or industry sector. Because incident investigation acts within a management system based on continuous improvement, it is to be expected that investigation results will provide valuable input to the methodologies being used to predict hazards and prevent their occurrence.

REFERENCES

 

Amyotte, P. R., A. U. Goraya, D. C. Hendershot, and F. I. Khan. 2007. Incorporation of inherent safety principles in process safety management. Process Saf. Prog. 26(4):333-346.

Amyotte, P. R., D. K. MacDonald, and F. I. Khan. 2011. An analysis of CSB investigation reports for inherent safety learnings. Paper No. 44a in Proceedings of 13th Process Plant Safety Symposium, 2011 Spring Meeting & 7th Global Congress on Process Safety, March 13-16, 2011, New York: American Institute of Chemical Engineers.

Balasubramanian, S. G., and J. F. Louvar. 2002. Study of major accidents and lessons learned. Process Saf. Prog. 21(3):237-244.

Blank, H., J. Musch, and R. F. Pohl. 2007. Hindsight bias: On being wise after the event. Soc. Cognition 25(1):1-9.

CCPS (Center for Chemical Process Safety). 1989. Guidelines for Technical Management of Chemical New York: American Institute of Chemical Engineers.

CCPS. 2003. Guidelines for Investigating Chemical Process Incidents. 2nd Ed. New York: American Institute of Chemical Engineers.

CCPS. 2007. Guidelines for Risk Based Process Safety. Hoboken, NJ: John Wiley & Sons.

CCPS. 2009. Inherently Safer Chemical Processes: A Life Cycle Approach. 2nd Ed. Hoboken, NJ:

John Wiley & Sons.

CSB (Chemical Safety Board). 2007. Investigation Report: Refinery Explosion and Fire—BP, Texas City, TX. Report No. 2005-04-I-TX. Washington, DC: CSB [online]. Available: http://www.csb.gov/assets/document/CSBFinalReportBP.pdf. Accessed: Sept. 28, 2011.

CSB. 2008. Investigation Report: LPG Fire at Valero-McKee Refinery—Valero Energy Corporation, Sunray, TX. Report No. 2007-05-I-TX. Washington, DC: CSB [online]. Available: http://www.csb.gov/assets/document/CSBFinalReportValeroSunray.pdf. Accessed: Sept. 28, 2011.

CSB. 2010a. Investigation Report: Xcel Energy Hydroelectric Plant Penstock Fire—Cabin Creek, Georgetown, CO. Report No. 2008-01-I-CO. Washington, DC: CSB [online]. Available:http://www.csb.gov/assets/document/Xcel_Energy_Report_Final.pdf. Accessed: Sept. 28, 2011.

CSB. 2010b. Urgent Recommendations from ConAgra Investigation.. Washington, DC: CSB [online]. Available: http://www.csb.gov/assets/document/CSB_Gas_Purging_Urgent_Recommendations.(2).pdf. Accessed Sept. 28, 2011.

CSB. 2010c. Urgent Recommendations from Kleen Energy Investigation Washington, Washington, DC: CSB [online]. Available: http://www.csb.gov/assets/document/KleenUrgentRec.pdf. Accessed: Sept. 28, 2011.

CSChE (Canadian Society for Chemical Engineering). 2002. Process Safety Management, 3rd Ed.Ottawa, ON: CSChE.

Department of Labor. 2000. Process Safety Management. OSHA 3132. Washington,. OSHA 3132. Washington, DC: OSHA Publications Office.

Fischhoff, B. 1975. Hindsight foresight: The effect of outcome knowledge on judgment under uncertainty. J. Exp. Psychol. Human 1(3):288-299.

Goraya, A., P. R. Amyotte, and F. I. Khan. 2004. An inherent safety-based incident investigation methodology. Process Saf. Prog. 23(3):197-205.

Hendershot, D. C. 2006. Inherently Safer Design.. SAChE (Safety and Chemical Engineering Education) [online]. Available: http://sache.org/index.asp. Accessed: Sept. 28, 2011. Hendershot, D. C., and J. Murphy. 2008. Inherently Safer Design Conflicts and Decisions.. SAChE (Safety and Chemical Engineering Education) [online]. Available: http://sache.org/index.asp. Accessed Sept. 28, 2011.



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