• domino effect;
  • solid oxidizer;
  • sodium chlorate;
  • NFPA 430;
  • case study

This case study examines a succession of three separate fires which occurred in a period of 4 days at an agricultural chemical manufacturing facility. The facility was located in a small chemical park. The succession of fires illustrates the concept of the domino effect: the first fire caused the second fire, and the second fire caused the third. The final fire was responsible for the total destruction of two businesses and the interruption of a third business. Each fire involved the solid oxidizer sodium chlorate. Despite having manufactured agricultural chemicals for over 25 years, the owner and management of the facility had lost their sense of vulnerability to the hazards of sodium chlorate. The fundamental root cause of these fires was the facility owner's inadequate control of the hazards of sodium chlorate. Workers at the facility had little comprehension of the ability of sodium chlorate to cause organic materials to spontaneously ignite. Housekeeping at the facility was poor. And finally, too large of a quantity of sodium chlorate was stored inside the facility, and this large inventory of solid oxidizer was placed adjacent to combustible materials. Simple procedural safeguards would have been sufficient to prevent the ultimate property damage. © 2014 American Institute of Chemical Engineers Process Saf Prog, 2014