Severity
Incident
Leak
Yes
Ignition
No

A health physics technician (HPT) discovered that a scaler in an analytical laboratory was out of P-10 gas (90%Ar and 10% CH4). The HPT went to the building where auxiliary gas cylinders are stored. He located a P-10 gas cylinder and turned to search for a hand-cart. There were no hand-carts present, and the technician had to get one from another room. When he returned to the cylinder storage area, he loaded the wrong cylinder. It contained hydrogen gas instead, however, the two cylinders were next to each other and they were basically identical. The empty cylinder was then replaced by the full one and the scaler was purged for several minutes before it was used. The alpha channel worked well, however, the beta channel did not respond. An instrument technician was contacted to identify any possible electronic failures in the instrument and he discovered that the gas was hydrogen rather than the P-10 gas. The hydrogen cylinder was shut off, disconnected and removed. The correct P-10 cylinder was located and connected to the scaler.

Incident Date
Dec 15, 2003
Setting
Equipment
  • Hydrogen Storage Equipment
  • Gas cylinder
Damage and Injuries
Contributing Factors
When Incident Discovered
Lessons Learned

All chemicals, including gases, should be clearly labeled and expiration dates (if applicable) identified. Incidents are more common when incompatible chemicals are mixed or when chemicals are stored/transferred using incompatible equipment. Personnel should ensure that labels are read and understood prior to mixing, dispensing, or transferring chemicals.

Key:

  • = No Ignition
  • = Explosion
  • = Fire
Hydrogen Incident Summaries by Equipment and Primary Cause/Issue
Equipment / Cause Equipment Design or Selection Component Failure Operational Error Installation or Maintenance Inadequate Gas or Flame Detection Emergency Shutdown Response Other or Unknown
Hydrogen Gas Metal Cylinder or Regulator   3/31/2012
4/30/1995
2/6/2013
4/26/2010 12/31/1969     3/17/1999
11/1/2001
12/23/2003
Piping/Valves 4/4/2002
2/2/2008
5/11/1999
4/20/1987
11/4/1997
12/31/1969
8/19/1986
7/27/1991
12/19/2004
2/6/2008
10/3/2008
4/5/2006
5/1/2007
9/19/2007
10/31/1980
2/7/2009 1/24/1999
2/24/2006
6/8/1998
12/31/1969
2/7/2009

9/1/1992
10/31/1980

10/3/2008  
Tubing/Fittings/Hose   9/23/1999
8/2/2004
8/6/2008
9/19/2007
1/1/1982 9/30/2004
10/7/2005
  10/7/2005  
Compressor   10/5/2009
6/10/2007
8/21/2008
1/15/2019
    10/5/2009 8/21/2008  
Liquid Hydrogen Tank or Delivery Truck 4/27/1989 12/19/2004
1/19/2009
8/6/2004 12/31/1969   1/1/1974 12/17/2004
Pressure Relief Device 7/25/2013
5/4/2012
1/15/2002
1/08/2007
12/31/1969        
Instrument 1/15/2019 3/17/1999
12/31/1969
2/6/2013
    11/13/73    
Hydrogen Generation Equipment 7/27/1999     10/23/2001      
Vehicle or Lift Truck   7/21/2011         2/8/2011
12/9/2010
Fuel Dispenser   8/2/2004
5/1/2007
6/11/2007
9/19/2007
  2/24/2006
1/22/2009
     
Fuel Cell Stack            

5/3/2004
12/9/2010
2/8/2011

Hydrogen Cooled Generator       12/31/1969
2/7/2009
     
Other (floor drain, lab
anaerobic chamber,
heated glassware,
test chamber,
gaseous hydrogen
composite cylinder,
delivery truck)
  11/14/1994
7/21/2011
7/27/1999
6/28/2010
8/21/2008
12/31/1969
3/22/2018
    6/10/2019
  • = No Ignition
  • = Explosion
  • = Fire