Severity
Incident
Was Hydrogen Released?
Yes
Was There Ignition?
Yes
Incident Date
Describe the incident, including corrective steps taken and their result.
A pinhole at the base of a hand-held hydrogen torch, allowed hydrogen to leak. In the process of lighting a second torch, the leaking hydrogen was ignited. The operator, being startled by the "pop" of the lighted hydrogen allowed the #2 torch to drop and hang by its hose support approximately 6" from the floor. The hydrogen and oxygen hoses on the #1 torch were burned through and hung approximately 12" from the floor. The free burning #1 hose burned the #2 hydrogen and oxygen hose assembly through, causing both hoses assemblies to burn without valve control. The hose size is 1/4" and is used in various areas of the plant.
Lessons Learned
- Unprotected hoses are susceptible to glass shards, abrasion, and burns during normal use. This leak was formed from a glass shard penetrating the tube wall.
- Flexible hoses require protective sheaves to avoid cuts, abrasions and burns during normal use. Hydrogen supplied workstations require emergency shut off valves that are readily accessible by operators and are removed from the normal usage point of the gas. A request has been submitted to facilities engineering to select an appropriate valve. Once this has been done a follow-up request to facilities will be made to install such a valve. Such corrective action will be implemented plant-wide.
- All existing hoses have been replaced. Weekly inspections during the units clean-up period has been requested of all glass workers. The hoses will be inspected for wear and burns. Flexible hoses on equipment have been replaced with stainless steel tubing where applicable.