IRATA Safety Notice- keeping our industry safe
1. The Incident
On 30 July 2014, a high-potential near miss incident took place on board a semisubmersible drilling platform (could have resulted in a fatality)
During derrick inspection activities whilst using rope access, both ropes of a team member where destroyed caused by accidental activation of the derrick elevator. All moving derrick equipment had been isolated electrically before start of the activities correctly and in accordance with the project’s risk assessment (except for the elevator).
The person involved promptly acted upon noticing that the elevator started to move, which enabled him to stand on a nearby support beam and secure himself to the cable tray directly next to him.
Arrangements were made that no persons outside the rope access crew itself (team of 12) could use/activate the elevator from the bottom position (intermediate stops halfway up the derrick and at the crown). The rig floor and surrounding area had also been barrier off.
A team of 2 RA technicians from the team of 12 were working together on the derrick’s corner leg adjacent to the elevator support tracks, but around the corner.
After completion of their inspection descent, one team member climbed back up on the ropes towards the crown to guide torque tools suspended from a light winch along the same route upwards.
Before ascending the ropes were released from the railing to which they were tied down (to prevent them being blown sideways).
Even though agreements were made to ask permission via radio before using the elevator, a RA tech belonging to a second team (next to the one asking the permission) accidentally pressed the elevator call button on the control panel.
A safety alert was raised among company personnel and shared with the client.
3. Lessons Learned
Task Risk Assessment for use of the elevator (and when changing procedures) with a RA team nearby should have been carried out with the whole team and formally recorded on paper;
All moving machinery should be isolated when carrying out RA work (even when arrangements are made to keep third parties away from control points);
Make proper arrangements to prevent ropes getting moved by wind / caught by moving parts (rigging, rope bags, etc.);
(Radio) Communication procedures should be clearly agreed with the entire team (transfer & verbally confirm all information);
To have a clear description of / policy on a Level 3’s role in projects with large team sizes.
The Operating Member Company (OMC) has implemented additional control measures including: training of employees regarding communication; updating guidance on project risk assessments; adding ‘Confirm isolation of all moving machinery’ to pre-shift meeting checklist.
Furthermore the OMC has cooperated with several clients to issue a standing order to an entire fleet of one drilling contractor which prohibits the use of rope access in active derricks and to confirm complete isolation of moving machinery (also elevators) in derricks. The OMC is also communicating this message across to other drilling contractors & clients.
5. Recommendations for further reading from the ICOP
Refer to Annex A - Risk Assessment for guidelines and principles of the risk assessment process, which can and should be applied to all work situations, see also 188.8.131.52 The hazard identification and risk assessment should be site specific. They should be documented and should cover all aspects of the work to be undertaken. The document(s) should be available to personnel working on-site and should be regularly reviewed formally by them during the course of the work, to take account of changing circumstances, e.g. weather conditions and other work being carried out. Operations such as oil platforms, refineries, power stations and railways have a formal written permit-to-work system to address hazards, by requiring certain precautions to be taken. Examples are: electrical isolations; restriction of other work; communication requirements; specified personal protective equipment
Refer to 1.4 - Principles and controls for the essential elements of a safe system of work including 184.108.40.206.6 An efficient communication system should be established between all rope access technicians in the team and, where necessary, third parties, e.g. the control room, if offshore.
Refer to Annex P – Recommended actions for the protection of anchor lines, see also 2.11.3 – Use of anchor lines which contains 220.127.116.11.6 The effects of wind on the free end of anchor lines should be taken into account. Care should be taken to ensure that the tail end of anchor lines cannot snag on dangerous objects, such as working machinery, power lines or a moving vehicle. This could lead to the need for additional monitoring.
Refer to 2.11.7 - Pre work checking.
Refer to 2.11.8 - Exclusion zones.
Refer to 2.11.9 - Communication which contains 18.104.22.168 An efficient communication system should be established between all rope access technicians and, where necessary, to third parties (e.g. sentries or the control room, if offshore). This should be agreed and set up before work starts and should remain effective for the whole of the time that people are at work.