On the 20th of September, 2022 at the BP Husky Toledo refinery in Ohio, a level transmitter change out from a month prior triggered a chain of events that would cost two operators their lives. We look at how poor Management of Change, high alarm rates and a resistance to stopping the job, let a plant upset turn into a disaster.With John Chidgey.Formal Report:

U.S. Chemical Safety Board Issues Final Report into Fatal 2022 Fire at BP-Husky Refinery
Fatal Naphtha Release and Fire at BP-Husky Toledo Refinery (PDF)
CSB June 2023 Investigation Update (PDF)
CSB Comments on the OSHA September 20, 2022, Federal Register Notice (PDF)

News Releases and Articles:

BP Faces $156K OSHA Fine in Refinery Explosion
BP accused of serious violations after fatal blast at US refinery

General Information:

Naphtha
What You Need to Know About California’s PSM Regulation for Refinery Safety
OSHA Penalties

Support Causality on PatreonEpisode Gold Producers:
'r', Steven Bridle and Kellen Frodelius-Fujimoto.Episode Silver Producers:
Mitch Biegler, Shane O'Neill, Jared Roman, Katharina Will, Chad Juehring and Ian Gallagher.

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