煉油廠大修風險管理之研究~以 T 煉油廠為例

Abstract

工場大修主要目的為修護與檢查工場機器設備，以確保再度運轉生產時之可靠度及安全性，尤以長年連續運轉生產之煉油廠製程，機器設備等需長期使用，有許多機器設備及管線等在平日無法作修護與內部檢查工作，都必需預先縝密計畫安排在大修期間內完成，然而有些機器設備損傷情況往往是在停爐檢查之後才發現，由於工場允許停爐之期間短，再加上工場空間狹隘，有許多局限空間作業，設備管線交錯複雜，施工機材滿佈，施工工種及人員複雜且綿密交錯共同進行，時程密集緊湊，故可稱得上是各種高風險作業條件及惡劣環境的總集，呈現顯著高風險中的高風險，經常有工安事故發生，故事業單位及勞檢機構都非常重視，不斷加強各種防災及稽核作為，然而所能掌握與運用的各項資源是有限的，對複雜的大修動態風險難免仍有無法掌控之處，還是有重大工安事故再度發生，故乃有深入分析及探討研究之必要。 本研究經由搜集T公司95年1月至100年5月有紀錄可查之有關事故案例總計有505筆，作為事故統計分析基礎數據，套用簡單實用的資料篩選與分類整理統計分析，來探討過去T煉油廠大修的工安事故風險，發現煉製事業部(RBU)及石化事業部(PBU)兩者之比例分別為37%與7%， T公司下轄有8個事業部2個工程處，RBU及PBU兩者合計約44%，已接近該公司事故之半數，足見該兩者之重要性，再篩選出RBU下轄三廠及PBU與大修有關事故案例總計為62筆，故明顯看出其發生事故之比例確實較平常高約3.5倍。 經予以再細分其事故發生階段，統計發現有84%發生在施工階段，而在停爐處理與再開爐等兩期間發生事故次數及人員傷亡比例約同為8%，兩者發生事故次數及人員傷亡比例約略相當，但在再開爐階段之事故後果其財務損失嚴重性相對高很多，故在再開爐前務必結合各方面專業有豐富經驗的專才組成再開爐前查核小組，依大修後工場開爐前製程安全查核表專業分工逐項查核，避免發生非專業人員對大修現場實際危害風險辨識度與偵測度不足之形式檢查查核制度缺失，實施以來，經多年的實際驗證，也確能及早發現多項檢修疏漏，並立即修正偏差，發揮及時停工之功用。 針對大修現場作業的風險，本研究以安全衛生作業標準結合工作安全衛生分析與LEC方法作風險評估，並加入福特公司之危害辨識可偵測度因子及杜邦公司之STOP理念與HACCP觀念，對管理與監督者掌握作業動態的風險有其助益，而將整個作業拆解成數個有順序之工作步驟，每個步驟之風險皆有其特性與差異，並能呈現出關鍵性作業與其關鍵點，提醒作業人員及時踩煞車斷然停止危險作業，並仔細審慎檢視作業環境與各項作業條件，確認可進行下一步驟後再進行，避免因忽略作業環境與各項作業條件之改變而未能及時採取有效風險控制措施而陷入危害風險中。 另對於T煉油廠及其他相似性質工廠屢次再發生之相似事故，予以彙整，T煉油廠或其他相關文獻已有良好之改進對策與解決方案者，一併將該等彙集，使本文形成大修風險管理之小知識庫，以供政府部門及業界作研擬對策之參考。

The main purpose of the workshop intensive maintenance for inspection of plant machinery and equipment repair, is to ensure the reliability and safety of plant re-running, especially for the long-term continuous operation of the oil refinery processes; machinery and equipment of the oil refinery need long-term use, but there are many equipments and pipelines that can not repair and internal inspection in working days, for complete whole those work within intensive maintenance period should be in advance careful planning, but some equipment damage often could be found after the plant shutdown inspection. Because the allowed plant shutdown period was very short, workshop space was narrow, many confidence space work, equipment and pipelines staggered complex, construction machine and material were full, construction trades and workers staggered joint complex and dense, compact and time-intensive. A variety of high-risk working conditions and the total set of harsh environments, showing significant high-high-risk, accident always happen, therefore, institutions and labor inspection agencies have taken great focus on disaster prevention and audit act, but all the resources are limited, still can't control the complex dynamic risk of the intensive maintenance, still happening major public safety incidents again. So, the deep analysis and research are necessary. The study by collecting total 505 records of T company incidents data based from January 2006 to May 2011 were the basis of statistical analysis, applying simple and practical screening technology to explore the risk of past T refinery accidents risk during intensive maintenance. We found that the accidents ratio of refining business division (RBU) and Petrochemical business Division (PBU) were 37% and 7%. T company including eight business Division Agency , the accidents ratio of RBU and PBU taken together was about 44%, close to half of the T company's accident, reflecting the importance of both divisions, and then filter out 62 incidents both of the three plants under RBU and PBU, so obviously figured out that the accidents happened during intensive maintenance period was indeed higher than usual about 3.5 times. Statistical accidents by subdivided the intensive maintenance stage, found that 84% occurred in the construction phase, and roughly equivalent occurred in shutdown process and re-running phase each was 8%, but the consequences financial losses of the accidents in re-running phase seriousness was relatively much higher than in shutdown process by past experience, so audit before re-running professional expertise team should combine the professional expertise with extensive experience in all aspects, professional itemized one by one audit according to the process safety checklist of after intensive maintenance and before re-running, to avoid the defect of non-professional audit lack of recognization and detection, since the implementation of many years of practical verification, as indeed can be detected early number of intensive maintenance oversight, and immediately correct deviations in time to play a stop-running function. For the risk management of intensive maintenance job, this study combined with job safety and hygiene standards for safety and health job analysis, LEC methods for risk assessment and hazard identification, joining the detection factor of risk assessment method of Ford Company and HACCP concept and STOP concept of DuPont Company, and the concept of combined job safety and hygiene standards for supervisor and worker to handle the dynamic risk of the job has its benefit, while dismantling the entire job into several sequential steps, the risk of each step has its characteristics and differences, and show out the key step and its key point of the job, to remind the job workers in a timely manner to stop dangerous work categorically brakes, and carefully review the environment and conditions of the job scenario, to confirm the next step can be carried out after job environment and to avoid ignoring the change in job conditions and are unable to take effective risk control conduit into a hazard situation. On the other hand, for T oil refinery and other similar plants, the repeated similar incidents happened again, were be summarized. T oil refineries or other related literature have been good to improve the response and solution of those, and such a collection provided the small knowledge bank for the risk management of intensive maintenance. Suggestions based on this study findings were made for the reference to government departments and the related industry.