Incident Investigation

Developing, sustaining, and enhancing the organization's incident investigation competency is one of four elements in the RBPS pillar of learning from experience. The characteristics of an effective incident program and how organizations might begin to enhance their own incident investigation process, can be found in this Introduction to Incident Investigation.

More information regarding incident investigation, check out CCPS' Guidelines on learning from experience.

Critical Alarm Management : Connecting the Dots

Conference Presentation
Global Congress on Process Safety
Tuesday, April 3, 2012 - 12:00am
In the aftermath of some high profile national security incidents, investigations starting with the catastrophe or near miss and working backwards...

Management of Change: Quality Implementation and Performance

Conference Presentation
Global Congress on Process Safety
Monday, April 2, 2012 - 12:00am
It is often said that the only thing which is permanent in this world is change. In the process industry, as elsewhere, change is a main lever for...

Acid Release From Catalyst Tanks

Conference Presentation
Global Congress on Process Safety
Tuesday, March 15, 2011 - 8:00pm
This is the story of how the cumulative effects of several seemingly innocent changes to a catalyst system resulted in a near miss Process Safety...

Incident Investigation- Addressing Common Oversights

Conference Presentation
Global Congress on Process Safety
Monday, March 14, 2011 - 8:00pm
Principles of incident investigation may be used in daily process troubleshooting and near miss events to identify root cause. Identifying and...

Explosion at T2 Laboratories

Archived Webinar
Sep 22, 2010
This webinar discusses the CSB investigation and findings related to the explosion and chemical fire at T2 Laboratories, Inc. in December 2007.

Investigation of an Explosion in a Gasoline Purification Plant

Conference Presentation
Global Congress on Process Safety
Tuesday, March 23, 2010 - 8:00pm
On May 24, 2007 an explosion and subsequent fire destroyed a tank farm located at a gasoline purification plant in Sløvåg, Norway. In addition to the...

Consequence Modeling of Chlorine Release

Conference Presentation
Global Congress on Process Safety
Monday, March 22, 2010 - 8:00pm
This paper describes the Consequence Modeling of Chlorine release from a Chlor Alkali plant as a part of Process Hazard Analysis. The objective was...

Case Histories and Lessons Learned

Conference Presentation
Global Congress on Process Safety
Wednesday, April 29, 2009 - 9:30am
Reviews of process safety incidents and near misses provide valuable learning opportunities. Papers dealing with incidents, near misses, and the...

Fire, Explosion, & Quantitative Analysis

Conference Presentation
Global Congress on Process Safety
Tuesday, April 28, 2009 - 11:30am
Fires and explosions result in the largest losses in process safety accidents. The increased sensitivity by industry, regulatory, and public sectors...

Safety Culture and Operational Discipline

Conference Presentation
Global Congress on Process Safety
Monday, April 27, 2009 - 9:30am
This session focuses on the cultural aspects of a successful Process Safety program. Papers that are presented cover new and innovative ideas on...

My Neighborhood Radioactive Waste Dump

February 22, 2016
Like so many of us, I jog through my neighborhood in pursuit of 10,000 steps a day. My urban journey through Queens, NY, is a slow blur of delis, liquor marts, and grocery stores...

Incidents That Define Process Safety

March, 2008
Incidents That Define Process Safety describes approximately fifty incidents that have had a significant impact on the chemical and refining industries' approaches to modern process safety. Events are described in detail so readers get a fundamental understanding of the root causes, the...

Guidelines for Investigating Chemical Process Incidents, 2nd Edition

March, 2003
This book provides a valuable reference tool for technical and management personnel who lead or are a part of incident investigation teams. This second edition focuses on investigating process-related incidents with real or potential catastrophic consequences. It presents on-the-job information,...

CEP: Process Safety Beacon - Mechanical Integrity of Tubing

Process Safety Beacon
Proper installation, maintenance, and inspection of metal tubing is important in preventing fires and toxic material releases in process plants. Do not forget about tubing just because it is usually small. Even a small leak can cause a fire that can...

Conduct an Effective Incident Investigation

Frederick T. Dyke
Information that can reveal the root cause of an incident resides in many places — within the plant or process unit, in control rooms and offices, and even in witnesses’ minds. Here’s how to find the data and conduct effective witness interviews.

RELEASE: A Model with Data to Predict Aerosol Rainout in Accidental Releases

March, 1998
This book documents CCPS's Aerosol Research Program to develop a model to predict liquid rainout from release of a pressurized, liquefied gas--and, hence the residual amount of material in a vapor cloud, which may be greater than the amount calculated from an enthalpy chart. RELEASE predicts the...

Nitrogen — Hazard and Safeguard

Process Safety Beacon
This Beacon is not focused on a single incident, but on incidents that continue to occur across industry — nitrogen asphyxiation.
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