Amilcar

P etroleum O perations

Learning from incident:

Boiler Feed Water Pump Incident
 Agenda
• Where it happened
• Target Audience for this alert
• What happened
• Why it happened
• Causes of the incident
• Lessons Learned

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 Where it happened

LNG PRODUCER, at Brunei Darussalam, ASIA

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 Where it happened

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https://www.bruneilng.com/the-plant/
 Target Audience for this alert

Pump Operators Maintenance Staff

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 What happened ?

• May, 18th 2021, at 8:23 am

• a loud “bang” was heard from the boiler feedwater
pump area.
• A fire was observed at a pump location.
• security alarm was activated & CCR triggered
emergency response protocol.
• All personnel at site were accounted for with no
injuries
• no impact to Operation since a spare pump kicked-in
as per design.
• The system was immediately isolated and made safe.
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 Why it happened ?
metal to
Motor rotor metal contact temperature
moved out of started in started to rise fire ignited
position at
the bearing rapidly
high speed
housing

Rotor & Creation of

Fire
bearing lube oil leaking
aggravated
deformed path

back
Significant fire flames
cover gave
heat rose visible
way
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 causes of the incident

• Process allowed closure of maintenance work orders

without appropriate assurance.
• Unjustified deviations from manufacturer recommended
maintenance requirements.
• Unclear roles and responsibilities in maintenance tasks.

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 Lessons learned

• OEM maintenance recommendations need to be aligned

with SAP maintenance tasks. When not, a TA approved
justification needs to be in place to document the
deviation.

• Ensure resources are secured for basic maintenance

tasks, upfront of any major events.

• Ensure all maintenance procedures & tasks clearly define

single line accountabilities.