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The Industrial Operator’s Handbook, Second Edition

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PART I of this text focuses on the consequences of failure (discussing the twenty common components of accidents) in order to demonstrate the need for a systematic approach to industrial operations.

PART II introduces the objectives and elements of a successful operating strategy, the concepts of operating boundaries and operating principles, and the need for alert, well-trained operators-the most important element of successful operations in any industry.

PART III expands on the details of twelve essential skills for every industrial operator, including what they are, why they are important, and how to establish and use them.

PART IV continues in the vein of implementing the strategy by discussing how to put all the elements together, going beyond simple failure avoidance to process and product improvement-true operating success.

This book isn't just for industrial operators and managers. Everyone will enjoy reading it.

This textbook is used for TECHSTAR's Systematic Industrial Operations course.


Part I: The Nature of Industrial Failure 
Chapter 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Anatomy of an Accident 
Crash of Eastern Airlines Flight 401, December 1972 . . . . 3
A Chain of Insignificant Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Complex Failure Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Lessons of Eastern 401. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
  
Chapter 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Common Components of Accidents 
Grounding of the Exxon-Valdez, March 1989. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Twenty Common Accident Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
  
Part II:A Strategy for Operating Success 
Chapter 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Systematic Industrial Operations 
Objective of the Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Elements of the Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
An Underlying Operating Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Reliable Equipment and Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Well-Defined Operating Boundaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Valid Policies and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
An Efficient Operating Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Alert,Well-Trained Operators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Superb Leaders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
A Team Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
  
Chapter 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Boundaries of Safe Operation 
Safety Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Identifying the Hazards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Determining the Risk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Establishing Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Categories of Operating Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Developing Operating Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
The Safe Operating Envelope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
  
Chapter 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Principles of Operation 
Chernobyl Atomic Power Station Accident, April 1986. . . . . . 71
The Primary Cause. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Principles of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
  
Chapter 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
The Alert,Well-Trained Operator 
Big Bayou Canot Bridge Accident, September 1993 . . . . . . . . . . . . . . . . . . . . . . . 79
Tenets of Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Determining Job Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Selection of Candidates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Developing the Training Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Phases of Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Initial Training Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Certification Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Continuing Training Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Fitness for Duty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Effective Management Oversight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
  
Part III:Vital Operating Skills 
Chapter 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Controlling Equipment and Processes 
Fatal Gas Release at Bhopal, December 1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Combined Accident Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
The Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Twelve Vital Operating Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
  
Chapter 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Conducting Pre-Task Briefings/b> 
 
Utility Crew Electrocution, April 1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Accident Prevention through Pre-Task Briefing . . . . . . . . . . . . . . . . . . . . . . . . . 113
Elements of a Pre-Task Briefing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Pre-Task Briefing Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Common Pre-Task Briefing Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Post-Task Debriefing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
  
Chapter 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Understanding and Using Procedures 
Northwest Airlines Flight 255, August 1987. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
The Accident. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
The Cause: Failure to Use and Comply with Procedures . . . . . . . . . . . . . . . . . . 121
Contributing Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Policy or Procedure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Developing Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Desirable Characteristics of Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Procedure Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Review and Approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Controlling Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Revising Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Using Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
An Example of Procedure Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Reporting Status Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Training to Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Enforcing Procedural Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
  
Chapter 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Monitoring Critical Operating Parameters 
Why Monitor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
When to Monitor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
How to Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Actions for Abnormal Values. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Special Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
  
Chapter 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Independent Verification 
What Is It? . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 137
For All Tasks? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Who Decides?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Process or Point Verification? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Guidelines for Independent Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Informal Verification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
  
Chapter 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Communicating Vital Information 
Sinking of R.M.S. Titanic, April 1912 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Questions of Cause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
The Lesson of Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Elements of Effective Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Effective Verbal Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Written Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Emergency Communications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
  
Chapter 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Keeping Logs and Recording Data 
Data Record Sheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Narrative Logs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Specialized Formats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
  
Chapter 14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Recognizing Abnormalities 
Crash of Air Florida Flight 90, January 1982 . . . . . . . 157
An Accumulation of Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Sources of Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Recognizing Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Performing Inspection Tours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Prioritizing Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Responding to Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Your Intuition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
  
Chapter 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Combatting Emergencies and Casualties 
The TMI-2 Accident, March 1979 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
The Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Responding to Industrial Crisis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Planning for Emergencies and Casualties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Training for Emergencies and Casualties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Responding to Emergencies and Casualties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Learning from Emergencies and Casualties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
  
Chapter 16. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Overseeing Maintenance, Modification, and Testing 
Phillips 66 Chemical Complex Explosion and Fire, October 1989 . . . . . . . . . . 188
A Preventable Accident? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Configuration Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Maintenance,Modification, or Testing?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Who is Responsible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Tiers of Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Operations/Maintenance Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Guidelines for Maintenance Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Types of Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Operations/Testing Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Guidelines for Testing Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
  
Chapter 17. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Isolating Energy Hazards 
TOSCO Unit 50 Oil Refinery Fire, February 1999. . . . . . 205
The Accident. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Primary Cause: Failed and Improper Isolation . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Contributing Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Sources of Hazardous Energy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Other Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Means of Isolation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Lockout Isolation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Tagout Isolation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Using Danger and Caution Tags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Determining Tag Locations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
  
Chapter 18. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Training On-the-Job The Purpose of OJT. . . 
Elements of a Good OJT Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
On-the-Job Training Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
  
Chapter 19. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Performing Shift Turnovers 
Continental Express Accident, September 1991 . . . . . . . 229
The Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Definition, Purpose, and Applicability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Eight Principles of Shift Turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
The Process of Shift Turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Preparing the Station for Turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Pre-Shift Meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Pre-Shift Tour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Station Turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
Post-Turnover Meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Guidance for Successful Turnovers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
  
Part IV: Implementing the Strategy 
Chapter 20. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Investigating Abnormal Events 
The Challenger Accident, January 1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Cause of the Accident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Contributing Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
An Investigative Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Deciding to Investigate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Designating Investigators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Gathering and Preserving Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Event Critique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Analyzing the Evidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Determining Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Correcting Causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Documenting the Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Disseminating the Lessons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
The Next Level: Investigating Success. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
  
Chapter 21. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Conducting Continuing Training 
What Is It? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Airline Industry Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Application to Industry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Choosing Continuing Training Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Integrating Continuing Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Impediments to Continuing Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
  
Chapter 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Evaluating Operating Performance 
Why Evaluate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
The Benefits of Looking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Evaluation Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
Formal or Informal?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Levels of Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
What Should Be Evaluated? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
Organizational Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Evaluation Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Evaluation Strategy and Logistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Responding to Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
What to Do With What You Find . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Cultivating the Self-Assessment Habit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
The Costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Topic Review and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
  
Chapter 23. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
A Case Study in Implementation 
The Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
The Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Your Task . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
What Should You Do?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
The Obstacles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
The Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Preparing to Take Over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Controlling Immediate Safety Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Establishing Leadership Confidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Identifying the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Evaluating the Problem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Establishing Written Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Teaching the Systematic Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Guidelines for Conducting the Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Implementing and Evaluating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
How Long Will It Take? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Measuring Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
Topic Summary and Questions to Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
  
Chapter 24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Your Challenge 
Topic Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Implementing the Systematic Approach to Operations . . . . . . . . . . . . . . . . . . . 306
Tailoring and Implementing Your Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . 306

PREFACE

What's This Book About?
The Industrial Operator's Handbook presents the elements vital to systematic industrial operation. Safe, efficient industrial operation is predicated, in part, upon conservative design and well-executed construction. Ultimately, however, the responsibility for successful operation falls to skilled, alert humans systematically controlling the equipment that they are charged with operating. Accordingly, this book is dedicated to the study of improved industrial performance through a team approach to operation. Its premise is that there is no substitute for the alert, well-trained operator controlling equipment within specified operating bands in accordance with approved procedures.

Who Is This Book For?
This book is written to educate operators,maintenance technicians, laboratory analysts, craftsmen, engineers, team leaders-anyone engaged in the operation or technical support of an industrial complex-in the principles and skills of systematic industrial operation. Although written from the perspective of the operator, the concepts presented herein apply equally to the maintenance technician, lab analyst, engineer, or team leader.

Why Read This Book?
Whether you're a company CEO or an entry level technician, The Industrial Operator's Handbook develops the strategy for systematic industrial operation in such a logical and fascinating way that you will be intrigued while you learn.
The philosophy of industrial operation, if properly developed and applied, is essentially the same for every technology.Whether you build microchips, manufacture automobiles, operate a nuclear power-generating station, fly commercially, or run the gravel crusher for your company's road construction operation, once you understand it, you can apply it wherever you go. As a bonus, you will soon find that the principles and skills presented within this text are as important for driving, flying, hobby woodcraft and metal-working, or farming as they are for commercial industrial operation. The text is divided into four parts: The Nature of Industrial Failure (Part I), A Strategy for Operating Success (Part II), Vital Operating Skills (Part III), and Implementing the Strategy (Part IV). Through a series of case studies and the lessons drawn from them, you will:
* Probe the methods of failure by which most industrial accidents occur,
* Investigate twenty common components of accidents,
* Explore a common-sense strategy for systematic industrial operations,
* Determine the purpose of operating limits and the safe operating envelope,
* Learn two simple, but immutable principles of operating success,
* Review how alert,well-trained operators are developed,
* Evaluate twelve vital operating skills that every operator and leader should master,
* Examine the importance of investigating abnormal events,
* Realize the worth of continuing training,
* Discover the role of self-assessment in implementing the strategy, and
* Analyze a case study in implementing the systematic approach.

Principles with "Staying Power"
The principles and conventions presented in this book aren't "gimmicks". Rather, they are time-proven tenets that, once learned, renew and confirm themselves daily to every member of an industrial team.Developed and refined over a several years, this text incorporates decades of learning, evaluating, and practicing the principles of successful industrial operations. TECHSTAR has provided training in these principles for industrial and nuclear facilities nationwide-principles that have become lifelong benchmarks for thousands of industrial professionals. Consequently, one great feature of The Industrial Operator's Handbook is that it will never become outdated. In fact, the text can be used again and again as a basis for analyzing your own successes and failures as well as those from other industries. It provides a distinct and unchanging path to direct you and your team in improving industrial operations.

What's New in the Second Edition?
Our objective in this edition is still to assist industrial teams in improving performance through heightened awareness of the causes of industrial accidents and the techniques by which good teams avoid them. We have added and discussed a twentieth common accident contributor-design deficiencies. As we saw in the Chernobyl accident, it's hard to operate and maintain equipment and systems that are poorly designed at the outset. There are three additional enlightening case studies which contain important lessons in communication, command and control, configuration management, procedural compliance, and leadership. Our discussion of the operating organizational structure has been revised and clarified with particular emphasis on the role of supporting teams and their coordination to successfully accomplish the central facility mission. Finally,we have enhanced and expanded the study of operating performance evaluation,emphasizing the need for both formal evaluation and informal self-assessment. All great teams-whether in sports, business, or combat-continuously engage in critical self-analysis. Great teams always find ways to get even better.

Use It for Training
At least as important as your own education is educating and training your team in the philosophy and skills of effective and efficient industrial operations. This text provides an extraordinary tool for accomplishing just that.The book progresses in a logical sequence intended to facilitate leading your team through a comprehensive study of industrial operations, one or two chapters at a time. The Topic Summary and Questions to Consider at the end of each chapter provides an excellent forum to compare your operations with those described in the text, prompting you to ask, "Are we making the same mistakes we just read about?" Furthermore, after you've studied The Nature of Industrial Failure (Part I) and The Strategy for Operating Success (Part II), you can begin a sequential review of Part III's twelve Vital Operating Skills. And, since the skills build on one another, you have a wonderful opportunity to study and practice one skill at a time. In fact, by working through the book systematically in a "study one, practice one" sequence, you can build an effective one-year continuing training program that (rigorously applied) will dramatically improve your team's performance. Remember, though, there aren't any "free lunches".Don't expect much if you approach it with an attitude of "I'll let them read it and hope they get the point". If you don't believe it, teach it, and reinforce it by your own example, no one else will take it seriously or put much effort into it, either.

 

 


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