Text For Citation: 03 Item/Group: 015 Hazard: REFINERY

29 CFR 1910.119(l)(1) The employer shall establish and implement written procedures to manage changes (except for "replacements in kind") to process chemicals, technology, equipment, and procedures; and changes to facilities that affect a covered process. A. The employer did not ensure that an MOC was completed for upgrades to the control room. This violation was identified during inspections of the facility from November 2009 to March 2010, Silver Eagle Refining Inc., 2355 South 1100 West, Woods Cross, UT, 84087. The main control room was located within process units. In response to document request 1-UOSH-218, the employer stated "In connection with its re-start of the #1 Crude Unit, Silver Eagle revalidated it's PHA for the #1 Crude Unit. In the context of that revalidation, Silver Eagle thoroughly addressed the management of change issues associated with the control room upgrade. Those issues were incorporated into the revalidation of the PHA." The employer could not provide an MOC for the control room upgrades. Although incorporated into the PHA, the employer did not fulfill the requirement of completing a written MOC. By not completing and following MOC procedures, critical items such as improving the ventilation system were not identified and addressed. As a result, the ventilation system has still not been upgraded to prevent it from drawing in flammable or hazardous vapors. By not completing a written MOC, the employer was deprived of information used in current and future repairs/retrofits. As a result, employees were exposed to potentially hazardous situations that can result in serious injury or death. This may be a system-wide occurrence that requires evaluation of all changes (except for "replacements in kind") throughout the facility.