fracas - failure secene investigation
DESCRIPTION
FRACAS – Failure Scene Investigation For failure analysis, much of the data needed can’t be collected from SCADA system or by other automatic means. This paper discusses ways to secure the failure scene, collect that data, and preserve it for analysis.TRANSCRIPT
by Jim TaylorCRE, CPE, CPMM
Director of Operations, Machinery Management Solutions, Inc.
www.machineryhealthcare.comhttp://blog.machineryhealthcare.com
FRACASFailure Scene Investigation
Key Takeaway: Effective root cause elimination can be done by
the average maintenance professional
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You work in a facility or plant.
You’re a Maintenance professional: A Crafts Person, a Planner, a Supervisor, a
Maintenance Manager, or an Engineer.
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Low availability and repeat failures on your equipment is affecting your production and
customer service.
You want to find and eliminate these failures.
To keep track of it all, you need a
system.
A Failure Reporting,
Analysis, and Corrective Action
System (FRACAS).
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First, You must capture as much information about the Event as you
can.
FSI
Failure Scene
Investigation
You must capture the details of the Event in enough detail to do effective failure analysis.
As found condition
Failed components
Operating parameters
Sequence of events
Fluid levels
Signs of over temperature or pressure
You are the designated
Failure Scene Investigator.
by West Midlands Police
You are not the repair person.
You must capture the timeline of the Event in order to reconstruct the event.
T0 – time of eventT1 – time of trouble reportT2 – maintenance on sceneT3 – trouble shooting complete, parts orderedT4 – parts on siteT5 – repairs completeT6 – test completeT7 – system back on line
The four basic components of the failure scene
investigation process are:
The accident sequence
Physical Evidence collection
Digital evidence collection
Narrative evidence collection
The nature and complexity of the accident determines the extent to which these components are evaluated.
Arriving at the scene: Initial Response
1. Initial Response/Receipt of Information
2. Safety Procedures
3. Emergency Care
4. Secure and Control Persons at the Scene
5. Boundaries: Identify, Establish, Protect, and Secure
6. Turn over Control of the Scene and Brief Investigator(s) in Charge
7. Document Actions and Observations
Preliminary Documentation &
Evaluation
1. Conduct Scene Assessment
2. Conduct Scene ”Walk-Through“ and Initial Documentation
Processing the scene
1. Determine Team Composition
2. Contamination Control
3. Documentation
4. Prioritize Collection of Evidence
5. Collect, Preserve, Inventory, Package, Transport, and Submit Evidence
Completing & recording scene
investigation
1. Establish Failure Scene Debriefing Team
2. Perform Final Survey of the Failure Scene
3. Documentation of the Failure Scene
The key to an effective failure analysis is having the right information.
To do that, you must systematically collect that information.
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