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Accident Report Detail

Accident: 909499 - Employees Hospitalized After Exposure To Chemical

Accident: 909499 -- Report ID: 0454510 -- Event Date: 01/14/1993
InspectionOpen DateSICEstablishment Name
12046928301/14/19932869Albright & Wilson Americas
At approximately 9:30 a.m. on January 14, 1993, a chemical release occurred when an employee added the wrong material to a reactor vessel during the start-up phase for producing chloralkyl phosphite. An exothermic reaction took place in the vessel and the vent piping, causing an over pressurization throughout the vessel, circulation system, and vent piping. Two discs ruptured and released the material into the atmosphere. The material also escaped from expansion seals in the vent piping and from the gasket seals at the circulation dump, agitator, and the bottom of the reactor vessel. The cooling jacket that surrounds the reactors ruptured when the cooling water that was applied changed to steam and pressure built up inside the jacket. As a result of the release, Employees #1 and five coworkers were exposed to the chemicals. Employee #1 was treated for skin contact injuries and taken to a medical facility for evaluation. The apparent cause of the accident was employee error. The employee was inadequately trained on start-up of a vessel. Citations were issued for violations of training and maintenance under 1910.119 (a repeat violation). Recommendations were made for other parts of the 1910.119 standard that were under a settlement agreement and therefore not cited, such as operating procedures, work protection, mechanical integrity programs, and management of change programs.
Keywords: inadequate maint, work rules, toxic atmosphere, inexperience, chemical reaction, high pressure, skin, overexposure, untrained
Employee # Inspection Age Sex Degree Nature Occupation
1 120469283 Non Hospitalized injury Other Occupation not reported

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