Abstract: On Sunday, January 21, 1990, at approximately 5:10 a.m., Employee #1, a licensed tankerman, was employed by Riverside Marine Services, which was contracted to off load a barge containing isobutane at the BP Oil Refinery (dockside) in Belle Chasse, LA. The barge had been off loaded, and Employee #1 had disconnected the flange on the Chiksan south marine arm, which was the vapor line, from the barge and was storing the arm on the dock. Three Crosby fist grip clips were attached to the 0.625-inch wire rope retaining line. The clips came off the wire rope, allowing the marine arm to swing violently back and forth. The lower end of the arm, the flange end, struck Employee #1 in his right chest and killed him. Upon investigation, it was found that a stud on one of the clips did not have a nut on it and the paint on the clip did not indicate that a nut was ever on the bolt. The remaining clip bolts had very little paint scrapings, indicating that the nuts were never fully torqued either at the factory or upon installation at the refinery. Once any weight was applied to the retaining cable, the fist grip clips could not hold the weight and the wire rope slipped, allowing the marine arm to swing.