NTSB Safety Recommendation P-92-011

NTSB safety recommendation P-92-011.

THE NTSB RECOMMENDS THAT THE SECRETARY OF THE ARMY: EQUIP EACH EMPLOYEE WHO HAS RESPONSIBILITIES THAT MAY AFFECT THE SAFETY OF GAS PIPELINE SYSTEMS THAT ARE OWNED OR OPERATED BY THE ARMY WITH THE NECESSARY TEST, INSPECTION, AND REPAIR EQUIPMENT, AND TRAIN HIM/HER IN THE PROPER USE OF THAT EQUIPMENT.

Priority: CLASS II

Overall Status: Closed - Acceptable Action

Issued Date: 1992-05-01

Adopted Date: 1992-04-08

Overall Date Closed: 1993-01-06

Synopsis: ON DECEMBER 9, 1990, A GAS SYSTEM VALVE BETWEEN ONE OF FORT BENJAMIN HARRISON'S GAS DISTRIBUTION SYSTEMS AND A DISCONTINUED STEEL GAS SYSTEM SEGMENT WAS INADVERTENTLY OPENED, ALLOWING NATURAL GAS TO ENTER RESIDENTIAL BUILDINGS THAT HAD PREVIOUSLY RECEIVED THEIR GAS FROM THE DISCONTINUED SEGMENT. GAS ACCUMULATING IN BUILDING 1025 OF HARRISON VILLAGE WAS IGNITED BY ONE OF MANY AVAILABLE SOURCES, SUCH AS ELECTRICAL SWITCHES AND APPLIANCES, AND THE RESULTING EXPLOSION KILLED 2 OCCUPANTS AND INJURED 24 OTHER PERSONS. ONE BUILDING WAS DESTROYED, AND TWO WERE DAMAGED.

Probable Cause: Failure of the Army to construct, maintain, and operate the Fort's gas distribution system in accordance with its own and the industry's standards.

Ntsbnumber: DCA91MP002

Report Number: PAR-92-01

Addressee Name: United States Department of War, Department of the Army

Addressee Status: Closed - Acceptable Action

Addressee Date Closed: 1993-01-06

Addressee Acronym: DA

Addressee Organization Type: G-Federal Government

Communication Date: 1992-08-27

Communication Type: Official Correspondence

Communication Contents: ARMY REGULATIONS HAVE BEEN AMENDED TO REQUIRE THAT EACH INSTALLATION DEVELOP AND IMPLEMENT A SITE SPECIFIC NATURAL GAS OPERATION AND MAINTENANCE PLAN IN FULL COMPLIANCE WITH THE REQUIREMENTS OF 49 CFR PART 192. THE IMPLEMENTATION OF THE PLAN REQUIRES THE INSTALLATION TO HAVE ON HAND, AND TRAIN PERSONNEL TO USE, APPROPRIATE TEST AND INSPECTION AND REPAIR MATERIALS.

Addressee Acronym: DA

Addressee Organization Type: G-Federal Government

Communication Date: 1993-01-06

Communication Type: Official Correspondence

Communication Contents: THE SAFETY BOARD IS AWARE THAT AMENDED ARMY REGULATIONS NOW REQUIRE EACH ARMY INSTALLATION TO DEVELOP AND IMPLEMENT A SITE-SPECIFIC NATURAL GAS OPERATION AND MAINTENANCE PLAN IN COMPLIANCE WITH 49 CFR PART 192. THE PLAN REQUIRES THE INSTALLATION TO TRAIN PERSONNEL AND TO USE APPROPRIATE TEST AND INSPECTION EQUIPMENT AND REPAIR MATERIALS. BECAUSE THE AMENDED ARMY REGULATIONS MEET THE INTENT OF SAFETY RECOMMENDATION P-92-11, IT HAS BEEN CLASSIFIED "CLOSED--ACCEPTABLE ACTION."