Journal of the Korean Society of Safety (한국안전학회지)

The Korean Society of Safety (한국안전학회)
권호 표지
DOI QR코드

DOI QR Code

A Study on the Analysis of Human-errors in Major Chemical Accidents in Korea

국내 화학사고의 휴먼에러 기반 분석에 관한 연구

  • Park, Jungchul (Department of Safety Engineering, Korea National University of Transportation) ;
  • Baek, Jong-Bae (Department of Safety Engineering, Korea National University of Transportation) ;
  • Lee, Jun-won (Korea Occupational Safety & Health Agency) ;
  • Lee, Jin-woo (Korea Occupational Safety & Health Agency) ;
  • Yang, Seung-hyuk (Korea Occupational Safety & Health Agency)
  • Received : 2017.12.05
  • Accepted : 2018.01.05
  • Published : 2018.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

This study analyses the types, related operations, facilities, and causes of chemical accidents in Korea based on the RISCAD classification taxonomy. In addition, human error analysis was carried out employing different human error classification criteria. Explosion and fire were major accident types, and nearly half of the accidents occurred during maintenance operation. In terms of related facility, storage devices and separators were the two most frequently involved ones. Results of the human error-based analysis showed that latent human errors in management level are involved in many accidents as well as active errors in the field level. Action errors related to unsafe behavior leads to accidents more often compared with the checking behavior. In particular, actions missed and inappropriate actions were major problems among the unsafe behaviors, which implicates that the compliance with the work procedure should be emphasized through education/training for the workers and the establishment of safety culture. According to the analysis of the causes of the human error, the frequency of skill-based mistakes leading to accidents were significantly lower than that of rule-based and knowledge based mistakes. However, there was limitation in the analysis of the root causes due to limited information in the accident investigation report. To solve this, it is suggested to adopt advanced accident investigation system including the establishment of independent organization and improvement in regulation.

Keywords

References

  1. Ministry of Employment and Labor of Korea, "Prevention Strategies for Major Industrial Accidents", August 2017.
  2. Ministry of Employment and Labor of Korea, "Prevention Strategies for Major Chemical Accidents", May, 2013.
  3. T. E. McSween, "The Values-Based Safety Process: Improving Your Safety Culture with Behavior-Based Safety", Wiley, 2003.
  4. D. H. Kim, "Study on Human Error Analysis of Chemical Plants", KOSHA Occupational Safety and Health Research Institute, 1999.
  5. CCPS (Center for Chemical Process Safety), "Guidelines for Investigating Chemical Process Incidents", 2003.
  6. J. B. Baek, "A Study on the Measurement of Process Safety Culture for Improvement of Status to Process Safety Management", KOSHA Occupational Safety and Health Research Institute, 2003.
  7. J. K. Park, "A Study on the Improvement of the Chemical Accident Response System", Korea Environment Institute, 2013.
  8. H. S. Lee and J. P. Yim, "A Study on Prevention Measure Establishment through Cause Analysis of Chemical-Accidents", J. Korean Soc. Saf., Vol. 32, No. 3, pp. 21-27, 2017. https://doi.org/10.14346/JKOSOS.2017.32.3.21
  9. A. Graziano, A. P. Teixeira and C. Guedes Soares. "Classification of Human Errors in Grounding and Collision Accidents using the TRACEr Taxonomy", Safety Science, Vol. 86, pp. 245-257, 2016. https://doi.org/10.1016/j.ssci.2016.02.026
  10. S. C. Theophilus, V. N. Esenowo, A. O. Arewa, A. O. Ifelebuegu, E. O. Nnadi and F. U. Mbanaso, "Human Factors Analysis and Classification System for the Oil and Gas Industry (HFACS-OGI)", Reliability Engineering and System Safety, Vol. 167, pp. 168-176, 2017. https://doi.org/10.1016/j.ress.2017.05.036
  11. Y. S. Yoon, D.-H. Ham and W.-C. Yoon, "Application of Activity Theory to Analysis of Human-related Accidents: Method and Case Studies", Reliability Engineering and System Safety, Vol. 150, pp. 22-34, 2016. https://doi.org/10.1016/j.ress.2016.01.013
  12. National Institute of Advanced Industrial Science and Technology (AIST) and Japan Science and Technology Corporation (JST), RISCAD (Relational Information System for Chemical Accidents Database), http://riscad.db.aist.go.jp/PHP_EN/.
  13. J. Park, J. B. Baek, I. G. Hong, J. H. Kim and S. K. Hong, "Techniques and Management Strategies for Preventing Human-error Related Chemical Accidents", KOSHA Chemical Material Center, 2012.
  14. CCPS (Center for Chemical Process Safety), "Guidelines for Preventing Human Error in Process Safety", American Institute of Chemical Engineers, 2004.
  15. HSE, "Reducing error and influencing behaviour 2nd ed. HSG48", 1999.
  16. D. E. Embrey, "Techniques for auditing and reducing risk from human error", In Ergonomics in the Process Industries, IChemE, North-Western Branch Papers No. 5, Rugby, 1993.
  17. J. Rasmussen, "Skills, rules, knowledge; signals, signs, and symbols, and other distinctions in human performance models", IEEE Transactions on Systems, Man and Cybernetics, Vol. 13, pp. 257-266, 1983.
  18. R. J. Taylor, "Human Error in Process Plant Design and Operations - A Practitioner's Guide", CRC Press, 2016.
  19. KOSHA, "Survey Results of Factories with Old Facilities", 2014.
  20. J. Reason, "Human Error", Cambridge University Press, 1990.
  21. I. G. Hong, J. B. Baek, "A Qualitative Study on Safety Rule Violation Motives at Manufacturing Plants", J. Korean Soc. Saf., Vol. 31, No. 2, pp. 133-142, 2016 https://doi.org/10.14346/JKOSOS.2016.31.2.133
  22. S. Dekker, "The Field Guide to Understanding Human Error", Ashgate, 2006.