Page1of8RevitalisingproceduresIntroductionThisdocumentprovidesguidanceforemployersresponsibleformajorhazardsonhowtodevelopproceduresthatareappropriate,fit-for-purpose,accurate,‘owned’bytheworkforceand,mostofall,useful.Itcoversoffshoreandonshoreoil,gasandchemicalinstallations;willalsoapplytorailwayoperatorsandnuclearinstallations,andisalsorelevanttonon-majorhazardsindustries.Thisguidanceisintendedtoprovidepracticalhelpformanagers,supervisorsandothersinthechemicalandpetrochemicalindustrieswhoareinvolvedindesigning,using,checkingandreviewingsafeworkingproceduresforsafety-criticaltasksorsafety-relatedactivitiesorprocesses.Itwillalsohelpoperatorsandsafetyrepresentativeswhoareinvolved-astheyshouldbe-inhelpingdrawuporreviewprocedures.Followingarecentmajorincident,severalinadequacieswereidentifiedwiththeprocedures.Criticalinformationwasdistributedbetweenvariousdocuments,withincorrectcross-referencing.Insufficientdetailwasprovided,withnoidentificationofsafetycriticaltasksorroles.Therewasevidencethatprocedureswerenotusedasworkingdocuments.Whyaddressprocedures?Problemswithproceduresarefrequentlycitedasthecauseofmajoraccidents.Themaincausesaretoomuchrelianceplacedonprocedurestocontrolrisk,afailuretofollowsafeworkingproceduresortheuseofinadequateprocedures.AstudyofrefineryincidentsintheUnitedStatesconcludedthatprocedureswerethemostcommonhumanfactorsrootcause(accountingfor22%ofallrefineryincidents).Proceduresproblemshavecontributedtosomeoftheworld’sworstincidents,suchasBhopal,PiperAlphaandClaphamJunction.Onemajoroilcompanyrevieweditsoperatingproceduresandbenefitedfromsignificantefficiencygains,forexample,reducedstart-uptimes.Thefullinvolvementofemployeeswasacrucialfeatureofthisprocess.Whatareprocedures…andwhydoweneedthem?Proceduresareagreedsafewaysofdoingthings.Writtenproceduresusuallyconsistofstep-by-stepinstructionsandrelatedinformationneededtohelpcarryouttaskssafely.Theymayincludechecklists,decisionaids,diagrams,flow-chartsandothertypesofjobaids–moreontheselater.Rememberthatproceduresarenotalwayspaperdocuments–theymayappearas‘onscreen’helpincontrolsystemdisplays.Inthemajorhazardindustries,proceduresareessentialforanumberofreasons:•Tominimiseerrors/failures;•Toprotectagainstlossofoperatingknowledge(forexample,whenexperiencedpersonnelleave);Page2of8•Tostandardiseworkingpractice;•Toprovideabasisfortraining;•Tomeetstatutoryrequirements.ProceduralviolationsManymajorhazardcompaniesstresscompliancewithproceduresasacontrolagainstmajoraccidents.Duringsiteinspectionsandthroughreadingsafetyreports,weareofteninformedthatoperatorsadheretowrittenprocedures.Twoimportantquestionstoaskhereare:(i)Dothey?and(ii)Howdoyouknowthattheydo?Peopledonotalwaysfollowproceduresoutsideofworkactivities(suchastheHighwayCode)andsoisitreasonabletoassume100%complianceatwork?Determiningwhetheraprocedureislikelytobefollowedornotisasimportantasconsideringthetechnicalmeritsoftheprocedure.Theconsequencesofinadequateprocedures,oroperatorsnotfollowingprocedures,canbedisastrous.Whydopeoplenotalwaysfollowprocedures?Proceduresmaynotbecompliedwithforavarietyofreasonsandsomeofthemorecommonare:•Proceduresarenotcorrectorout-of-date;•Proceduresaredifficulttouseorfollow;•Proceduresarenotreadilyavailable/portable;•Thereareeasierwaysofperformingthetask;•Pressurefrompeers;•Afailuretounderstandtherisks;•Perceivedpre...
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