Health and Safety Executive

Executive summary - Findings and recommendations

The investigations carried out by the Competent Authority identified a number of key findings for each of the three incidents. Further investigations into alarm handling, the overall safety management systems at the Complex, the response to the presence of asbestos during the incidents, the overall environmental impact of the incidents and the emergency response during the incidents were also carried out by the Competent Authority and also identified a number of issues. Key recommendations relating specifically to the circumstances surrounding each of the incidents were made and are included in the main text of this report.

The investigations also identified a number of common themes and a number of wider conclusions were drawn as a result of the investigations relating to the health, safety and environmental management system at Grangemouth. These were:

  • BP Group policies set high expectations but these were not consistently achieved  because of organisational and cultural reasons;
  • BP Group and Complex Management did not detect and intervene early enough on deteriorating performance;
  • BP failed to achieve the operational control and maintenance of process and systems required by law;
  • The BP Task Force findings and recommendations properly addressed the way forward to ensure safe and reliable operations at the Complex.

Recommendations were made by the Competent Authority for the BP Grangemouth Complex and for BP Group and these are included in the main text of the report.

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25.10.10