Fire Investigation Report NDT-Kuwait

???????????????????????????????????NDT System & Services

???????C / O Ratqa General Trading and Contracting Co ??????????????????????????

?????????????????????????????????P. O. Box 9525, Ahmadi 61006,

??????????????????????????????????????Ahmadi, Kuwait????

???????????????????????Fire Incident 15 January 2011

????????????????????????By: Suranath M De S Kalinga

?Executive summary:

On the early morning of Saturday, 15 January 2011, fire occurred in the workshop of NDT System and Services which belongs to Ratqa General Trading and Contracting, located in Ahmadi 61006, Ahmadi, Kuwait.

?Around 2.00 hours the fire took place and spread all over the workshop with thick black smoke. There were no personnel, either NDT or adjacent Schlumberger offices which, present during the fire. A Ratqa Night watchman staying nearby heard some unfamiliar noise (some blast sound) and smell of burning, informed the security about it and subsequently, Ratqa security informed the fire protecting authority of the same. There was no indication whether the fire alarm was ringing because no one witnessed the fire alarm being ringing due to the fire.

?The fire-brigade arrived within expected time, controlled the situation and stopped fire from spreading further. If they had failed to do so, we might have ended up with a much more serious issue since within a short period of time, the fire almost reached to?the lithium battery storage area, adjacent to the workshop.

?The?exact cause of the fire is unknown?so far, Possibilities include Pyrophoric black powder from the?42” Cleaning tool?which returned from the site or an electrical?short circuit?caused to ignite and spread to the tool and rest of the items which were burned.

Description of accident:

On January 15, 2011, at approximately 02.00 hours, a person who was staying nearby noticed that there was a fire at the NDT workshop and informed the security of Ratqa about it and subsequently, security informed the fire control. Ratqa security also informed NDT project manager Solomon Koshy about the fire incident, and Solomon informed his manager Robb Issac. When both of them were arriving at the scene the fire was put out by firefighters.

The contracted people of NDT, worked sometime close to 01.30 hours on 15th?January for refurbishing a 42" tool which was scheduled for another cleaning task and left the workshop without any evidence of fire. No one was available for interviewing due to all of them being engaged with scheduled tasks. At about 02.00 hours on 15 January 2011, fire started inside the workshop and burned some of the equipment, accessories, fittings and structure of the warehouse. The heat and smoke passed to the adjacent Schlumberger offices and destroyed complete roof panels, network cables, electrical wires, electrical structures, walls and electronic appliances. They have to do replacement, repair and cleaning to the interior of their offices.

?The building and its structure were damaged due to fire, all the panels of the roof being replaced along with exterior sheets of the workshop walls. It required complete rewiring by replacing breaker boxes, panel board, fans and electrical switches with lights. The contents of the workshop which melted into black puddle on the floor are 42" Cleaning?pig, four sealing disks, four supportive disks, eight spacers, etc. It seems one brush is damaged and needs to be replaced. Other brushes seem to be usable. Pigs had been completely refurbished with new parts for a run which was scheduled 15th?morning prior to the fire. The body needed to be cleaned up to prepare for reassembly.

42” Cleaning tool was completely refurbished prior to leave workshop by NDT and its contracted personal which scheduled for next day cleaning run.

We are waiting for a report from the authorities to conclude the incident. Ratqa is a sole contact with the authorities. Mr. Duaij Al-Anzi is in touch with the enforcement authorities for obtaining necessary reports.

One of the possible reasons for the fire is short circuits and after the incident we found a completely destroyed switch board.

Mr. Duaij Al-Anzi went ahead and ordered all of the repairs to building and overhead cranes, which are already underway.

The fire spread outside the workshop to some wooden crates between the workshop and office. We were lucky because it was heating up the south wall of the NDT office building. Right next to the wall which is blackened on the outside, is NDT storage of used and new lithium batteries.

The wood workbenches were completely burned and some of the accessories also burned, those are one pinger, two above ground marker boxes, pneumatic tools, hoses, slings, belts and lifting etc. Various powered hand tools, supplies, etc. are among the burned items. Most of the other items should just have minimal smoke damage and can be cleaned up.

After removing all the debris and rest of the tools and accessories, NDT workshop shown above with blackened panels and exterior sheets. It is not possible to identify the cause of the fire and point of origin. Only one fire extinguisher is shown in the photo and three of others burned in the fire.

This picture says, what are the effects for NDT and associated partners faced.

Probable Reason of accident:

Human error – Failed to have behavior safety program

There is no evidence of negligence or behavior of workshop personnel that led to the fire. The only factor we need to consider is they left the workshop just 30 minutes or less prior to the fire started. There was no hot-work being performed, nor any electrical appliances or similar works for igniting such a fire. The probabilities are igniting black powder which might lie on 42” cleaning tool or short circuits due to electrical failure.

?It is difficult to identify the factors which may cause a fire, after vacating and renovating the fire site. The point of origin and reason for fire cannot be identified from available details.

?As per information provided by Solomon, NDT Project Manager, the tool was cleaned with water at the receiving end. It was transported from the site to the workshop and NDT personnel already refurbished prior to leaving it in the workshop. There was not any suspicious notification from any personnel who worked with the tool.

?We need to review procedures and processes for avoiding such incidents and need to conduct training programs and refresh programs for educating NDT staff and its associate workforce.?

Lack of fire safety Risk assessment and analysis of the area

There was not any fire safety risk assessment considered prior to this incident. There were not any fire detectors or fire sprinklers for mitigating or controlling such events. No one indicated whether they heard a fire alarm ringing.

The floors are oil contaminated and once fire ignites easily can spear all over.

Lack of hazard identification process or weak system

There is not much room between workshop’s tasks and electrical panel boards. While using overhead cranes, due to some reasons or due to power loads, power wires may get heated and ignite or it may generate short circuits. As per work condition and available space it seems the lack of hazard identification or weak system were in place.

As per work instructions and knowledge of the NDT work force, we cannot consider that NDT personnel don't know the effects of the black powder and its properties such as it is combustion material.?

Measure against:

?It is necessary to review procedures after any incident and we, NDT, need to follow new procedures and processes for avoiding future events. Safety assessment checks need to be conducted at NDT offices and workshops in regular intervals. It is possible to use a recommended checklist which can be a guideline for arranging safety. It is necessary to carry out safety awareness programs among the employees and refresh all their knowledge.

It is important to liaise with other service providers such as fire extinguishers inspection and PAT test for all the electrical arrangements. It needs to arrange certification for lifting equipment. We need to liaise with local training providers for obtaining fire fighting training and first aid training.

It is important to arrange procedures for identifying and handling hazards, such as Lithium batteries and some chemicals. The process and procedures available with the company need to be arranged according to local requirements.

?NDT needs to start monitoring contractors and their associates’ safety qualification while stipulating tasks.

Measure effective:

Internal audits and providing ownership to the employees of their tasks, NDT can achieve ambient targets. Senior management should motivate their subordinates and insist on recording all the required data and review those in necessary periods.

The technique developments include addressing human factors, procedural errors and ‘man-machine interface’ issues. This type of hazard identification is useful for identifying potential problems relating to procedural failures, human resources, human errors, fault recognition, alarm response, etc.?

?Measure closed:

The employer, NDT, should examine the foreseeable major accidents and consider how human factors may contribute to or cause those accidents. It is important for employees with experience in the specific area being studied to participate to identify the hazards that may be present.

This should involve identifying the ways in which ‘just being human’ can influence the performance of individual tasks and roles.

?NDT should provide a basis for identifying, evaluating, defining and justifying the selection of control measures for eliminating or reducing risk, and to therefore lay the foundations for demonstrating the adequacy of the standards of safety proposed for the facility.