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Oversights and omissions in process hazard analyses: Lessons learned from CSB investigations§


  • This article was presented at the 43rd Annual Loss Prevention Symposium at the AIChE 2009 Spring National Meeting in Tampa, Florida, April 26-30, 2009.

  • This article has been prepared for general informational purposes only. This article represents the individual views of the author and all references, conclusions or other statements regarding completed CSB investigations are limited to information that is already in the public domain. Furthermore, this article is not a product of the Board and its contents have not been reviewed, endorsed, or approved as an official CSB document. For specific and accurate information on completed investigations, please refer to the final published investigation reports by going to the CSB website at and clicking on the specific report desired under “Completed Investigations.” To the extent, this article includes statements about the conclusions, findings, or recommendations of the Board, such statements come under the general prohibition in 42 U.S.C. §7412(r) (6)(G).

  • §

    This is a US Government work and, as such, is in the public domain in the United States of America.


Although process hazard analyses have been voluntarily used in the chemical processing industries for over 30 years and required by U.S. regulation for certain processes involving highly hazardous chemicals since the early 1990s, failing to apply or continued misapplication of these techniques allow process hazards to remain either undetected or unappreciated. Using findings from past CSB investigations as examples, this article discusses some problems observed in process hazard analyses that diminished their overall effectiveness and prevented them from fully identifying and/or evaluating process hazards. Some practical solutions are presented for making process hazard analyses more effective. Published 2010 American Institute of Chemical Engineers Process Saf Prog 2010