Importance of Indications of Deviations for Preventing Incidents at Seveso Sites

Incidents over the past 20 years at Seveso sites in the Netherlands have been analysed with the Storybuilder MHCA (major hazard chemical accidents) model. The model assumes that deviations from process control barriers can be used to bring the process back to a safe envelope. For this, deviations ne...

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Main Authors: Henk J. Manuel, Mark P.N. Spruijt, Jochem H.J. Wijtten, Bert G. Wolting
Format: Article
Language:English
Published: AIDIC Servizi S.r.l. 2025-06-01
Series:Chemical Engineering Transactions
Online Access:https://www.cetjournal.it/index.php/cet/article/view/15196
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author Henk J. Manuel
Mark P.N. Spruijt
Jochem H.J. Wijtten
Bert G. Wolting
author_facet Henk J. Manuel
Mark P.N. Spruijt
Jochem H.J. Wijtten
Bert G. Wolting
author_sort Henk J. Manuel
collection DOAJ
description Incidents over the past 20 years at Seveso sites in the Netherlands have been analysed with the Storybuilder MHCA (major hazard chemical accidents) model. The model assumes that deviations from process control barriers can be used to bring the process back to a safe envelope. For this, deviations need to be indicated (I), detected (D), diagnosed (D) and responded (R) to: the "IDDR" framework. This framework helps in determining how deviations were handled in incidents, which influencing factors played a role and how they were connected to flaws in the safety management system. Analysis of 375 incidents shows that in half the cases studied deviations were not properly indicated, either due to missing equipment or procedures or simply being inadequate, not fit for purpose. Influencing factors that can be used to improve on indicating deviations are given in this paper: periodic inspections and review of hazard assessments, leak testing, monitoring of process parameters and last minute risk assessment. Flaws in the safety management system can lead to deviations and the paper provides some thoughts on possible improvements with respect to the elements of operation control, management of change and identification and evaluation of major hazards. The paper gives a number of examples of incidents for clarification of elements of the model and helps with learning from incidents.
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spelling doaj-art-114d4a61066545449be4a07d3e7eee9c2025-08-20T02:37:41ZengAIDIC Servizi S.r.l.Chemical Engineering Transactions2283-92162025-06-01116Importance of Indications of Deviations for Preventing Incidents at Seveso SitesHenk J. ManuelMark P.N. SpruijtJochem H.J. WijttenBert G. WoltingIncidents over the past 20 years at Seveso sites in the Netherlands have been analysed with the Storybuilder MHCA (major hazard chemical accidents) model. The model assumes that deviations from process control barriers can be used to bring the process back to a safe envelope. For this, deviations need to be indicated (I), detected (D), diagnosed (D) and responded (R) to: the "IDDR" framework. This framework helps in determining how deviations were handled in incidents, which influencing factors played a role and how they were connected to flaws in the safety management system. Analysis of 375 incidents shows that in half the cases studied deviations were not properly indicated, either due to missing equipment or procedures or simply being inadequate, not fit for purpose. Influencing factors that can be used to improve on indicating deviations are given in this paper: periodic inspections and review of hazard assessments, leak testing, monitoring of process parameters and last minute risk assessment. Flaws in the safety management system can lead to deviations and the paper provides some thoughts on possible improvements with respect to the elements of operation control, management of change and identification and evaluation of major hazards. The paper gives a number of examples of incidents for clarification of elements of the model and helps with learning from incidents.https://www.cetjournal.it/index.php/cet/article/view/15196
spellingShingle Henk J. Manuel
Mark P.N. Spruijt
Jochem H.J. Wijtten
Bert G. Wolting
Importance of Indications of Deviations for Preventing Incidents at Seveso Sites
Chemical Engineering Transactions
title Importance of Indications of Deviations for Preventing Incidents at Seveso Sites
title_full Importance of Indications of Deviations for Preventing Incidents at Seveso Sites
title_fullStr Importance of Indications of Deviations for Preventing Incidents at Seveso Sites
title_full_unstemmed Importance of Indications of Deviations for Preventing Incidents at Seveso Sites
title_short Importance of Indications of Deviations for Preventing Incidents at Seveso Sites
title_sort importance of indications of deviations for preventing incidents at seveso sites
url https://www.cetjournal.it/index.php/cet/article/view/15196
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