NTSB Safety Recommendation P-84-034

NTSB safety recommendation P-84-034.

THE NTSB RECOMMENDS THAT THE WASHINGTON GAS LIGHT COMPANY: DEVELOP AND IMPLEMENT THE USE OF CHECKLISTS FOR ALL WORK PROJECTS IN WHICH ACTIONS MUST BE TAKEN IN AN ORDERED SEQUENCE TO AVERT SAFETY HAZARDS.

Priority: CLASS II

Overall Status: Closed - Acceptable Action

Issued Date: 1984-08-23

Adopted Date: 1984-08-09

Overall Date Closed: 1985-08-19

Synopsis: ON OCTOBER 13, 1983, SEVEN EMPLOYEES OF THE WASHINGTON GAS LIGHT COMPANY WERE ASSIGNED TO PERFORM REQUIRED ANNUAL OPERATING AND MAINTENANCE INSPECTIONS ON A FLOW CONTROL VALVE AND A PRESSURE CONTROL VALVE AT ITS HERNDON GATE STATION IN FAIRFAX COUNTY, VIRGINIA. AS PART OF THE WORK TO BE DONE, THE EMPLOYEES DISCONNECTED THE GAS CONTROL SIGNAL LINE AND REMOVED THE BOLTS OF THE FLOW CONTROL VALVE BONNET BEFORE INSPECTING THE PIPE SEGMENT CONTAINING THE CONTROL VALVES TO INSURE THAT IT HAD BEEN ISOLATED AND VENTED PROPERLY. AT 10:13 A.M., WHILE TRYING TO REMOVE THE VALVE BONNET, NATURAL GAS AT ABOUT 150 PSIG BLEW THE BONNET UPWARD, AND GAS FILLED THE ENCLOSED PORTION OF THE BUILDING IN WHICH THE EMPLOYEES WERE WORKING. THE EMPLOYEES WITHIN THE STATION FLED OUTSIDE TO SAFETY; HOWEVER, THE FOREMAN REENTERED THE BUILDING. MOMENTS LATER, AT 10:18 A.M., GAS WAS IGNITED AND EXPLOSION AND FIRE, FOLLOWED DEMOLISHING THE BUILDING. THE FOREMAN WAS KILLED AND TWO EMPLOYEES RECEIVED MINOR INJURIES. THE CIRCUMSTANCES OF THIS ACCIDENT, AS WELL AS THOSE INVOLVED IN THE OCTOBER 29, 1982, ACCIDENT AT BURKE, VIRGINIA, INDICATE THE NEED FOR BETTER TRAINING OF WGL EMPLOYEES TO SUPPORT THEIR UNDERSTANDING OF PROCEDURES AND TO BE ALERT TO THE POTENTIAL CONSEQUENCES WHEN SUCH PROCEDURES ARE NOT CARRIED OUT EXPLICITLY. WHILE THE SAFETY BOARD IS PLEASED THAT WGL HAS INTENSIFIED TRAINING GIVEN TO ITS TRANSMISSION AND DISTRIBUTION DEPARTMENT EMPLOYEES, AN EQUALLY INTENSIVE EFFORT APPEARS NEEDED FOR ALL EMPLOYEES WHOSE RESPONSIBILITIES INVOLVE OPERATIONS WHEREIN A FAILURE TO UNDERSTAND OR TO FOLLOW REQUIRED SAFETY PROCEDURES MAY RESULT IN INJURIES OR DEATH TO EMPLOYEES OR THE PUBLIC.

Probable Cause: None

Ntsbnumber: DCA84MP001

Report Number: PAR-84-03

Addressee Name: Washington Gas

Addressee Status: Closed - Acceptable Action

Addressee Date Closed: 1985-08-19

Addressee Organization Type: P-Private Industry

Communication Date: 1985-01-11

Communication Type: Official Correspondence

Communication Contents: WASHINGTON GAS LIGHT COMPANY LTR: CHECKLISTS HAVE BEEN OR WILL BE DEVELOPED AND IMPLEMENTED FOR ALL MAJOR WORK PROJECTS IN WHICH ACTIONS MUST BE TAKEN IN AN ORDERED SEQUENCE TO AVERT SAFETY HAZARDS.

Addressee Organization Type: P-Private Industry

Communication Date: 1985-03-05

Communication Type: Official Correspondence

Communication Contents: WGL LETTER: STEP-BY-STEP PROCEDURES FOR MANY ACTIVITIES WERE INCLUDED IN THIS RESPONSE.

Addressee Organization Type: P-Private Industry

Communication Date: 1985-08-19

Communication Type: Official Correspondence

Addressee Organization Type: P-Private Industry

Communication Date: 1985-05-03

Communication Type: Official Correspondence