Click here for Investigation Information Page Summary
On November 5, 2005 two contractor employees were asphyxiated while preparing to reassemble a pipe on a pressure vessel while it was being purged with nitrogen. The first worker, in an attempt to retrieve a roll of tape from inside the vessel, was overcome by nitrogen, collapsed in the vessel, and died. His co-worker, the crew foreman, was asphyxiated while attempting to rescue him.
Valero Energy Corporation2006-2-I-DE-R3
Audit work permit procedures and nitrogen purge safety procedures at each Valero U.S. refinery. Determine if issues identified in this Case Study are occurring elsewhere. Implement corrective action, including training, where necessary.
Status: Open - Acceptable Response or Alternate Response
2006-2-I-DE-R4
Require Valero U.S. refineries to revise and conduct nitrogen hazards awareness training.
Emphasize:
- An oxygen-deficient atmosphere rapidly overcomes the victim.
- There is no warning before being overcome.
- An oxygen-deficient atmosphere might exist outside a confined space opening.
- Rescuers must strictly follow safe rescue procedures.
Status: Open - Acceptable Response or Alternate Response