

incident• Financial impact at a facility level

(US$1.000.000 – US$10.000.000)

•

Multiple fatalities of company

or associated personnel•

Major production loss

•

Severe injury, illness, or

fatalities of one or more members

of the community, serious impact

on public safety

• Financial impact at corporate

level (US$10.000.000 –

US$100.000.000)

•

Catastrophic environmental

Acceptable PoF(per year)

Minor

Moderate

Major

Catastrophic

Severity

Level

Safety and Environmental

Aspect CriteriaBusiness Aspect Criteria

Criteria beingmet Low Risk

MediumRisk

HighRisk

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Modern Safety Management System & Risk Assessmentrisk Assessment Mix