The royal commission set up to investigate last year`s explosion and fire at the Longford gas processing facilities in southeastern Victoria state has laid the bulk of the blame squarely at the door of plant operator Esso Australia Ltd.
Esso is a partner with BHP Petroleum Pty. Ltd. in the gas plant and in the Bass Strait fields that feed it.
The explosion and fire killed two workers and injured a number of others, while cutting off gas supplies to Victoria state for 2 weeks in late September 1998 (OGJ, Oct. 5, 1998, p. 39).
Management blamed
Daryl Dawson and his fellow commissioners found that the calamity was due primarily to the failure of Esso management. In particular, the report points to inadequate training of both operators and supervisors, plus a lack of firm operating and safety procedures as the major contributors to the explosion and loss of life.
The 287-page report, released last week, also said the disaster was caused by a reduction in supervision at the Longford plant, failure to conduct a crucial hazard study, and a desire on the part of Esso to cut costs.
Listing five main conclusions, the commissioners said that the ultimate cause was the failure of Esso to equip its employees with appropriate knowledge to deal with the events that occurred. Among the other four main findings, the commissioners concluded that:
Explosion cause
The commission, which heard testimony for 53 days earlier this year, identified the immediate cause of the explosion in one of the heat exchangers at Longford as being the following succession of events:
Management system blasted
The report criticized Esso`s management system, known as Operations Integrity Management System (OIMS), as being repetitive, circular, and impenetrable.
It said the accident demonstrated in itself that important components of Esso`s system of management were either defective or not implemented. And the commissioners questioned why a vital hazard operability study (Hazop) for Gas Plant No. 1 was never conducted by Esso, as required by OIMS.
If the Hazop study had been carried out, operators and supervisors would not have "...remained ignorant of the hazards associated with a loss of lean oil flow and consequent low temperature."
The commission made no adverse findings against BHP, Esso`s Bass Strait joint venture partner. In its submission to the inquiry, BHP said Esso was operator and that BHP was not responsible for Esso`s management practices at Longford.
Recommendations, responses
In its recommendations, the commission report said that Esso should be required to evaluate the design of critical areas of Longford and to show that its operating standards, practices, and policies are periodically reviewed.
It also recommended that Esso be obliged to demonstrate its training programs and techniques for imparting knowledge of all identifiable hazards and the procedures required to deal with them.
And it suggested that a new government authority be formed to administer safety audits for all major-hazard facilities in Victoria.
For its part, Esso has declined to answer any questions about or comment on the commission`s findings. Managing Director and Chairman of Esso Australia, Robert Olsen, read a prepared statement saying the company needs more time to analyze the report and hold discussions with the Victorian government. He did say, however, that he was deeply saddened by the accident, which killed two Esso employees.
The royal commission also found that the Victorian government had failed to enact legislation requiring Esso to complete a safety report identifying the relevant hazards of the plant in line with national safety standards for such plants.
Victorian Premier Jeff Kennett responded by saying that his government would consider the commission`s recommendations for legislative action to extend safety case reporting procedures to all major hazardous facilities in the state. And the government would examine the establishment of a specialist agency to monitor and administer those safety procedures.
Also reacting to the commission findings, lawyers behind a $1 billion (Australian) class-action suit against Esso vowed to press for a trial date to hear the compensation claim on behalf of more than 1 million Victorians. They said that the class action had been strengthened by the commission`s finding of negligence against Esso.
Ironically, on the day of the report`s release, Esso said that it is now in a position to reestablish the ability of all three Longford gas plants to provide gas for the coming winter. The final phase of the rebuilding works has been completed, and the plant has returned to its former capacity. Additional operating capabilities and flexibilities have been built into the operation so that, as Esso says, it will be able to supply gas despite any future problems that might occur at Gas Plant No. 1.
The ultimate cause was the failure of Esso management to equip its employees with appropriate knowledge to deal with the events that occurredellipseInadequate training of both operators and supervisors, plus a lack of firm operating and safety procedures (were) the major contributors to the explosion and loss of life. Also contributing to the disaster were a reduction in supervision at the Longford plant, failure to conduct a crucial hazard study, and a desire on the part of Esso to cut costs.
