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CRITICAL CONTROL MANAGEMENTIMPLEMENTATION GUIDE

2 Critical Control Management Implementation Guide

Foreword 3

Part1:Howtosupportcriticalcontrolmanagementimplementation

Introduction 5

HistoryoftheCMMapproach 7

WhyshouldmyorganisationundertaketheCCMapproach? 8

Commonchallenges 10

Planningforchange 11

Part2:Implementationsteps

ImplementingtheCCMprocess

Guidetopart2 14

Step1:Planningtheprocess 16

Step2:Identifymaterialunwantedevents(MUEs) 18

Step3:Identifycontrols 21

Step4:Selectthecriticalcontrols 26

Step5:Defineperformanceandreporting 33

Step6:Assignaccountability 37

Step7:Site-specificimplementation 39

Step8:Verificationandreporting 44

Step9:Responsetoinadequatecriticalcontrolperformance 48

Aftertheprocess 50

AppendicesAppendixA:Definitions 53

AppendixB:Howtopromoteariskmanagementculture 54

AppendixC:Projectplanningchecklist 55

AppendixD:TheBHPBillitoncriticalcontroldecisiontree 56

Acknowledgments 57

3Critical Control Management Implementation Guide

FOREWORD

ICMMmembercompaniesarecommittedtoensuringthewell-beingofworkers,communitiesandtheirfamilies.Whileminingisaninherentlyhazardousactivity,thisdoesnotmeanthataccidentsareinevitable.Healthandsafetyhastobeattheheartofalloperationsandprocesses.

Fatalitiesandcatastrophicincidentscontinuetooccur,butourmembercompaniesacknowledgethatthisisunacceptableandbelieveagoalofzerofatalitiesisachievable.

ICMMiscommittedtoprovidingleadershipandresourcesformanaginghealthandsafety.Wehavedevelopedanapproachcalledcriticalcontrolmanagement(CCM)toimprovemanagerialcontroloverrarebutpotentiallycatastrophiceventsbyfocusingonthecriticalcontrols.

Thisnoteisafollowupto,anddesignedtobereadinparallelwith,theHealthandsafetycriticalcontrolmanagementguidepublishedbyICMMinApril2015.ItprovidesadditionalpracticalguidanceonpreventingthemostserioustypesofhealthandsafetyeventsandusescasestudiestodemonstratetheCCMapproach,providingactionstoachievethetargetoutcomeswithineachstep.

Sincethelaunchofthefirstguide,wehavebeendelightedwiththehighlevelofuptakeoftheCMMapproachwithinmembercompaniesandothercompanieswithintheminingandmetalsindustry.Wewouldliketothankourmembersforthesupportandguidancetheyhaveprovidedduringthedevelopmentofthiswork.

WecontinuetoencouragethoseimplementingCCMtoprovideuswithfurtherexamplesofgoodpracticewhichwecanshareinfuturedocumentsorthroughotherknowledgesharingactivities.

TomButler ChiefExecutiveOfficer,ICMM

PART 1HOW TO SUPPORT CRITICAL CONTROL MANAGEMENT IMPLEMENTATION


INTRODUCTION

TheInternationalCouncilonMiningandMetals(ICMM)haspublishedtheHealthandSafetyCriticalControlManagementGoodPracticeGuide(GoodPracticeGuide)(2015),whichoutlinestheapproachtocriticalcontrolmanagement(CCM)foruseintheminingandmetalsindustry.ThisdocumentprovidesguidancetoimplementtheCCMapproachintheGoodPracticeGuide.Italsoprovideshistoryandcontextoftheapproach,potentialbenefitsandobstacles,andhowanorganisationcanadoptCCM.

NotethatthereisnoonerightwaytoimplementtheCCMGoodPracticeGuide,anditwillneedtobetailoredtosuitindividualcompaniesandsites.

Thedocumentisintwoparts.

Part1covers:

• summaryoftheprocess

• historyoftheCCMapproach

• benefitsoftheCCMapproach

• challengeswhenimplementingtheCCMapproach

• howtoprepareandplantoimplementtheCCMapproach.

Part2covers:

• Astep-by-stepguidethatuseshealthandsafetycasestudiestodemonstratetheapproach.Thedocumentprovidesactionstoachievethetargetoutcomeswithineachstep.

Whatisthecriticalcontrolmanagementprocess?

TheCCMprocess(seeFigure1)isapracticalmethodofimprovingmanagerialcontroloverrarebutpotentiallycatastrophiceventsbyfocusingonthecriticalcontrols.Thesesortsofeventsarecalledmaterialunwantedevents(MUEs).MiningindustryexamplesofMUEsincludeundergroundfires,coaldustexplosionsandoverexposuretodieselparticulatematter.NotallMUEsthoughinvolvesuddenevents.Forexample,MUEsmayalsoincludethepotentialexposureofgroupsof

workerstocarcinogenicorotheragentatharmfullevelsoveraprotractedperiod.Theseallhavethepotentialtocausemultiplecasualties,buttheycanalsoaffecttheongoingviabilityofabusiness.Inotherwords,theyrepresentamaterialrisktothebusiness.PreventionofMUEsrequiresspecificattentionatthehighestlevelofanorganisationalongsideothermaterialbusinessrisks.

TheCCMapproachisbasedon:

• havingclarityonthosecontrolsthatreallymatter:criticalcontrols(Step4)

• definingtheperformancerequiredofthecriticalcontrols(Step5)–whatthecriticalcontrolhastodotopreventtheeventoccurring

• decidingwhatneedstobecheckedorverified(Step5)toensurethecriticalcontrolisworkingasintended

• assigningaccountabilityforimplementingthecriticalcontrol–whohastomakeitwork?(Step6)

• reportingontheperformanceofthecriticalcontrols(Step8).

Figure1:Thecriticalcontrolmanagementprocess

Planning steps

Impementation steps

Feedback loop

1Planning the process

3Identify controls

4Select the critical controls

8Verification and reporting

5Define performance and reporting

7Site-specific implementation

6Assign accountability

9Response to inadequate

critical control performance

2Identify material unwanted events (MUEs)

Planning steps

Impementation steps

Feedback loop

1Planning the process

3Identify controls

4Select the critical controls

8Verification and reporting

5Define performance and reporting

7Site-specific implementation

6Assign accountability

9Response to inadequate

critical control performance

2Identify material unwanted events (MUEs)


Underlyingassumptionsofthecriticalcontrolmanagementprocess

TheCCMprocessisbuiltuponanumberofassumptions.

Assumption1ThemajorityofMUEswithintheminingandmetalsindustryareknown,asarethecontrols.

Assumption2MostseriouseventsincludingMUEsareassociatedwithfailurestoeffectivelyimplementknowncontrolsratherthannotknowingwhattherisksandcontrolsshouldbe.

Assumption3Morecanbeless.Ahazardmanagementplanof50pageswilloftencontainalargenumberofcontrols,whichcanbecomplextounderstand,implementandmonitor.Thiscanleadtolessrobustmanagementofcriticalcontrols.Lesscanbemore.Thefewernumberofcontrols,themorerobustlytheycanbemonitored.

Assumption4Somecontrolsaremoreimportantthanothers.Thesecriticalcontrolsshouldbemonitoredmoreregularly.


Managinghealth,safetyandenvironmentinhigh-hazardindustries

Thereisalonghistoryofembarkingonprogrammestoimprovemanagerialcontrolovermajorincidentsinavarietyofindustries.Majorimprovementinitiativeshavetypicallyfollowedmajordisastersandhaveinvolvedbuildingonpre-existingideasandprogrammesthathadnotreceivedsufficientsupportpriortotheincidents.InEurope,theSevesoincidentin1976ledtoEuropean-wideregulatorychangeinvolvingatypeofsafetycase,whichhasinfluencedregulatorysystemsaroundtheworld.TheAlexanderKiellandandPiperAlphadisastersintheNorthSeainthe1980shadasimilarbutmorelimitedimpactonupstreampetroleum’semphasisonmanagingmaterialevents.Morerecently,theBPTexasCitydisasterinAmericain2005andtheBuncefieldpetroleumterminalexplosioninBritaininthesameyearhavestimulatedgreaterfocusonMUEs.Theseincidentshavedrivendevelopmentofawiderangeofguidanceandstandards.Examplesinclude:

• CenterforChemicalProcessSafety20-elementapproach

• EnergyInstitute20elements(2010).

Typicalapproachtoimprovinghealth,safetyandenvironmentinhigh-hazardindustries

Atraditionalapproachtoimplementacontrol-focusedapproachwouldtypicallyinvolveselectingareputableprocesssafetymanagementframework(suchastheEnergyInstitute20-elementprogrammementionedabove)andconductinga“gapanalysis”.Thistaskassessesthecompany’scurrentsituationandidentifiestheareasinacompany’smanagementsystemwherefurtherworkisneededtomeettherequirementsofthechosenframework.Aprioritisationofgapanalysisresultswouldbeundertakenbeforedevelopingaplantoimplementtherequirementstoadopttheframework.

Thisisusuallyrecommendedandregardedastheorthodoxapproach.However,thereislittleguidanceprovidedonhowtodothisasopposedtowhatisrequired.Whilethisapproachisentirelyvalid,itcanresultinrelativelyhigh-levelactionswithlimitedimpactonthepracticesoftheorganisation.Thisincludesalimitedimpactonmanagingcriticalcontrols.Forexample,ifonedeterminesinyourcompanythatmanagementofoperationalinterfacesrequiresmoreworktomeettheEnergyInstituteguidance,thentheimprovementworkinacompanymayfocusonthis.Thisisanimportanttopicandnodoubtwillyieldrewardsintime.Itisstilldifficulttoseehowthiswillsustaininterestatthefrontlineoncriticalcontrols,norhelptostartandsustainaprogrammetoimprovecriticalcontrols.

Similarapproaches

Therehavealsobeensomeapproachestomanagingmajorhazardsthatarespecificallyfocusedon“criticalcontrols”evenifthistermhasnotbeenused.

Forexample,inBritaintheOffshoreInstallations(SafetyCase)Regulations1992,andlatertheOffshoreInstallations(PreventionofFireandExplosion,andEmergencyResponse)Regulations1995,createdafterthePiperAlphadisasterin1988,introducedtheconceptofsafetycriticalelements(SCEs)(similartotheideaofcriticalcontrolsintheICMMguidance).TheseregulationsalsointroducedaregulatoryrequirementforaprocessofexaminingtheconditionandperformanceofSCEs.

Whatisdifferentaboutthecriticalcontrolmanagementapproach?

CCMalsofocusesonthespecificcontrolstopreventorminimiseanMUE.ThiscanestablisharobustCCMsystemquickerandmoreefficientlythanthemethodsoutlinedabove.Anymanagerialchangeprogrammeneeds“quickwins”todemonstratethatthechangeworks.TheCCMapproachisfocusedonachievingmorepracticalandvisibleactionsforcriticalcontrols.

Thiswillincreasethelikelihoodthatthechangeinemphasisforanorganisation(iemaintaininggainsonpersonalsafetywhileenhancingmanagerialcontroloverMUEs)canbesustained.

TheCCMapproachfocuseson:

• identifyingwhatcontrolsareneeded(manycontrolswillalreadybeinplace)

• identifyingthecriticalcontrols

• ensuringsupervisorsandmanagersaremonitoringthecriticalcontrolstochecktheyareprovidinginpracticewhattheyareassumedtoprovide.

HISTORY OF THE CRITICAL CONTROL MANAGEMENT APPROACH


Whyisafocusonmaterialunwantedeventsneeded?

Manycompanieshaveimprovedtheirsafetyperformanceasmeasuredbylosttimeinjuryfrequencyratesandsimilarmeasures.However,MUEssuchasfatalaccidents,rarercatastrophiceventsandsignificanthealthexposurescanstilloccur.Investigationsofincidentsthatarematerial(MUEs)tocompanies,includingfatalaccidentsandrarercatastrophicevents,typicallyshowthatknowncontrolsforknownriskswerenoteffectivelyimplementedinpractice.ThisisthereasonforthefocusoncriticalcontrolsthatischampionedbytheCCMapproach.

ManyofthesystemsandplansinplacetopreventMUEsareoftensetoutinbulkyandcomplexsafetymanagementsystems,hazardmanagementplans,andprocedures.Theycanbedifficulttoimplementandcanbecome“shelfware”.Experiencealsosuggeststhatthesesystemsandplanslackclarityastowhatthereallyimportantorcriticalcontrolsare.ThekeytotheCCMapproachisafocusonthecriticalcontrols,clearlydescribed,monitoredandreportedupon.Muchofthepre-existingdetailedinformationinmanagementplans,riskassessmentsandsoonisstillneeded.ThisprovidesmuchofthebackgroundmaterialtoenabletheCCMapproachtobeimplemented.

1Source:A.Hopkins,Safety,CultureandRisk:TheOrganisationalCausesofDisasters,Sydney,NewSouthWales,CCHAustralia,2005.

Whatarethebenefitsofimplementingthecriticalcontrolmanagementapproach?

ByadoptingtheCCMapproachwecanreducetheriskofanMUE.ThisisbecausetheCCMapproach:

• focusesonasmallerandmoremanageablenumberofriskcontrols–thecriticalcontrols

• usesbowties,whichprovideasimpleandreadilyunderstoodpictureofthelinksbetweentheMUE,howitcanbecaused,andthecriticalcontroltopreventitoccurringandminimisetheconsequencesifitdoes

• documentsthecriticalcontrolsinasimpleformat,makingexplicittheperformancerequiredofthem,howtheyaretobecheckedandwhoisresponsibleforthem

• providesawayofmeasuringthe“health”orperformanceofcriticalcontrols–knowingthehealthofcontrolsprovidesamechanismtoallowmoreeffectivegovernanceoverthiscategoryofmaterialbusinessrisks

• givesaclearunderstandingofthecontrolsneededtomanageMUEsacrossalllevelsoftheorganisation.

Companieshavealsoreportedotherbenefits.Theseinclude:

• Abetterunderstandingofcriticalcontrolshasledtomoreproductiveandinsightful“visibleleadership”interactionsbetweenmanagersandtheworkforce.ThisoccursbecausethedocumentsproducedasaresultofimplementingtheCCMapproach,forexamplebowties(Steps3and4)andcriticalcontrolinformationsummaries(Step5),makeiteasiertohavemeaningfuldiscussions.Seniormanagersnowhavethedetailtoaskgood-qualityquestionsaboutcriticalcontrolsevenifthesubject-matterisoutsideoftheirexpertise.

• Afocusonthecontrolshasledtobettermaintenanceandimprovedassetintegrity.Thishasresultedinreduceddowntimeandloweredmaintenancecosts.

• ActivelymanagingtheriskofanMUEalsomanagestheriskofreputationdamage.

• AfocusoncontrolsandoversightoftheMUEsallowsbettergovernanceanddecision-making.

WorkforceandcultureTheCCMapproachsupportsthedevelopmentofaneffectivesafetyculture.CCMemphasisestheimportanceofeffectiveimplementationofcriticalcontrols.Inotherwords,itfocusesonimportantpracticesthatpreventorminimiseMUEs.Afocusonpracticesor“howwedothingsaroundhere”isanacceptedwayofdevelopingandsustaininganeffectivesafetyculture.AsAndrewHopkinshaspointedout,aneffectivesafetycultureisnecessarytomakesafetysystemswork.1

WHY SHOULD AN ORGANISATION UNDERTAKE THE CRITICAL CONTROL MANAGEMENT APPROACH?


Learningfromtheexperienceofothers

ThisguidanceisbasedonpracticalexperiencefromanumberoforganisationsthathaveembarkedontheprocessofimprovingtheirmanagerialfocusonMUEs.Thelessonslearnt2fromthisexperience,andfromotherindustriesthathavecarriedoutsimilarwork,isreflectedinthefollowingguidanceonhowtoimplementtheCCMapproach.

Themainlessonsfromothercompaniesinbothminingandotherindustriesare:

• MostcompaniesreportedthattheyalreadyhadtheinformationnecessarytoimplementaCCM-typeapproachintheformofhazardidentificationandriskassessments.However,theyhadnotdistilledorsummarisedthisinformationintoareadilyusableform.

• Companiesusuallycannotgetthisrightthefirsttime–itrequiresexperience.ButthisexperienceisusefulasitbuildsunderstandingoftheMUEs,thecontrolsandthecriticalcontrols.

• Thereisnoonerightanswertothequestion,whichcontrolsarethecriticalcontrols?Thisdependsontheparticularcircumstancesofacompanyandminesite.

• ImplementingtheCCMapproachrequiresaprojectmanagementapproachanddedicatedhumanresources.

• Whereverpossibletheexperienceofinternalcompanypersonnelshouldbeused.Inparticular,theinvolvementofsubject-matterexpertsontechnicalareaswillberequired.However,externalresourcesmayalsobeneeded,particularlyintheearlystagesofaCCMproject.

2Lessonslearntareonlyreallylearntwhenanorganisationappliesthelessonsandchangesprocessesandbehaviours,andtheresultsofthechangescanbemeasured.Untilthisisdonelessonsarenoteffectivelylearntbutarestillstrictlyspeakinglessonstobelearnt.

• CreatearealisticprojectplanthatdoesnotunderestimatethetimerequiredtothoroughlyreviewtheMUEsanddeveloptheCCMmaterial.


ThissectionidentifiessomeofthecommonchallengesfacedbycompaniesimplementingtheCCMapproach.Section5providesadditionalguidanceonhowtomakethechange.

Doesyourorganisationhaveexistinginternalguidance?

Manycompaniesalreadyhaveexistingguidanceonsafetymanagementand/orriskmanagement.ExistingguidanceisunlikelytoadvocateorsupporttheCCMapproachexplainedintheICMMHealthandSafetyCriticalControlManagementGoodPracticeGuide.

Asaresult,itmaybenecessarytoexplicitlyagreeandexplainwithintheorganisationhowthisapproachsupportseffectivemanagementofMUEs,includinghowtheICMMguidancerelatestoexistingguidanceandpractices.Thesemightrequirechanging.Examplescouldincludegovernanceframeworks,existinghealthandsafetymanagementsystemsandtrainingpackages.

Humanresourcesandinvestment

OftenthehumanresourcingrequirementsneededtoundertaketheCCMapproachisunderestimated.Thisleadstoorganisationsattemptingto“jobshare”CCMwithother(oftenhealth,safetyandenvironment(HSE)oroperational)duties.ThispresentsachallengeassharinghumanresourceswillresultinalesseffectiveandthoroughmanagementoftheCCMprocess.

Aheadofregulation?

TheCCMapproachconsistsofconceptsandactionsthatmaybeunfamiliartoregulatorsinsomejurisdictions.ThismayrequirecompaniesorsitestojustifyandexplainCCMtoregulators.

Prominenceofpersonalsafety

Theminingindustryhassuccessfullyreducedthenumberofinjuriesandfatalities.Thishasledtoanunderstandableandbroadlysuccessfulfocusonreducingpersonalsafetyincidents.However,asMUEsarerelativelylow-probabilitybuthigh-consequenceinnature,theyareoftendifficulttomobiliseattentiontowards.OrganisationsthereforeneedtoexplaintheirfocusonMUEs,inadditiontoafocusonpersonalsafety,andacknowledgeanysimilaritiesordifferences.

COMMON CHALLENGES


PlanningforthechangeiscriticaltothesuccessoftheCCMprocess.Step1oftheprocessoutlinedinPart2explicitlydealswithplanningfortheCCMapproach.However,therearestepsthatneedtobetakenbeforeyoucanembarkontheCCMapproach.Thissectiondescribesthosekeyactions,issuesandthemestobetakenintoaccountpriortostartingtheCCMprocess.Thesekeythemesare:

• planningactivities

• projectscoping

• organisationalreadiness.

Planningactivities

PlanningactivitiesneedtobeundertakenbeforeplanningtheCCMproject.Thisensuresthattheorganisationhastherequiredmaturityandunderstandingtoproperlyscopethetask.Theactivitiesincludethefollowing.

SeniorleadershipsupportSeniorleadershipcommitmenttotheprocesswillhelptorealisethebenefits.EnsuringseniorleadershipunderstandstheCCMprocessandbenefitsisessential.Externalexpertisemaybeneeded.

CommonlanguageAcommonandagreedsetoftermstodiscusstheCCMprocessisessentialtocommunicatekeyconcepts.StaffwillhavevaryinglevelsofexperiencewithMUEsandunderstandingofrelevantterms(suchascriticalcontrols).AlistofdefinitionsandabbreviationsisshowninAppendixAandmayhelptodefineterms;however,anorganisationshoulddecideonthebestlanguageforthem.

AssuranceoftheprocessAsenseofuneaseanduncertaintyiscommoninorganisationsundergoingchange.TheadoptionoftheCCMprocessmaychallengeexistingprocessesandprocedures,propagatingthesefeelings.Ifassuranceintheoutcomesofthechangecanbeclearlycommunicated,itcanhelpaddresstheuneaseanduncertainty.Considerusingexamples

ofsuccessfulapplicationofthecontrol-focusedapproachintheminingandmetalsindustry(andinotherhigh-hazardindustries,suchasoffshorepetroleum)ascasestudiesofthesuccessoftheprocess.

Projectscoping

TheprojectscopewillsettheexpectationsandoutcomesofcompletingtheCCMprocess.Itisimportanttohaveascopetailoredtoyourorganisation.Youshouldconsiderthefollowingquestions.

Doyouhaveaclearendpoint?ImplementingtheCCMprocesstoahighstandardrequiressignificantorganisationalchange,humanandcapitalresources,andinvestment.Considertheendpointfortheprojectandthewiderorganisation.Thiscouldincludethesupportframeworkssuchasgovernanceframeworks,existinghealthandsafetymanagementsystemsandtrainingpackages.Onceyouhaveaclearvisionoftheendpointyoucanidentifytheprojectoutcomes.Thisenablesprogresstrackingandwillhelpencourageandmotivatestaff.

Doyouhaverealisticexpectations?OrganisationsneedarealisticexpectationoftheCCMprocess.Aftercompletingtheprocesstherewillnotbe100%assurancethatMUErisksarecontrolled,buttherewillbeoversightoftheMUEs.TherewillbecontinuousreviewandimprovementtoensurethegreatestlevelofMUEcontrol(asdiscussedinStep9).

Doyouhaverealistictimelines?ThecomplexityoftheCCMapproachisoftenlargerthaninitiallythought.Itisnotuncommonforamulti-yearprojecttoseetheCCMapproachfullyimplemented.Organisationsshouldconsiderwhatarealistictimelineforimplementationisand,ifpossible,discusstheexperiencewithasimilarorganisationthathasundertakentheprocess.

Doyouhaveaplanforprojectgovernance?Arobustgovernancestructureiscrucialforanylargeproject.Thisshouldnotbeconfusedwithgovernanceovercontrolmonitoring,whichispartoftheCCMprocess.Yourorganisationmayhaveprojectgovernancestructuresalreadydefined.Ifnot,arobuststructureshouldinclude:

• internalstructuresandreporting–thisincludesclearlyidentifyingtherolesandresponsibilityofstaff,anditshoulddefinemechanismsforprogressreportingwithinthegovernancestructure(thismaybeintegratedintocurrentsystems)

• achangemanagementmethodologyorapproach

• aprojectgovernancebodysuchasasteeringcommitteeorgovernanceboard–thisgroupensuresthereisadequateoversightthroughoutthelifeoftheproject.

Howmuchtrainingdoyourkeystaffneed?Theprojectmanager,projectteamandseniorleadershipwithintheorganisationshouldhaveagoodunderstandingoftheCCMapproach.Thisshouldincludeanunderstandingofthetheory,terminology,challengesandbenefitsoftheapproach.Adequatetrainingmayrequireengagingexternalexpertisetodeliverthis.

Haveyouscopedyourexistinginternalexperienceandexpertise?AnorganisationshouldleverageoffitsexistingexperiencesinmanagingMUEs.Forexample:

• Organisationsshouldidentifyinternalexpertisetheymayhave,suchasstaffthathaveattendedMUEriskmanagementandriskcontroltraining.

• SomeorganisationshaveriskassessmentsandbowtiesthatareabletobeusedintheCCMprocess.

• Learnfromincidentswithinyourcompanyandfromtheindustryasawhole.

PLANNING FOR CHANGE


Organisationalreadiness

TheGoodPracticeGuideprovidesaCCMjourneymodelandmappingtool(AppendixA,page23),intendedtoassistacompany,businessunitorsitetobenchmarkitscurrentCCMmaturity.ThiswillhelpassessorganisationalreadinesspriortoundertakingtheCCMapproach.AhighermaturityscoresuggestsahigherlevelofcapabilitytoimplementtheCCMapproach.

Inadditiontothetool,organisationsshouldconsiderthefollowingfourquestionstoassessreadiness:

• Doyourproposedprojectmanagershaveappropriateunderstanding,educationandtraining?

• Doyouhaveaconsistentandagreedterminology?

• Doyouhaveseniorleadershipbuy-in?

• Doyouhaverealistictimelinesandoutcomesfortheproject?

Ifyouansweryes,yourorganisationhasabaselevelofreadinesstoadopttheCCMapproach.


PART 2IMPLEMENTATION STEPS


GUIDE TO PART 2

Part2containsguidanceonhowtoimplementeachoftheninestepssummarisedintheGoodPracticeGuide.ThisimplementationguidanceshouldbeusedinconjunctionwiththeGoodPracticeGuide,notasastand-alonedocument.Thisguidanceisnotprescriptive,butprovidesadviceandsuggestionstoaidimplementation.

Part2hasthefollowingmaincomponents:

• step-by-stepguidance(Steps1–9)

• aworkedexampleforeachstepusingafictitiouscompanyEastCoastCoal(ECC)asavehicletoillustratehowtheCCMprocessmaybeimplemented(seebelowfortheintroduction)

• bowties–oneforasafetyMUE(undergroundfireandcoaldustexplosion)andtheotherahealth-relatedMUE(dieselparticulatematteroverexposure)–eachbowtieispresentedtwice:firstlywithasampleofthecontrolspresentedandsecondlywithcriticalcontrolsidentified.

WhenimplementingtheCCMprocess,onepersonwillnothavealltheknowledgerequiredtocompletetheprocess.Whennecessary,conductworkshopsorformaworkinggroupwithpersonnelwhohavetheappropriateknowledgeandexpertise.Considertheuseofexternalexpertiseifnecessary.

TheCCMapproach

AlthoughtheCCMapproachisbasedonatriedandtrustedapproachthathasbeeninuseinotherindustriesforover20yearstomanagemajorhazards,thereislimitedexperienceofapplyingthisapproachintheminingandmetalsindustry.Thisimplementationguidancedrawsonthelimitedpracticalexperiencethatisavailableandontheexperiencegainedinotherindustries.

ThisexperiencestronglysuggeststhereisnoonerightwaytoimplementtheCCMapproach.Companieswillneedtoadapttheapproachdescribedheretosuitthecircumstancesinwhichtheyoperate.

EastCoastCoal

Part2usesacasestudytoillustratetheapplicationofeachstep.Thecasestudyinvolvesafictitiouscompany,EastCoastCoal,thatisimplementingtheCCMapproach.TherearetwoMUEs,oneahealtheventandtheotherasafetyevent.


CASE STUDY

EastCoastCoalLtd(ECC)isacoalminingcompanywithoperationsinseveralcountries.Theseoperationsareacombinationofundergroundandopen-pitmining.ECChas4,000employeesinitsinternationaloperations.ThecompanyhascomeundernewleadershipaftertherecentretirementoftheCEO.

ECCwantstoimplementanewstrategytobettercontroloperationalrisks.Managementhasevaluatedandexploredothersafetystrategiesinthepast.Anattempttoimprovesafetylackedmomentumandrequiredmoreresourcesthanexpected.Italsofocusedprimarilyonfatalaccidentsandlosttimeinjuries,whichareimportant,butdidnotadequatelyaddressrarerhealthandsafetyriskssuchasmultiplefatalaccidentsandevenrarercatastrophicevents.

Seniormanagementareawareofrarebutcatastrophicrisks

Managementrecognisedanumberof“weaksignal”events,includingsomeminorincidents,thatcouldhaveprovendisastrous,suggestingthattheywerestillvulnerabletoamajorevent.HavingrecentlyseenapresentationontheresultsoftheinvestigationintotheUpperBigBranchMinedisasterinWestVirginia,America,seniormanagementhaveaskedwhatcanbedonetoimprovetheirfocusoncontrollingthecompany’smajorrisks.

TheCOOaskedtheHSEmanagertoarrangeameetingwithanumberofexperiencedandrespectedstaff.Thesecomprisedsomesubject-matterexperts,

includingtheventilationofficerfromoneoftheundergroundmines,theengineeringmanager,theHSEmanager,aminemanagerandahead-officeriskanalyst.

InternalmeetingofexperiencedpersonneltodiscussMUEs

TheCOOmetwiththeexperiencedandrespectedstaffandexplainedthebackgroundtothemeeting.TheCEOhadbeenbriefedontheUpperBigBranchMinedisasterinAmericaandthePikeRiverdisasterinNewZealand.TheCEOaskedmembersoftheleadershipteamifsuchaneventcouldhappenintheiroperations.Therewasamixedresponse.Somemembersoftheleadershipteamthoughtnobutotherswerenotsosure.Onememberoftheleadershipteampointedoutthatifthesamequestionwasaskedinthosecompaniesinvolvedinmajordisasters,beforetheincidenthappened,theywouldprobablyhavesaidadisastercouldn’thappentothem.TheCEOaskedtheCOOtoinvestigateandadvisewhatshouldbedone.Asaresult,thismeetingwastakingplace,andhewantedtoheartheviewsofthe(veryexperienced)staffthatwerepresent.

Aswiththeleadershipteam,viewsweremixed.Onepersonpointedoutthattheyhadextensiveanddetailedhazardmanagementplansinplace.Somebodyelsesaidthattheyhadenjoyedaverylowandindustry-leadinglosttimeinjuryfrequencyrate(LTIFR).Anothersaidthatthegovernmentregulatorhadvisitedthemineregularlyandnotraisedanyproblems.

However,otherviewswereexpressedtoo.Thenearmissesthatcouldhaveledtoseriousevents,whichfortunatelydidnotescalatetotheirfullpotential,weredescribed.ItwasalsopointedoutthattherewaslittleornoconnectionbetweenalowLTIFRrateandtheprobabilityofafatalormajorincident.Itwasdiscussedthatanairlinesafetyrecordisnotjudgedbytheoccupationalhealthandsafety(OHS)ofairsideworkersandbaggagehandlersbuthowwelltheaircraftareoperated.Alowbackinjuryratetothebaggagehandlersdoesnotmeanthattheiraircraftmaintenanceproceduresareallinorder.SomebodyelsefromaroundthetablequotedfromanOHSsafetymagazinethatsaid,“theimplementationofsafetymanagementislargelyineffectivebecause…documentedsystemsaretoocomplexfortheorganisationtocomprehend,implementandmaintain”.Shesaidthatsoundslikesomeofoursystems.

TheCOOaskedtheHSEmanagertoconveneaworkinggrouptoreviewtheICMMHealthandSafetyCriticalControlManagementGoodPracticeGuideandtoprepareaprojectplan.

INTRODUCTION TO EAST COAST COAL


STEP 1: PLANNING THE PROCESS

Targetoutcome

Developaplanthatdescribesthescopeofaproject,includingwhatneedstobedone,bywhomandthetimeframes.

Action1:Developaprojectplan

AcomprehensiveprojectplanwillassistinthesuccessfulimplementationoftheCCMprocess.Asaminimumtheprojectplanshouldcover:

• theorganisationalcontextthatwilldeterminetheconductoftheproject

• theprojectobjectives–ensuretheyareclearandreasonableforthetimeframeoftheproject

• theresponsibilitiesofteamsandindividuals

• thebusinessareasthatwillbeimpactedduringimplementation.

WithintheplanidentifytherequirementsforeachstepintheCCMprocess.Thisprovidesclarityontheresourcesneededtoachievetheexpectedoutcomes.Thisincludes:

• timelinefortheproject,andforeachstepoftheproject

• financeneededtosupporttheproject,andamechanismtotrackspendthroughouttheproject

• projectapproach,whichdependsonthesizeandscopeoftheprojectthatanorganisationdeemsmostappropriate–thiscouldincluderegionalrollout,orsite-specificpilotproject(apilotprojectshouldbeconsideredtoaddresstheprojectchallengesandbarrierstoimplementation,aswellashowtobetterrealisethebenefitsoftheCCMprocess)

• humanresourcingrequirements,suchaswhoandhowmanypeopleareinvolvedateachstageoftheproject:

– adedicatedprojectmanagerfromstartupthroughtocompletion

– aninternalprojectteamdedicatedfulltimetotheproject–thesizeoftheteamwilldifferbetweencompanies

– subject-matterexpertsfortechnicalmattersandadvice–someorganisationswillhaveinternalexpertise;however,othersmayrequireexternalexpertise

– formulti-siteimplementation,tomaintainfocusontheproject,considerallocatingpersonneltobespecificallydedicatedtotheCCMprojectfulltime–thiswillassistwithsite-specificimplementation.

TheCCMprocessispotentiallyaresource-intensiveprocess.Ensuringthatadequateresourcesareavailableisessentialtothesuccessoftheproject.Minimalresourceswilllengthenthetimelineoftheprojectandmayresultinfurthercoststogettheprojectontrackandimpactonoutcomes.

Theprojectplanprovidesthegovernanceframeworkfortheprocess.Assuchthecompany’sexecutiveandgovernancebodies(includingtheboardofdirectors)shouldreviewandagreetotheprojectplanpriortotheprojectstartup.

Developadetailedimplementationplan.Thedetailedimplementationplanisanessentialtomappingthestepsintheprocess.Usetheprojectplanningchecklist(seeAppendixC)toensurethekeyitemsareincludedintheplan.

ScopingandplanningtheimplementationoftheCCMprocessisessentialtosuccess.Thisrequirescarefulthoughtandforwardplanningforeachstep.Thisstepdescribestheconsiderationsforthedevelopmentofaprojectplantoguidetheimplementationoftheoverallprocess.

Actionsinplanningtheprocess

Action 1 Develop a project plan


STEP 1 CASE STUDY

EAST COAST COAL’S PROJECT PLAN DEVELOPMENT

ECCembarkedonplanningtheCCMprocess.First,ECCformedaworkinggrouptooverseetheprojectthatconsistedofappropriatepersonnelwithvaryingroles,expertiseandlevelsofseniority.

Theworkinggroup’sfirsttaskwastodefinetheobjectivesfortheproject.Thegroupreflectedonthecompany’svisionandvaluestoaligntheproject’sgoalswiththeirHSEstrategy.Quantifiabletargetsweresettomeasurethesegoals.Benefitsfortheprojectwerearticulated.

Itwasdecidedearlyonbytheworkinggroupthattakingonthisprojectallatoncecouldbeoverwhelming,andsothegroupchosetoimplementtheprocessatonlyonesitefortwoMUEstobeginwithbeforetryingtheCCMapproachwiththerestofthecompany.

Arealistictimelinewascreatedtoreflectthesignificanceofthetaskandtheamountofresourcesrequired.Thistimelineincludedmilestonestotrackprogress.

Responsibilitiesweredefinedfortheproject.Becauseofthesignificanceof

theproject,theCEOaskedtheCOOtooverseetheproject.Appropriatestaffwereallocatedtotheprojectfortheorganisationasawholeaswellasatthesite-specificlevel.Groupswithintheorganisationwereidentifiedtoleveragespecificskillsorexpertise.Thisstepalsoinvolvednotingareaswhereknowledgemaybeinsufficientandexternalguidancewouldberequired.

Overviewoftheprojectplan

OrganisationalcontextTheECC’svisionistobealeadingcoalandmetalsminingcompany.Thecompany’svaluesincludeprotectingthewell-beingofitsemployeesandminimisingitsenvironmentalimpact.

ProjectaimTheprojectaimistoimplementtheCCMacrossthecompany.

ResponsibilitiesAtacorporateleveltheCEOandboardwillprovideoversightoftheproject,whiletheHSEmanagerisinchargeofimplementingtheguidance.Atthesitelevelthesitemanagerwillbeinchargeofoverseeingthattheimplementation

occurs,whilethesiteHSEmanagerwillbeinchargeofimplementingthecontrolsandassociatedprocesses.

BusinessunitsInvolvedAtthecorporatelevel,thebusinessunitsinvolvedwillincludethecompanyCEO,boardandHSEdivision.AtthesitelevelthesitemanagerwillensuretheimplementationoftheCCMframeworkwhilethesiteHSEmanagerwillimplementthecontrolsandsupportingactivities.

TimelineApilotprogrammewillseektohaveasinglecriticalcontrolframeworkimplementedwithin36months,andacrosstheorganisationin48months.

Withtheprojectplaninplace,theworkinggroupbegandevelopingmethodstoidentifyandassessrisks,identifycontrolsandwhethertheyarecriticalornot,andhowtomeasuretheimpactoftheproject.Thegrouprecognisedtheimportanceofcreatingeffectivemethodstoidentifycriticalcontrolsastheywouldbeappliedlaterintheproject.Tosupportthis,theworkinggroupengagedexternalexpertise.


Action1:IdentifymajorhazardsandMUEs

ThefirststepoftheprocessistoidentifythemajorhazardstotheorganisationandtoidentifyMUEstobecontrolled.InidentifyingtheMUEsconsider:

• reviewinginternaldocumentsforMUEs,suchasexistingriskassessments(oftenMUEshavealreadybeenidentifiedbutforadifferentpurpose)–assesstherelevanceofthesedocumentstotheCCMprocessbeforeusingthem

• reviewingthewidercontextforhistoricalandforeseeablefutureevents–considerreviewingrecentglobalminingincidentsforrelevantMUEs,includingassociatedcompaniesthatmayhavesimilarorrelevantMUEstoyourorganisation,andconsiderreviewingindustrynewspublications(egAustralianMining)

• discussingdifferenttypesofrisksseparately(egundergroundrisksmayneedtobeconsideredseparatelytoabove-groundrisks).

ThemajorhazardsandMUEsidentifiedshouldbespecifictoyourorganisationbutcouldbeapplicabletomultiplesites.

Action2:CheckMUEsposeamaterialrisk

ThenextstepistoassesstheidentifiedMUEstoensuretheyareamaterialrisk.Thatis,iftheMUEeventuates,itwillimpacttheabilityofthebusinesstomeetitscoreobjectives.Thiscanbedonebydefiningmaterialitycriteria,thenapplyingthesecriteriatoeachoftheMUEs.IftheMUEmeetsaminimumnumberofcriteria,itisdeemedmaterial.ThisactionwillprovideassurancethattheMUEshouldprogressintheCCMprocess.

First,definethematerialitycriteria.Thisisthethresholdthatariskmustexceedbeforebeingconsideredamaterialrisk.Thematerialitycriteriawilldifferbetweenorganisations,soidentifywhatyourorganisationconsidersasmaterialtothebusiness(egthepossibilityofmultiplefatalitiesorcausingashutdownandlossofproductionformorethan12months).

Definitionsofmaterialitymaydifferbetweencompaniesduetothesizeandnumberofsites,operations,minetype,commodityandlocationoftheoperation.Whendefiningthematerialitycriteria,considerwhatisthethresholdahazardneedstoexceedtohaveamaterialimpactontheorganisation.

Second,applythematerialitycriteriatoeachMUE.WorkmethodicallythroughapplyingthecriteriatoeachMUE.TheMUEsthatsatisfythecriteriaarematerialrisksandprogresstothenextstep.TheMUEsthatdonotsatisfythecriteriaarenotmaterialanddonotneedtobemanagedbytheCCMprocess.However,theseMUEsmaystillneedtobemanagedthroughothermeans.ThelistofMUEsshouldbereviewedperiodically.

Action3:AssessopportunitiestoeliminatetheMUEbyimprovingdesign

AssesseachMUEfordesignopportunitiesthatcouldeliminateitasanMUE.Theaimofimprovingdesignistoreducethelikelihoodof

STEP 2: IDENTIFY MATERIAL UNWANTED EVENTS (MUES)

Targetoutcome

IdentifytheMUEstobemanaged.SummarisethekeyinformationforeachMUE.

ThisstepwillidentifythemajorhazardsandMUEs,thenassesstheknown(andunknown)majorhazardstochecktheyarematerialtothecompany.ThisensurestheCCMprocesswilltargetthemostrelevantMUEs.ThestepwillconsiderifanMUEcanbeeliminatedbyimprovingdesignoftheoperation.ThedesignimprovementsaimtoreducethelikelihoodofanMUEoccurring,ortheimpactoftheconsequences,andthusremovetheMUEasamaterialrisk.Theoutcomeofthisstepincludesa“hazarddescription”documentthatsummarisesthekeyinformationoftheMUE.

ActionstoidentifyMUEs

Action 1 Identify major hazards and MUEs

Action 2 Check MUEs pose a material risk

Action 3 Assess opportunities to eliminate the MUE by improving design

Action 4Describe the MUE, the hazard and the release mechanism and consequences


WHAT WERE THE MATERIALITY CRITERIA EAST COAST COAL DECIDED UPON?

anMUEoccurringortheimpactoftheconsequences,andthusremovingitasamaterialrisk.Whenassessingtheopportunitiesforimproveddesignconsider:

• reviewingdocuments(suchasmaintenancedocuments,policiesandprocedures)toidentifyimprovements

• reviewingthedesignimprovementopportunitiestodetermineiftheMUEsareeliminatedfromtheCCM–someimprovementswillbeimplementedwhiletheprocesscontinues.

Action4:DescribetheMUE,includingtherelevanthazard,mechanismofreleaseandtheconsequences

SummarisetheinformationforeachMUEinadocumenttoprovidecontextforotherstounderstandtheMUE.ThedevelopmentofthedocumentshouldincludestaffthatunderstandtheMUEandtheCCMprocess.Ataminimumthedescriptionshouldconsider:

• thebackgroundandimportanceoftheMUE–thisprovidescontextofwhereitexists

• themechanismofreleaseoftheMUE–inotherwordsthefactorsthatcouldinitiateit

• thescopeandboundaryoftheMUE–thisisthesystemsandareaswhereitexists(andwhereitisnotconsideredarisk)

• thepotentialconsequencestopeople,environment,reputation,stakeholders,financialandanyothersignificantimpactontheorganisation.

Oncecompleted,reviewthedocumentusingappropriatepersonnel.ThiscouldbethepersonnelthatassistedinAction1ofthisstep,theCCMprojectmanagerortheprospectiveMUEowner(apersonwhowillbeidentifiedinStep6).

STEP 2 CASE STUDY

TheactionsinStep2are:

• identifymajorhazardsandmaterialunwantedevents(MUEs)

• checkwhichMUEswerematerial

• assessopportunitiestoeliminatebydesign

• describetheMUE,thehazard,thereleasemechanismandconsequences.

Oftheseonlyoneproveddifficulttodecideuponintheworkinggroup.Thiswasdecidingwhatwasmeantby“material”.

Materialityasascreeningtool

Theriskanalystprovidedsomeguidance,explainingthatmaterialitywasaconceptusedinenterpriseriskmanagementtodefinewhateventscouldstopabusinessfromachievingitsobjectives.Itwasnormallyusedtodescribethemostseriousevents.Inthecontextofhealthandsafetyitwastypicallyusedtodescribemajordisasters.ThePikeRiverMineexplosionsinNewZealandfellintothiscategorywhereasanindividualfatalityfromanoverturningbulldozer,whilestilltragic,wouldnotnormallyberegardedasanMUE.Materialityisadescriptionofapotentialconsequencefromanevent.ItisusedasascreeningtooltodecidewhichforeseeablehealthandsafetyeventsarethemostimportantandshouldbeincludedintheCCMprocess.

Whataboutexistingfatalriskcontrolsandgoldenrules?

Amemberoftheworkinggroupaskedabouttheexistingfatalriskcontrols.Whydidn’ttheseaddressMUEs?

TheHSEmanagersaidthatthiswasanimportantquestion.TheHSEmanageragreedthattherewassomeoverlap.However,thefatal

riskcontrolsandgoldenrulesweremainlyfocusedonseriousincidentsthatwereunlikelytoresultinmorethanoneortwofatalitiesatonce.Theywerealsofocusedonfrontlineworkerbehaviour.PreventionofMUEssuchasundergroundfires,orhealthriskssuchasexposuretodieselparticulatematter,alsoneededtherightfrontlineworkerbehavioursbutwerealsocriticallydependentonoptimisingthedesignofminelayout,equipmentandsystemsandeffectivelyimplementingcomplexsystemssuchasventilation.Manyofthesesortsofcontrolswerenoteasilymonitoredbybehavioural-basedsystemsasusedtosupportfrontlineworkerbehaviours.

Materialitycriteria

Followingthisdiscussion,theworkinggroupdecidedontwocategoriesofmaterialitycriteria:

• safety–incidentswithpotentialconsequencesofthreeormorefatalitiesinanyoneevent

• health–potentialforseriousimpairmentordeatharisingfromrepeatedexposuretooccupationalcontaminant(s)abovetheoccupationalexposurelevel.


UNDERGROUND FIRE AND COAL DUST EXPLOSION HAZARD DEFINITION

ThisisasafetyMUEexampleoftheoutcomefromAction4.

Background

Undergroundfireandcoaldustexplosionsareaprevalentriskforallundergroundcoalminingoperations.Theseexplosionstypicallyoccurfrommethanegasorfromcoalfinesmixingwiththeundergroundatmospheretoformacombustiblecomposition.Exposuretoanignitionsourcecanresultinrapidcombustion.Whenthiscombustionoccursinconfinedspaces,thesuddenreleaseinenergycausesashockwavetotravelthroughthetunnels.Accumulatedcoalfinesmaybecomeairbornefromtheshockwaves,whichleadstofurtherexplosions.Severedamagetoequipmentand/orpersonnelanddeathcanresultfromthepressurewaveorfromshrapnelcarriedbytheshockwave.Personnelmayalsoexperienceinjuryordeathfromtheradiant

heatofcombustion,orasphyxiationfromthedepletionofoxygen.Otherconsequencesoftheseeventsincludefinanciallossesfromequipmentdamage,litigationorprocessshutdown.

Scope

Thishazardexistswherecoalfinesarepresent–inparticular,undergroundminingandsurfaceoperationsforbrownandblackcoal.Thishazardmayalsoexistwhenminingothercommoditiesinanundergroundenvironmentdependingonthesurroundinggeologyandmethods.

Boundary

Undergroundactivities,associatedactivities(suchasmaintenance)andsystemsthatsupportundergroundoperations(egventilation,electricitysupply,watersupply,etc).

Potentialconsequences

Immediatedamage,injuriesordeathfromtheevent.Secondaryconsequencessuchasminecollapseswillbetreatedasaseparatehazard(butgiveconsiderationtoundergroundexplosionsasacause).Longer-termconsequencesmayincludelostproduction,processingdelaysorshutdown.

STEP 2 CASE STUDIES

DIESEL PARTICULATE MATTER OVEREXPOSURE HAZARD DEFINITION

ThisisahealthMUEexampleoftheoutcomefromAction4.

Background

Dieselparticulatematter(DPM)isacomplexmixturethatmakesupdieselexhaust.Organiccompounds,sulphates,nitrates,metalsandothertoxinsformacohesivelayerontheparticulate.Thisparticulateisabletobypassthebody’snaturaldefencesandbecomelodgedinthelungs.Ithasbeenrecognisedasanoccupationalhazardtominers,particularlyinundergroundoperations.Whiledieselexhaustcontainsmanyknowncarcinogens,DPMhasrecentlygained

prominenceasaparticularconcern.Thisisinresponsetothe2012studybytheInternationalAgencyforResearchonCancerreclassifyingDPMascarcinogenictohumans(Group1).ThiswasreinforcedbytheDieselExhaustinMinersStudybytheUSgovernmentthatexaminedover12,000minersandfoundanincreasedriskoflungcancer.

Scope

Thishazardexistsinundergroundenvironmentswithloworpoorventilationinwhichvehiclesormachineryemitdieselparticulate–inparticular,undergroundworkshopsthatundertakevehiclemaintenance.

Boundary

Anyconfinedspacewhereoperatorsanddieselparticulateareinaconfinedspace.

Potentialconsequences

Immediateandlong-termhealtheffectsfromDPMexposure(suchascancer).Becauseofitscarcinogenicproperties,theconsequencesoftheexposuremaytakeyearstodevelop.


STEP 3: IDENTIFY CONTROLS

Action1:Identifycontrols

InAction1identifythecontrolsforeachMUE,inparticularthecontrolsthatwillpreventtheeventfromoccurringormitigatetheconsequences.Controlscanbeadministrativeorengineeringbased.However,someengineeringcontrolshaveahumanoradministrativeelementtoensurethattheyareworkingcorrectly.Whenidentifyingcontrolsconsiderthefollowing.

IdentifyexistingcontrolsOftencontrolsarealreadyidentifiedwithinexistingcompanydocuments.SeekguidancefromstaffthathaveMUEorcontrolknowledgeastheywillbemostfamiliarwiththecompany’sinternaldocuments.Asastartingpointitisusefultoreview:

• internalriskassessmentsandbowties

• internalmaintenanceproceduresandstandardoperatingprocedures

• legislationthatmaycontaingeneralcontroladvice–legislationmayhaveassociatedguidanceorstandards(egenvironmentalstandards)containingcontrols;controlsshouldnotbecopiedfromstandardsastheyneedtobecriticallyassessedforrelevancetotheMUE

• riskassessmentsfromassociatedcompaniesorindustrieswithsimilaroperationsandMUEs–forexample,theremaybecommonrisksandcontrolsbetweensolventextractionplants.

ToolstohelpidentifycontrolsUsethedecisiontree(seeFigure3)andfollowingquestionstohelpdecideonwhatisorisnotacontrol.Itiscommontoidentifymanycontrols,somethatwillnotbesuitablefortheCCMprocess.Considerthefollowing:

• IsthecontrolspecifictopreventinganMUEorminimisingitsconsequences?

• Canyouspecifytherequiredperformanceofthecontrol?

• Canthecontrol’sperformancebeverified?

Targetoutcome

IdentifycontrolsforeachMUE,bothexistingcontrolsandpossiblenewcontrols,includingthepreparationofabowtiediagram.

Step3identifiesallthecontrols(existingandpossible)foreachMUE,andthenStep4identifiesthecriticalcontrols.Acontrolisdefinedasanact,object(engineered)orsystem(combinationofactandobject)intendedtopreventormitigateanunwantedevent.ThetoolsprovidedwithintheGoodPracticeGuidecanhelpidentifytheknownandpossiblecontrols.

Onceidentified,controlsarethenusedtodevelopabowtiediagramforeachMUE.Abowtiediagramisamethodtoillustratethelinkagesbetweenthepotentialcauseofanincident,orrisk,andtherelevantcontrols(moreinformationonthebowtiecanbefoundintheGoodPracticeGuideAppendixB).

Actionstoidentifycontrols

Action 1 Identify controls

Action 2 Develop a bowtie

Action 3 Assess the bowties and controls


Action2:Developabowtie

Onceallthecontrolsareidentified,developabowtie(seeFigure2).Abowtiesummarisesthemaincontrolsthatcompaniesshouldhaveinplacetopreventunwantedevents.Bowtiesareapopularmethodtoillustratethelinkagesbetweenthepotentialcauseofanincident,orrisk,andthecontrolsthatcanbeputinplace.Thesecontrolscaneitherpreventtheinitialincidentand/ormitigatetheconsequencesonceithasoccurred.

Thereisnoonerightwaytodevelopabowtie.However,thisisacriticalstageandthebowtieshouldbepreparedbycarefulreferencetothedefinitionsinAppendixA.TheGoodPracticeGuidecontainsinformationonbowtiesinAppendixB.TheimportantstepsincompletingthebowtiearestartingwiththeMUE,andconsideringthefollowing:

Unwantedevent

Hazard

Control

Control

Control

Control

Consequence

Consequence

Cause

Cause

PREVENTATIVE MITIGATING

Figure2:Asimplebowtiediagram

• WhatarethepossiblecausesthatcouldleadtotheMUE?

• Whatcontrolsareinplace(orcouldbeputinplace)topreventthecauseleadingtotheMUE?

• WhatarethemaximumforeseeableconsequencesoftheMUE?

• Whatcontrolsareinplaceorcouldbeintroducedtoreducethepossibilityoftheconsequencesoccurring?

Theuseofsoftwarecanbehelpfultodevelopbowties(suchasBowTieXP,BowTieProorMicrosoftVisio).

Whendevelopingthebowtieandselectingcriticalcontrols(Step4),itmaybeusefultoundertakethisasaniterativeprocess.Thisisbecausetheselectionofcriticalcontrolswillassistinrefiningthebowtie.

Action3:Assessthebowtiesandcontrols

Assessthebowtiesandcontrolstoensuretheyareappropriateandrelevantforeachcauseand/orconsequence,andagainstthehierarchyofcontrols.Thisassessmentshouldcheckthatthereisnotanoverdependenceononetypeofcontrol(forexamplepeople,engineering,etc).


HOW DID THE ECC IDENTIFY CONTROLS?

STEP 3 CASE STUDY

TheECCworkinggroupsetouttoidentifythecontrolsneededtopreventtheMUEfromoccurringortomitigateitsconsequences.Theworkinggroupgatheredarangeoftechnical,operationalandprojectknowledge,includingHSEstaffandassetmanagementandmaintenancestafftoidentifythecontrolsforeachMUE.Aworkshopwasheldtobringthisinformationtogether.

FortheundergroundfireandcoaldustexplosionMUE,theworkinggroupconsultedinternalexpertsforventilation,technicalservicesteam,subject-matterexperts,undergroundelectricalengineersandtheHSEmanager.Beforethemeetingeachindividualreviewedinternaldocumentsforpotentialcontrolswithintheirarea,whichconsistedofexistingriskassessments,safetydocumentsandsafetystandardstoidentifyactions,systems,processesorequipmentthatcouldcontroltheMUE.

ForthedieselparticulatematteroverexposureMUE,theworkinggroupconsultedthevehicle’smanufacturer,HSEstaffinparticularoccupationalhygieneexpertise,managerforsafety,thevehiclemaintenanceteamandtheventilationofficer.

ThecausesandconsequencesoftheMUEswereidentifiedandallthecontrolsthatcouldbeimplementedtopreventandmitigatetheMUEs.ThecontrolidentificationdecisiontreefromtheGoodPracticeGuide(seeFigure3below)wasusedtohelpidentifywhatisacontrol.

ThegroupdevelopedabowtiediagramforeachMUE(seeFigures4and5).

Theworkinggroupidentifiedaverylargenumberofpossiblecontrols(over60controls),especiallyfortheundergroundfireandcoaldustexplosionMUE.Thisisnormal,andasthebowtie(seeFigure2)shows,there

isawidevarietyoftypesofcontrols(orpotentialcontrols).Theserangedfromveryspecificcontrolssuchas“waterspraysonshearerhead”towide-rangingsystems(eg“ventilationsystem”)orcheckingormonitoringprocessessuchas“inspections”.

ThisisanormalandnecessarystepintheCCMprocess.However,managingalargenumberofcontrols,notallofwhichareclearlydefinedintermsoftheirimportanceorcriticality,isverydifficulttodoinpractice–hencetheimportanceoftheCCMprocess.Thenextstep(Step4)explainstheprocess

Figure3:Controlidentificationdecisiontree(Figure 2 in the Good Practice Guide page 10)

Source:M.Hassall,J.Joy,C.DoranandM.Punch,SelectionandOptimisationofRiskControls.ACARPreportnoC23007,2015.Availableatwww.acarp.com.au/reports.aspx.

NO

NO

NO

YES

Is performancespecified, observable,

measurable andauditable?

Does it prevent or mitigate an

unwanted event?

Is it a human act,object or system?

YES

YES

NOT A CONTROL

A CONTROL

todeterminewhichofthecontrolsarecriticalcontrols.

Notethatthebowtiesonlyshowasampleofthecontrolsandpotentialcontrolsidentified.ThesearecommonlyidentifiedcontrolsandhaveallbeentakenfrombowtieskindlysuppliedbyICMMmembercompanies.Asthebowtiesonlycontainasampleofcontrols,blankspaceshavebeenlefttosignifyotherthreats,consequencesandcontrols.A“quickguide”toreducingthenumberofcontrolshasbeenincludedinStep4.


Frictionalignition(miningactivities,

eglongwallshearerand/orcontinuous

miners)

Threat

Spontaneouscombustion

Threat

Frictionalignitionconveyorspills

Lubricationofbearingsof

conveyorrollersInspections

Maintenancemanagementsystem

forconveyors

Removalofcoalfines

Spontaneouscombustionhazardmanagementplan

Control Control

Ventilationsystem

GasdetectionSeals

Control Control

Control Control

Ventilationsystem Control

Sharppicksonshearer

Waterspraysonshearerhead

Control Control

Control First-aidandtraumakits

First-aidandoperationalfirst-aid

training

Emergencyresponseplan

Control Control

Undergroundfireresponseprocedure

Firefightingequipment

Control Detectionsystems

Crisismanagementplan

Simulationandsecondegresswalks

Control Control

Presence of methane or coal dust in the mine

Significantlossoflife

Lossofproductionduetofire

Consequence

Longwallequipmentdamageduetofire

Consequence

CONSEQUENCESCONTROLSCONTROLSTHREATS/CAUSES

Underground fire and coal dust

explosions

Note:*Controlsinthisbowtiehavenotbeenassessedforvalidity(iebowtieincludessomenon-controls)

Figure4:Undergroundfireandcoaldustexplosionbowtie*

STEP 3 CASE STUDY


Figure5:Dieselparticulatematteroverexposurebowtie*

Oldenginetechnology

Crankcaseemissions

Noexhaustaftertreatment

Spotventilationsystem

Dilutionbyventilationsystem

Control Control

Control Operatorenclosedinenvironmentalcab

Control Respiratoryprotectiveequipmentused

Medicalsurveillanceprogramme

Occupationalhygieneprogramme

Control Control

Excessive exposure to diesel particulate

matter and gases

Excessivedieselparticulate

matterandgases’accumulationintheworkplaceatmosphere

Personalexposureto

dieselparticulatematterandgases


matterandgases’accumulation

attheoperatorposition

Ill-healtheffectsfromexcessive

exposure

Consequence


Fuelandlubricatingoilcomposition

Poororinadequate

maintenancepractices

Operatingconditions

Inappropriatevehicleoperation

PurchasedasperTier3or4

policyEnginereplaced

asperplan Control

Biodieselfuelused

Syntheticfuelused

Lowashoilused

Lowsulphurdieselused

(10ppm)

Fueladditivesused Control

Closedcrankcaseventilationdesign

Filteredopencrankcaseventilation

design

Full-flowdieselparticulatefilterused

Partial-flowdieselparticulatefilterused

Dieseloxidationcatalyticfilterused

Filtrationsystemwithdisposablefilter

elementsused

Dieselvehiclemaintainedtoplan

Post-servicetail-gasmeasurementstaken

andreviewed

Note:*Controlsinthisbowtiehavenotbeenassessedforvalidity(iebowtieincludessomenon-controls)

Limitingthenumberofvehiclesinanarea

Roadsmaintainedtominimiseengineload

“Noidlingpolicy”followed

Equipmentoperatedcorrectlyforemission

minimisation

Control Control

Control Control

Unacceptable diesel engine

emissions into workplace

atmosphere

STEP 3 CASE STUDY


Action1:Selectcriticalcontrols

SelectingthecriticalcontrolsinvolvesassessingallthecontrolsonanMUEbowtietoidentifyiftheyarecritical.TheCCMprocessisacontrol-focusedapproach.Selectingthecriticalcontrolsisanimportantstep.Whenselectingthecriticalcontrolsconsiderhowyouidentifythem.

TheBHPBillitondecisiontree(seeAppendixD)canhelpassessifacontrolisacriticalcontrol.Itcanalsobeusefultoconsiderthefollowingquestions:

• Isthecontrolcrucialtopreventingtheeventorminimisingtheconsequencesoftheevent?

• Isittheonlycontrol,orisitbackedupbyanothercontrolintheeventthatthefirstfails?

• Woulditsabsenceorfailuresignificantlyincreasetheriskdespitetheexistenceoftheothercontrols?

• DoesitaddressmultiplecausesormitigatemultipleconsequencesoftheMUE?Inotherwords,ifitappearsinanumberofplacesonthebowtieoronanumberofbowties,thismayindicatethatitiscritical.

Action2:Checkthecriticalcontrolscanbeimplemented

Checkifthecriticalcontrolscanbeimplementedbyaskingiftheycanbeactivelymonitored(seeStep8).Activemonitoringreferstotheprocessofcheckingtheextenttowhichtheperformancerequirements,setforacriticalcontrol(identifiedinStep5),arebeingmetinpractice.Inotherwords,canthecriticalcontrolsbecheckedthattheyareworkingasintended,andhowcanthisbedone?Toassesswhetherthecriticalcontrolsareimplementable,considerthefollowing:

• Whataretheperformancerequirementsofthecriticalcontrol?Ifunsure,isiteasytofindoutwhattheperformancerequirementsshouldbe?

• Howisthecriticalcontrolgoingtobeverified?Whatactivitieswillsupportverification?

Ifyoucannotclearlyanswerthesequestions,thiscontrolmightnotbeimplementableandthereforenotacriticalcontrol.

Action3:SummarisethecriticalcontrolsforeachMUE

CollatealistofcriticalcontrolsforeachMUE.ThesecriticalcontrolswillbeusedtomanagetheMUEriskandwillprogressthroughtheCCMprocess.Summarisethekeyinformationforeachcriticalcontrol.Ataminimumconsider:

• thehazard

• thethreats

• thecriticalcontrolname.

STEP 4: SELECT THE CRITICAL CONTROLS

Targetoutcome

SelectthecriticalcontrolsfortheMUE.Summarisekeycriticalcontrolinformation.

Step4selectsthecriticalcontrolsfromthecontrolsidentifiedinStep3.Criticalcontrolsarecontrolsthatarecrucialtopreventing,ormitigatingtheconsequencesof,anMUE.TheabsenceorfailureofacriticalcontrolwillsignificantlyincreasetheriskofanMUEoccurring,despitetheexistenceoftheothercontrols.ThetoolsprovidedintheGoodPracticeGuidehelpselectcriticalcontrolsandidentifyactivitiestoverifythecontrol,andtheperformancerequirementsofthecontrol.

Actionsforselectingcriticalcontrols

Action 1Select critical controls

Action 2Check the critical controls can be implemented

Action 3Summarise the critical controls for each MUE


STEP 4 CASE STUDY

HOW DID EAST COAST COAL DECIDE WHAT CONTROLS WERE CRITICAL?

TheECCworkinggroupfoundthattheyhadalargenumberofequipment,proceduresandsystemsthatcouldpotentiallyberegardedascontrols.Theyhadtoidentifywhichofthesewerecriticaltojustifytheextrarigourtodefineandmonitorthecontrolsandreportonhowwelltheyareworkinginpractice,asrequiredbytheCCMprocess.

GoodPracticeGuidequestions

TheworkinggroupworkedthroughtheGoodPracticeGuideguidance,includingasking:

• Isthecontrolcrucialtopreventingtheeventorminimisingtheconsequencesoftheevent?

• Isittheonlycontrol,orisitbackedupbyanothercontrolintheeventthefirstfails?

• Woulditsabsenceorfailuresignificantlyincreasetheriskdespitetheexistenceoftheothercontrols?

• DoesitaddressmultiplecausesormitigatemultipleconsequencesoftheMUE?

Usingthecriticalcontroldecisiontree–independenceofcontrols

TheworkinggroupalsousedthedecisiontreefromtheGoodPracticeGuide,reproducedhereinAppendixD.Theworkinggroupfoundthatthiswasusefulinhelpingtodecidewhetherornotacontrolwascritical.However,therewasavigorousdebateintheworkinggroupoverthemeaningof“independence”.Thefinalquestioninthedecisiontreeasks,iscontrolindependent?Whatdoesthismean?

Onememberoftheworkinggroupsaidthatnoneofthecontrolsatasiteorwithinthesamecompanycouldberegardedastotallyindependent

astheyalloperatedwithinthesamemanagementsystem.Inthissensetheycouldbesaidtobeinterdependent.Althoughthisviewhadmerit,afterdiscussionitwasdecidedforthepurposesofdecidingoncriticalcontrolsindependencewouldbeinterpretedinanarrowersense.Forexample,thewaterspraysontheshearerhead(tominimiseriskofignitionofflammablegas)wasacontrolthatoperatedindependentlyofensuringthepicksoftheshearerweremaintainedatadefinedlevelofsharpnesstominimisesparks.

EastCoastCoal’sshortcut

Theworkinggroupalsofoundtheycoulddevelopsomequestionstohelpthemfilterthecontrols.Theyappearbelowbutrequirecareintheiruse.Theyfoundaskingthesequestionspromptedproductivediscussiononwhetherornotsomethingwasacontrolornot.

Thesearethequestionstheyused:

• Isthecontroldescribedasamonitoring,verification,qualityassuranceorinspectionactivity?Isthemonitoringorinspectionactivityreallythecontrolorisitthethingorprocessbeinginspected?Forexample,ifinspectionofapressurereliefvalveisdescribedasacontrol,isittheinspectionactivityorthevalveitselfthatisthecontrol?

• Isthecontrolabouttrainingorcompetence?Ifso,considerremovingallcontrolsthatrefertocompetentoperatorsortraining.Nearlyallcontrolsrequirecompetentpeopletooperate,inspectormaintainthem.Trainingandcompetenceisofcourseimportantandoftenalegalrequirement.However,ifalltrainingandcompetencerequirementsare

addedtobowties,theycanbecomeverycomplexasnearlyallcontrolsrequireadegreeoftrainingand/orcompetence.Mostcompanieshavesystemsandprocessestomanagecompetence.Anotecanbeaddedtothebowtietoexplainthistopicisnotincludedonthebowtie.

• Isthecontroldescribedasasystem?Forexample,ECCfoundthatthemaintenancemanagementsystemorventilationsystemoftenappearedasacontrol.However,theseprovedtobetoogeneraladescriptionforacriticalcontrol.Forexample,thereweremanythousandsofitemsinthemaintenancemanagementsystem.ApplyingthisquestionledtoaproductivediscussionthatfocusedonidentifyingtheequipmentandthemaintenanceactivitythatwascriticaltopreventingormitigatingtheMUE.

• Isthecontroldescribedasaplan?Triggeractionresponseplansandhazardmanagementplanswerealsotreatedinthesamewayassystems.Theymaybecontrolsorhavespecificaspectsthatshouldberegardedascritical.Askingthequestionhelpedtodecidethis.


Criticalcontrolselectionassessmentfor“sharppicksonshearer”

Thecontrol“sharppicksonshearer”wasanalysedwiththeBHPBillitondecisiontreetool(seeAppendixD)tohelpassessifitwasacriticalcontrol.Figure6shows

thereasoning.ThiscontrolisrelatedtotheMUEforundergroundfireandexplosion.

ThislogicshouldbeappliedtotheremainingcontrolsthathadbeenidentifiedinStep3.

AnexampleofabowtieforMUEforundergroundfireandexplosionthatcontainsthereasoningbehindthecriticalcontrolassessmentisshowninFigure7.

STEP 4 CASE STUDY

Figure6:Assessmentofthecontrol“sharppicksonshearer”usingtheBHPBillitoncriticalcontroldecisiontreetoolandreasoningforeachdecisionpoint

Otherbarrierssuchaswaterspraysonshearer

headsexist

Criticalcontrol

Sharppicksonshearer

Reasoningfordecision

Doescontrolprevent,detector

mitigateamaterialrisk?

Sharppicksareabarriertopreventing

undergroundfires

Sharppickspreventfrictionalignition,which

canleadtofire

Doescontrolpreventevent

initiation?

Iscontroltheonlybarrier?

CriticalcontrolIscontroltotally

independent?

Iscontroleffectiveformultiplerisks?

Yes Yes

Yes NoNo


Controlisnotsupportedbyothercontrol

Sharppicksarenotusedtopreventotherrisks


Figure7:Undergroundfireandcoaldustexplosionbowtie

Control

Frictionalignition(miningactivities,

eglongwallshearerand/orcontinuous

miners)

Threat

Spontaneouscombustion

Threat

Frictionalignitionconveyorspills

Lubricationofbearingsof

conveyorrollersInspections

Maintenancemanagementsystem

forconveyors

Removalofcoalfines

Spontaneouscombustionhazardmanagementplan

Control

GasdetectionSeals

Control Control

Control Control

Ventilationsystem Control

Sharppicksonshearer

Waterspraysonshearerhead

Control

Control Emergencyresponseplan

Undergroundfireresponseprocedure Firefightingequipment

Detectionsystems

Crisismanagementplan

Simulationandsecondegresswalks

Presence of methane or coal dust in the mine

Significantlossoflife

Lossofproductionduetofire

Longwallequipmentdamageduetofire


Underground coal dust

explosions

Notacontrolbecausetoogeneral.Theplanmaycontaincontrols,buttheplanitselfis

notthecontrol

Notacontrol,butinspectionstodetect

build-upsofcoalfinescouldbeaBox4activity–seepage15

ofCCMGuide

Thiscontrolistoogeneraltobeacriticalcontrol.Whatspecificpartoftheemergency

responseplaniscritical?

Key

Control Criticalcontrol Notacontrol Reasoningforcontrolassessment

STEP 4 CASE STUDY


Criticalcontrolselectionassessmentfor“dieselparticulatefilter”and“‘noidlingpolicy’followed”

TheexamplesshowninFigures8and9demonstratethereasoningtodeterminethecontrolsarecritical.Again,thiswas

usingtheBHPBillitondecisiontree(seeAppendixD)forcriticalcontrolselection.

ThesecontrolsrelatetotheMUEfordieselparticulatematteroverexposure.

ThislogicwasappliedtotheremainingcontrolsthathadbeenidentifiedinStep3.

AnexampleofabowtieforMUEfordieselparticulatematteroverexposurethatcontainsthereasoningbehindthecriticalcontrolassessmentisshowninFigure10.

STEP 4 CASE STUDY

Figure8:Assessmentofthecontrol“dieselparticulatefilter”usingtheBHPBillitoncriticalcontroldecisiontreetoolandreasoningforeachdecisionpoint

Criticalcontrol

Dieselparticulatefilter




Dieselparticulatefilterandback-pressuresensorprevent/alertoverexposure

Neitherfilternorsensorpreventoverexposure

Filterassistsinqualityofdieselparticulate,andsensor

detectsdangerouslevels


initiation?

Doescontrolpreventordetecteventescalation?

Iscontroltotallyindependent? Iscontroleffective

formultiplerisks?

Yes No

Yes No


Controlcanactasastand-alonebarrier

OnlyusedtopreventthisMUE


No

Yes

Otherbarriersexist,suchasthosethathelpthe

engineworkefficiently

Figure9:Assessmentofthecontrol“‘noidlingpolicy’followed”usingtheBHPBillitoncriticalcontroldecisiontreetoolandreasoningforeachdecisionpoint

Notacriticalcontrol





initiation?


Yes No

No


Reducingengineusewilldirectlyreduceamountofdieselparticulatematter

Althoughcontroldoeslowerdieselemissions,itdoesnot

eliminateallemissions

Otherstrategiestominimisediesel

emissionsexist


STEP 4 CASE STUDY

Figure10:Dieselparticulatematteroverexposurebowtie


matterandgases’accumulationintheworkplaceatmosphere

Personalexposureto

dieselparticulatematterandgases


matterandgases’accumulation

attheoperatorposition

Ill-healtheffectsfromexcessive

exposure

CONSEQUENCES

Oldenginetechnology

Crankcaseemissions

Noexhaustaftertreatment

Spotventilationsystem

Dilutionbyventilationsystem

Control Operatorenclosedinenvironmentalcab

ControlRespiratory

protectiveequipmentused

Medicalsurveillanceprogramme

Occupationalhygieneprogramme

Control Control

Excessive exposure to diesel particulate

matter and gases

CONTROLSCONTROLSTHREATS/CAUSES

Unbalancedfuelandlubricatingoilcomposition

Poororinadequate

maintenancepractices

Operatingconditions

Inappropriatevehicleoperation

PurchasedasperTier3or4

policyEnginereplaced

asperplan Control

Biodieselfuelused

Syntheticfuelused

Lowashoilused

Lowsulphurdieselused

(10ppm)

Fueladditivesused Control

Closedcrankcaseventilationdesign

Filteredopencrankcaseventilation

design

Full-flowdieselparticulatefilterused

Partial-flowdieselparticulatefilterused

Dieseloxidationcatalyticfilterused

Filtrationsystemwithdisposablefilter

elementsused

Dieselvehiclemaintainedtoplan

Post-servicetail-gasmeasurementstaken

andreviewed

Limitingthenumberofvehiclesinanarea

Roadsmaintainedtominimiseengineload


Equipmentoperatedcorrectlyforemission

minimisation

ControlThisisacritical

controlasithasameasurableeffect

Unacceptable diesel engine

emissions into workplace

atmosphere

Notathreatbecause

operatorsareassumedcompetant

Notacriticalcontrol.Apolicydoesnot

directlypreventtheMUE

Thiscontrolistoogeneraltobeacriticalcontrol.Whatspecificpartofthesystemisthe

criticalcontrol?

Thiscontrolistoogeneraltobeacriticalcontrol.Whichspecificpartoftheprogramme

doesthemitigating?

Key

Control Criticalcontrol Notacontrol ReasoningforcontrolassessmentUnclassifiedcontrol


STEP 5: DEFINE PERFORMANCE AND REPORTING

Action1:Definethecriticalcontrolobjective

Definingtheobjectiveofthecriticalcontrolwillhelpunderstandtherole,expectationsandoutcomesofthecontrol.Thecriticalcontrolobjectiveisaspecificdescriptionofwhatthecontrolisrequiredtodo.Forexample,forthecriticalcontroltitled“probecalibration”,thecriticalcontrolobjectiveisthecalibrationofthepHandECprobes.Tohelpdefineacriticalcontrol’sobjective,consider:

• Whatistheoutcomeyouaretryingtoachievebyimplementingthiscriticalcontrol?

• HowwillthecriticalcontrolpreventtheMUE?

Action2:Defineperformancerequirementsforthecriticalcontrols

Theperformancerequirementsarethestandardstowhichacontrolhastoperform.Acontrol’sperformancerequirementshouldconsistofanaction(suchastoprevent,tomaintain,etc)andavalue(suchas0.1mLabovethecriticallevel,50%ofcapacity,etc).Aperformancerequirementneedstoconsiderthecontextofthecontrol,meaningthatatankholdingdieselmayhavedifferentintegrityperformancestandardstoanidenticaltankholdingacidicslurry.Anexampleofaperformancestandardforthecontrolofabundedareaaroundatankcouldbetohold90,000litres,whichis110%ofthevolumeofthetank.

Performancerequirementsforacontrolmayalreadyexistwithincompanydocuments.Thiscanbedeterminedbyreviewingtherelevantprocesses,procedures,maintenancemanualsandothersupportdocuments.Industrystandardsmayalsohelptodetermineperformancerequirements.However,cautionshouldbeappliedasindustry-wide

standardsmaynotbespecificorrelatedirectlytothecontextofthecontrol.Whennoperformancerequirementsexistforacriticalcontrol,theymustbedeveloped.Ifthisisthecase,theperformancerequirementsshouldconsiderbeing:

• specific–requirementsshouldbeclearlydefinedandnotvague

• measurable–performancerequirementsshouldbequantifiablewhereverpossible

• appropriate–theperformancerequirementsshouldalignwiththecriticalcontrolobjective(asdefinedinAction1)

• realistic–requirementsshouldbeachievableintheoperatingcontext.

Thefinalcomponentofthisactionistodefineacriticalcontrol’slevelofperformancethatwouldinitiateimmediateactiontoshutdownorchangeanoperation,orsignalthatimprovementstothecriticalcontrolarerequired.Theprocessfordefiningtheseperformancelevelsisthesameastheprocessforidentifyingperformancerequirementsabove.

Targetoutcome

Definethecriticalcontrols’objectives,performancerequirements,andhowperformanceischeckedinpractice.Summarisethisinformation.

Step5definesthecriticalcontrolobjectivesandtheperformancerequirementsforeachcriticalcontrol.ThisistheminimumperformancerequiredfromthecriticalcontroltoensureitseffectivenessinmitigatinganMUErisk.Thisstepidentifiesactivitiesthatwillimpactcriticalcontrolperformance.Theseactivitiesprovideanunderstandingofhowacriticalcontrolcanbeverifiedinpracticeandamechanismtomonitorthehealthofacriticalcontrol.

Actionsfordefiningperformanceandreporting

Action 1Define the critical control objective

Action 2Define performance requirements for the critical controls

Action 3Identify activities that impact critical control performance

Action 4Define verification or “checking” activities


Action3:Identifyactivitiesthatimpactcriticalcontrolperformance

Tomaintainthehealthofacriticalcontrol,identifywhatactivitiesimpactitsperformance,andsupportorenablethecriticalcontrol.Whenlookingforinformationtoreviewtheseactivitiesconsider:

• reviewingexistingprocesses,proceduresandmaintenancemanualsforday-to-dayactivitiesandtasks–speakwithpersonnelthatworkcloselywiththecontrolandareinvolvedinsupportingactivities(theywillhaveknowledgeonhowtheseactivitiesareconductedandtheirrelevancetocriticalcontrolperformance)

• listtheactivitiesthatsupport,improveandimpacttheperformanceofthecriticalcontrol–byknowingwhatreducesitsperformanceallowsthemanagementoftheactivities.

Action4:Defineverificationor“checking”activities

Verificationistheactofchecking,or“activelymonitoring”,thattheactivitiesthatsupportandimprovecriticalcontrolsarecompletedtoanacceptablelevel.Foreachcriticalcontrol,identifywhatisrequiredfromverification.

Thisprovideshigh-levelguidanceforlaterstepsthatwillidentifyhowtheverificationisdoneinpracticeandon-site(Step7),thencarryingouttheverificationactivityon-site(Step8).ItcanbeusefultoidentifytheseverificationrequirementswhilereviewingthedocumentsandspeakingwithpersonnelinvolvedinActions1–3ofthisstep.Inaddition,consider:

• whatcheckingisneededtoverifythecriticalcontrolismeetingitsrequiredperformance

• howfrequentlydoescheckingneedtooccur

• whattypeofcheckingisneeded(ieinspection,reviewlogs,reviewmonitoringsystem,etc).

Theoutcomesoftheverificationactivitiesshouldbereporteduptheownershipchainonaregularbasis.ThedetailedreportingstructureisdefinedinStep6.AttheendofStep5completeacontrolinformationsummaryforeachcriticalcontrol.Thecontrolinformationsummaryisaguideonlyandcanbeadaptedtosuitindividualorganisationneeds.


HOW DID EAST COST COAL DEFINE ITS PERFORMANCE?

STEP 5 CASE STUDY

Theworkinggroupdecidedthemosteffectivewaytocompletethisstepwasthroughaworkshopthatincludedthosepersonnelwhoknewaboutthecriticalcontrolsinpracticesuchasfirst-linesupervisors.Theobjectiveoftheworkshopwastodeterminethelevelofperformancerequiredforeachcriticalcontrol.

Thegroupalsoworkedouthowtoassesstheperformanceofthecriticalcontrol.Thegroupsummarisedthisinformationinatable–acriticalcontrolinformationsummary.

Belowareexamplesofthecriticalcontrolinformationsummariesforacriticalcontrolforthe:

• undergroundfireandcoaldustexplosionMUE(seeTable1)

• dieselparticulatematteroverexposureMUE(seeTable2).

Whatisthetargetperformanceforcriticalcontrol?

Picksmeettheacceptablepickprofiletemplate,betweenmarkers3and5.Picksoutsidethisrangearereplaced.

Whatisthecriticalcontrolperformancetriggerforshutdown,criticalcontrolrevieworinvestigation?

5percentofinspectionsindicatethatthepicksarebeyondthresholdconditionforuse.

Whatisthenameofthecriticalcontrolforundergroundfireandcoaldustexplosions?

Sharppicksonshearer

WhatareitsspecificobjectivesrelatedtotheMUE?

Toreducetheriskofignitionofflammablemixturebyreducingthefrictionbetweentheshearerandrock

Whatarethecriticalcontrolperformancerequirementstomeettheobjectives?

Whataretheactivitiesthatsupportorenablethecriticalcontrol?

Whatactivitiescanbecheckedtoverifythecriticalcontrolperformance?

Picksaresufficientlysharptoreducetherisktopreventsparking

Atemplateofacceptablepickprofileisdeveloped

Shearerpicksarevisuallyinspectedpre-shifttoassesstheircondition

Regularmaintenanceiscarriedoutonshearers

Picksinspectedagainstthetemplate

Reviewofinspectionrecordsweekly

Reviewofmaintenanceandreplacementrecordsmonthly

1

2

3 4 5

6

6

Table1:“Sharppicksonshearer”criticalcontrolinformationsummary


Table2:“Dieselparticulatefilters”criticalcontrolinformationsummary


Maintenancerequirementsidentifiedareconducted100%ofthetime,andback-pressuresensorcalibrationiswithintolerancefor100%oftests


Dieselparticulatefilterhousing/ductworkdamaged,orback-pressuresensoralarmtriggered

Whatisthenameofthecriticalcontrolfordieselparticulatematteroverexposure?



Reducedieselparticulatelevelsintheworkplaceatmospheretobelowtheoccupationalexposurelimit.




Filterhousing/ductworkmaintainedsothatparticulatesarecollectedandnotallowedtobypass

Back-pressuresensoralarmswhenbackpressureonfilterexceedscriticallevel

Enginesmaintainedtomaximisefilterlife

Pre-shiftfilterhousing/ductinginspectedfordamageatpre-start,andmaintenanceconductedifrequired

Dieselexhaustback-pressuresensoriscalibratedtoensureitdetectsback-pressureatthecorrectset-point

Electronicfuelenginemanagementsystems(EMS)–EMSismonitoredbyoperationsandmaintenancepersonnelMaintenanceisconductedfollowingdetectionofbelow-standardperformancebyEMS

Manualfuelinjectionsystems–opacitytestingofexhaustemissionconductedevery28days.Ifopacitytestfails(exceedsset-pointofxmg/m3),carryoutrequiredmaintenance–clean/replaceengineairinletfilter;cleanflametrap,checkvalveclearance,replaceinjector(s),compressiontest,replacedieselpump,clean/replacedieselparticulatefilter

Reviewpre-startinspectionrecordsandconfirmmaintenanceconductedwhenrequired.

Reviewcalibrationrecordstoensurethattheback-pressuresensorisworkingwithintolerancelimits.

Samplex%ofEMSreportsidentifyingfaults,andcheckthatmaintenancewasconductedandinaccordancewithoriginalequipmentmanufacturer(OEM)specifications.

Samplex%ofopacitytestreportsexceedingset-point,andcheckthatmaintenancewasconductedandinaccordancewithOEMspecifications.

1

2

3 4 5

6

7


Corporate level

Site level

RoleinCCM

MUE owner

Critical control owner

Verification activity owner

Title

Board

Company Chiefexecutiveleadership officerteam Chiefoperating officer

Site/minemanager

Linemanager

Supervisor

Responsibilities

Receivereportsfromleadershipteambiannually

DiscussMUEhealthandcriticalcontrolsonaquarterlybasisReceiveandcollateMUEandcriticalcontrolreportsfromallcompanysites,andproducecorporatereports

MonitorandreviewmonthlyreportsonMUEandcriticalcontrolhealth,andfeeduptocompanyleadershipteam

ReportoncriticalcontrolhealthtoMUEownerweekly

Undertakeoroverseeverificationactivities,andprovideregularreportsofactivitytothecriticalcontrolowner

Action1:Assignownershipandreportingaccountabilities

OwnershipforeachMUE,criticalcontrolandverificationactivityshouldbeassignedtospecificrolesorpositionswithintheorganisation.These“owners”areresponsibleforongoingassuranceinmanagingtheirallocatedtask.TheyalsoformthebasisofCCMgovernancethroughthelineofreporting.Identifyingownerswilldependonaninternalcompanystructureandthetasks

beingassigned.SuggestedownerresponsibilitiesareoutlinedinTable3,whichindicatestherolewithinCCM,anindicativetitlethisownermayholdwithinthecompanyandtheresponsibilitiesoftheowner.

ThelineofaccountabilityisalsooutlinedinTable3,fromtheverificationownerstotheleadershipteamandboardofacompany.EachtierwithinthelineofaccountabilityincludesadditionalgovernanceresponsibilitiesforCCMthan

thetierbelowit.Thisprovidesarobustgovernancestructurethatincludesalllevelsofownership.

Thehigh-levelreportingrequirementsarealsooutlinedinTable3.Theproductsofeachreport,andthefrequencyofeachreviewperiod,areoutlinedaspartofeachtier’sresponsibilities.ThiscanbeusedtodefineaverificationandreportingplanasoutlinedintheGoodPracticeGuide.

STEP 6: ASSIGN ACCOUNTABILITY

Targetoutcome

DevelopalistoftheownersforeachMUE,criticalcontrolandverificationactivity.Developaverificationandreportingplantoverifyandreportonthehealthofeachcriticalcontrol.

Step6assignsaccountabilityor“ownership”foreachMUE,criticalcontrolandverificationactivity,fromthesiteleveltothecompanyboard.Thisincludesoutliningtheresponsibilitiesofeachowner,includingreportingresponsibilities.

Actionstoassignaccountability

Action 1Assign ownership and reporting accountabilities

Table3:Ownershipandreportingresponsibilities


REPORTING ON CRITICAL CONTROLS AND MUES WITHIN EAST COAST COAL

Theworkinggroupdecidedtodefinereportingfromtheminesiteallthewaytotheboard.Thisincluded:

• whowouldreportoncriticalcontrolsandMUEs

• whatwouldbereported

• towhom

• thefrequenciesfordoingthis.

Therewassomediscussionaboutwhethertheworkinggroupshould

dothisamidconcernthattheycouldbeseentobeoversteppingthemarkbytellingtheleadershipteamandboardwhattodo.Theprojectsponsor,theCOO,wasaskedforadvice.TheCOOsaidthatneithertheleadershipteamnortheboardknewwhattheyneededtodo,butwouldappreciatetheworkinggroupidentifyingwhattheythoughtwasappropriate.

TheworkinggroupworkedonthebasisthatMUEsshouldnotreceive

anylessprominenceinreportingwithintheorganisationthanmaterialenterpriserisksorothertypesofhealthandsafety.Table3illustrateswhoreportsonwhat,towhomandthefrequenciesfordoingthis.

Thisproposalwasacceptedbyboththeleadershipteamandboardwiththeprovisoitwouldbereviewedafter12months’experience.

STEP 6 CASE STUDY


Step7shouldbeimplementedbyasite-specificteamwithoversightfromacorporatelevel(egtheCCMprocessmanager).ConsidertrainingthesitemanagerandleadershipteamearlyintheCCMprocessandinvolvingtheminasmanyactionsinthisstep.Considerallocatingonefull-timestaffmemberateachsitetoaidimplementation.

Action1:TailortheCCMprocesstothesitelevel

TailoringthedocumentsfromthepreviousCCMprocessstepsensurestheprocesscanbeimplementedatasitelevel.Thisconsiderssite-specificcontext,processesandassets.

SitesshouldreviewthekeydocumentsdevelopedintheCCMprocesssofar.Totailortheseatthesitelevel,considerengagingsite-basedpersonnelthatworkintheareasrelevanttotheMUE,controlsorverificationactivities.Thismayincludelinemanagers,supervisorsandoperators.Feedbackfromthesepositionswillensuretheprocessisimplementableon-site.

Thecriticalcontrolinformationsummary(Step5)isthekeydocumenttobetailoredandwillensuresite-specificconcernsareincluded.Thecontrolinformationsummaryforeachcriticalcontrolshouldbereviewed.Particularattentionshouldbefocusedonthe:

• criticalcontrolobjective

• criticalcontrolperformanceinformation

• verificationactivities.

AfulllistofdocumentsdevelopedthroughtheprocessthatcouldbereviewedandtailoredislistedinTable4.

Oncethisactioniscomplete,thissetofdocumentsisthe“site-specificMUEcontrolstrategy”.

Action2:Reviewthesite-levelCCMstrategy

ThedocumentstailoredinAction1shouldbereviewedbytheCCMmanageratthecorporatelevel.ThisensuresconsistencyintheapplicationoftheCCMprocessbetweensites.Sitesshouldadjustthematerialasnecessarybasedonfeedback.

STEP 7: SITE-SPECIFIC IMPLEMENTATION

Targetoutcome

ForeachMUEdefineaverificationandreportingplan.DevelopastrategytoimplementtheCCMatthesitelevel.

Step7describeshowtheCCMprocesscanbeimplementedonthesitelevel.ThisinvolvestailoringthepreviouslycompletedCCMprocesssteps(Steps2–6)toincludesite-specificdetail.ThisrequiresadaptingtheMUEhazarddescriptions(Step2),controlandcriticalcontrolidentification(Steps3and4),criticalcontrolinformationsummariesandverificationandreportingplans(Step5),andassigned“owners”tothesitelevel(Step6).

Actionsforsite-specificimplementation

Action 1Tailor the CCM process to the site level

Action 2Review the site-level CCM strategy

Action 3Develop a plan to implement the CCM strategy on-site

Action 4Implement the plan


Step

Step 2: Identify MUEs

Step 3: Identify controls, develop a bowtie

Step 4: Select the critical controls

Step 5: Define performance and reporting

Step 6: Assign accountability

Table4:Site-specifictailoreddocuments

Action3:DevelopaplantoimplementtheCCMstrategyon-site

TheplanshouldestablishafoundationforaneffectiveCCMapproachon-site.TheplanshouldsupportCCMleadership,developappropriateknowledge,identifyhowtocommunicateCCMandidentifysite-specificstandardsforthecriticalcontrols.

Communicatingthechangeisimportanttothesuccessofimplementation.ThismayincludeCCMmaterialininternalnewsletters,on-siteintranetpagesandthroughsitesafetyalerts.ThegoalofcommunicationistobringMUEstotheattentionoftheworkforce.

Developandimplementaneducation-trainingpackageforcurrentstaff,andtrainingmodulesfornewemployees,atalllevelsofthesiteorganisational

structure.ThisshouldincludedetailedCCMtrainingfortheseniorpersonnelonthesite.Developingatrainingpackageinvolvesthefollowing:

• Assesssitepersonneltrainingneeds.Forexample,seniorleaders,operationalpersonnelandsupportstaffhavedifferenttrainingrequirements.Trainingshouldprovidethecontextandknowledgetosupportstafftocarryouttheirduties.Usethesite-specificCCMdocumentsfromAction1tosupporttrainingforoperationalandsupportstaff.

• UseanagreedcommonlanguagetodiscussMUEs.ThelanguageshouldbealignedwithcompanytermsandagreedonbeforestartingtheCCMprocess.

• Introduceandexplaincompanydocuments,suchassite-specificstandardsandpoliciesrelatedtotheCCM.

Action4:Implementtheplan

Asasiteimplementsitssite-specificMUEcontrolstrategy,ensurethereisregularcommunicationbetweenthecorporateCCMmanagerandthesite-levelprojectleader.Assitesimplement,theymayrequireexternalassistanceintheprocess,forexampleindevelopinganddeliveringtraining.Atthecorporatelevel,companiesshouldassesstheirinternalcapabilitytoassistsites,anddecideonawhole-of-organisationapproachtoengagingexternalassistance.Forexample,ifanorganisationdoesnotpossesstherequiredcapabilitytodelivertraining,itshouldengageanexternalpartnertodelivertrainingacrossallsitestoensureconsistency.

Action1:Itemstobetailoredtositelevel

ReviewthehazarddescriptiondocumentforeachMUE.ChecktheMUEisrelevanttothissite

ReviewthebowtiediagramforeachMUE.Assessthebowtieanditsapplicabilitytothesite.Tailorthethreatsandconsequencesasnecessary

Reviewandtailorthecriticalcontrols.Ensurethecriticalcontrolsaresitespecificandappropriateforthesite-specificMUE

Reviewandtailorthecontrolinformationsummariesforeachcriticalcontrol.Considerthesite-specificrequirementsforthe:

• controlobjectives

• performancerequirements

• activitiesthataffectcriticalcontrolperformance

• activitiestoverifyperformance(verificationactivities)

• reportingrequirements

Reviewandtailortheassigned“owners”andthelinesofreporting.Matchthemtopositionsatthesitelevel


STEP 7 CASE STUDY

HOW DID EAST COAST COAL TAILOR THE CCM APPROACH FOR A SPECIFIC SITE?

AsdecidedduringStep1,ECCbegantheimplementationphaseoftheprocesswithjustonesite.ThisapproachwaschosensoECCcouldgatherexperienceandlearnlessonstoassistwhenimplementingtheCCMapproachacrossothersites.Thesitechosenwasanundergroundminethatproducesthermalandcokingcoal.Thesitehasbeenproducingfor15years.

Thesitehasastrongsafetyrecord,asmeasuredbylosttimeinjuries,buttheventilationsystemisatitsmaximumcapacity.Thisincreasestheconcentrationofdieselparticulatematter(anidentifiedpotentialMUE).Therockformationabovetheseamhasahighcontentofquartz,whichhasbeennotedascausingsignificantsparkingwiththelongwallshearer.

Asite-specificworkinggroupwasformedthatincludedmembersoftheCCMprojectteamandpersonnelfromthesite.TheknowledgefromthesitepersonnelwouldbeusedtodetermineiftheMUEs,controlsandtheverificationactivitiesthathadbeenidentifiedwouldbeappropriate.Thisstepalsoinvolvedassigningaccountabilitiestotheappropriatepositionson-site(seetables5and6).

Governanceoverchangesatsitelevel

AnimportantquestionraisedbyoneofthesiteteamwasifthesitepersonnelthoughtthatanMUEorcontrolwasnotappropriateorneeded,howwouldthisbedealtwith?Aconcernraisedbyamemberoftheworkinggroupwas

thatanindividualsitemightdecidethataparticularMUEorcontrolmightnotbeneededwithoutreferencetomoreseniormanagement,weakeningseniormanagement’sabilitytohavepropergovernanceprocesses.

Asaresult,itwasagreedthatanysignificantchangesproposedatsitelevelfromtheMUEsdecidedbyECCintheearlierstepsoftheprocessmustbedoneformallyusingthecompany’smanagementofchangesystem,includingseniormanagers’sign-off.


Note:Thecriticalcontrolinformationsummaryhasbeentailoredtothesite-levelcontextshownintheredtext.ThesummarycontainstheassignedMUE,criticalcontrolownersandverificationowners.

Table5:Undergroundfireandcoaldustexplosionsite-specificcriticalcontrolinformationsummary

MUE:Undergroundfireandcoaldustexplosion

Whatisthenameofthecriticalcontrol?

Sharppicksonshearer

WhatarethespecificobjectivesrelatedtotheMUE?

Toreducetheriskofignitionofflammablemixturebyreducingthefrictionbetweentheshearerandrock




Picksaresufficientlysharptoreducetherisktopreventsparking

AtemplateofacceptblepickprofileisdevelopedShearerpicksarevisuallyinspectedpre-shift[setasnewpoint

Regularmaintenanceiscarriedoutonshearers

Regularassessmentofthequartzcontentofthelayerabovethecoalseam.Samplesaretakenatevery50mtodeterminethequartzcontentisabove30%

Assignedowner

Undergroundminemanager

Linemanager

Picksinspectedagainstthetemplate

Reviewofinspectionrecordsweekly

Reviewofquartzcontentinspectionrecordweekly

Shiftsupervisor

Maintenancesupervisor

Headgeologist

1

2

3 4 5


Picksmeettheacceptablepickprofiletemplate,betweenmarkers3and5.Picksoutsidethisrangearereplaced

Whatisthecriticalperformancetriggerforshutdown,criticalcontrolrevieworinvestigation?

5percentofinspectionsindicatethatthepicksarebeyondthresholdconditionforuse

6

7


Table6:Dieselparticulatematteroverexposuresite-specificcriticalcontrolinformationsummary


Maintenancerequirementsidentifiedareconducted100%ofthetime,andback-pressuresensorcalibrationiswithintolerancefor100%oftests


Dieselparticulatefilterhousing/ductworkdamaged,orback-pressuresensoralarmtriggered

MUE:Overexposuretodieselparticulatematter

Whatisthenameofthecriticalcontrol?



Reducedieselparticulatelevelsintheworkplaceatmospheretobelowtheoccupationalexposurelimit




Filterhousing/ductingmaintainedsothatparticulatesarecollectedandnotallowedtobypass

Back-pressuresensoralarmswhenbackpressureonfilterexceedscriticallevel

Enginesmaintainedtomaximisefilterlife

Pre-shifthousing/ductinginspectedfordamageatpre-start,andmaintenanceconductedifrequired

Dieselexhaustback-pressuresensoriscalibratedtoensureitdetectsback-pressureatthecorrectset-point

Electronicfuelenginemanagementsystems(EMS)–EMSismonitoredbyoperationsandmaintenancepersonnel.Maintenanceisconductedfollowingdetectionofbelow-standardperformancebyEMS

Manualfuelinjectionsystems–opacitytestingofexhaustemissionconductedevery28days.Ifopacitytestfails(exceedsset-pointofxmg/m3),carryoutrequiredmaintenance–clean/replaceengineairinletfilter;cleanflametrap,checkvalveclearance,replaceinjector(s),compressiontest,replacedieselpump,clean/replacedieselparticulatefilter

Assignedowner

Minemanager

Maintenancesupervisor

Reviewpre-startinspectionrecords,andconfirmmaintenanceconductedwhenrequired

Reviewcalibrationrecordstoensurethattheback-pressuresensorisworkingwithintolerancelimits

Samplex%ofEMSreportsidentifyingfaults,andcheckthatmaintenancewasconductedandinaccordancewithoriginalequipmentmanufacturer(OEM)specifications

Samplex%ofopacitytestreportsexceedingset-point,andcheckthatmaintenancewasconductedandinaccordancewithOEMspecifications

Maintenancemanager

Maintenancemanager

Maintenancemanager

Maintenancemanager

1

2

3 4 5

6

7


STEP 8: VERIFICATION AND REPORTING

Action1:Undertakeverificationactivities

ActiontheverificationactivitiesdescribedinStep6.DuringAction1thehealthofacriticalcontrolwillbereportedonbycriticalcontrolowners,allowingtheMUEownertoreportontheoverallhealthofanMUE.Thisallowsanorganisation-wideassessmentofthecriticalcontroltobeidentified.Action1involves:

• verificationactivitiesbeingcarriedoutbytheverificationactivityowner(s),withverificationactivityreportssummarisedregularly

• reviewofverificationactivityreportsregularlybythecriticalcontrolowner(s),withcriticalcontrolsummaryreports

• reviewofcriticalcontrolsummaryreportsregularlybytheMUEowner,whowillprovidecriticalcontrolsummaryreportsandMUEsummaryreports

• reviewandcollationofresultsfromMUEreportsbyamemberoftheleadershipteamwhowillcirculatetheactionsneededwithseniormanagerson-siteandwiththecorporateCCMmanager.

Conductverificationactivitybyactivemonitoring(asoutlinedintheGoodPracticeGuide).Activemonitoringreferstotheprocessofcheckingtheextenttowhichtheperformancerequirements,setforacriticalcontrol,arebeingmetinpractice.Companyhealthandsafetymanagementsystemsmightuseavarietyoftermsfor“verification”activities.Commontermsincludeaudit,reviewandmonitoring.Activemonitoringmayincludeactivitiessuchas:

• checkingmaintenancelogs

• accompanyingoperatorsonroutineinspectionsforqualityassurance

• reassessingthecriticalperformancerequirementsonaregularbasis–forexample,acriticalcontrolof“probecalibration”shouldseethecontrolownerassessingifthecalibrationsettingsareappropriatetotakeaccuratereadings.

Action2:Reporting

Thepurposeofreportingistoefficientlycommunicatevariancesbetweenexpectedandactualperformance.ThereareanumberoflevelsofreportingintheCCMprocess,asdescribedinStep6.Reportsforeachstepoftheprocess(verificationactivities,criticalcontrolsandMUEs)oftenconsistofasummaryofinputs.Assuch,acriticalcontrolreportisasummaryofitsverificationactivityhealth,andsoon.

Reportingtheoutcomesofverificationactivitiesisthe“baselevel”report.Itcanbeachievedthroughmodifyingexistingpractices,suchasworklogsanddailychecklists.Theactivitiesshouldconsistofyes/noanswers,withdetailtobeincludedonlywhenthereisadifferencebetweenexpectedandactualperformance.

CriticalcontrolreportingCriticalcontrolsummaryreportsareacollationofverificationreportingactivitiespresentedinasinglemetricorseriesofmetrics.Forexample,acriticalcontrolreportmayincludeasinglemetricthatsummarisestheverificationactivityreports,oranumberofmetrics

Targetoutcome

Implementverificationactivitiesandreportontheprocess.Defineandreportonthestatusofeachcriticalcontrol.

Step8isthefirstpracticalstepintheCCMprocess.Theverificationandreportingactivitieswillbecarriedoutbytheownersofeachactivity.ThesiteCCMmanagershouldassistwiththefirstiterations,assistingownerswiththeirfunctionswithintheCCMprocess.

Actionsforverificationandreporting

Action 1Undertake verification activities

Action 2Reporting


MUEname:Undergroundfireandexplosion Overallhealth

Controls Owner Health Comments

Critical Supervisor1 ControlmatchingexpectedControl1 performance

Critical Supervisor2 ControlnotconsistentlymatchingControl2 expectedperformance

Critical Supervisor3 ControlconsistentlyachievingperformanceControl3 justbelowexpectedperformancethreshold

Critical Supervisor4 ControlmatchingexpectedControl4 performance

thatrepresentdifferentaspectsofmultipleverificationactivities.Thelevelofdetailshouldbedeterminedonasite-specificbasisdependingonthecomplexityofthecriticalcontrol.Despitethenumberofmetricspresented,theremustbeasinglemetricthatreportsontheoverallhealthofthecriticalcontrol.

Criticalcontrolreportsmayusea“trafficlight”reportingsystemtoallowquickidentificationofperformance.Atrafficlightsystemcategorisesthehealthintooneofthreecategories.Whilethedefinitionofeachcategoryshouldbedecidedbyeachorganisation,exampledefinitionsareincludedinTable7.

ThisallowsforsimplereportingofbothcriticalcontrolhealthandMUEhealth.AnexampleofanMUEhealthreportisincludedinTable8.WhendeterminingthesinglemetricthatrepresentstheoverallhealthofanMUE,considerusinganaveragescoreofthecontrols,orreporttheoverallhealthasequaltothelowestcriticalcontrolhealth.

AssessingthereportingprocessAssurancethattheverificationandreportingprocessisworkingcorrectlycanbeprovidedbycriticallyassessingregularreportsandestablishingaformalassurancemechanism.Whencriticallyassessingreports:

• ConsiderwhetheracriticalcontrolorMUEisreportedasconsistently“green”.Thisindicatesthereportingprocessmaybedefectiveandneedsrefinement,orownersneedfurtherCCMtraining.Inaddition,consistently“red”healthmayindicatetheassessmentcriteriamightbetoostringentandneedrefining.Alternatively,consistenthealthacrossallcontrolsmayindicateverificationactivitiesarenotbeingimplementedappropriately.

• Whenassessingacontrol’sperformance,considerthehistoryofthehealthofthecontrol.Reviewpreviousreportstounderstandthetrend.Iftheoverallhealthtrendisred,considerifadditional

Score Criteria

Expectedperformancenotachieved –controlisworkingunsatisfactorily

Expectedperformanceachievedinconsistently –controleffectivenessdecreased

Expectedperformanceconsistentlymatchesactualperformance –controliseffective

maintenanceisneeded.Forexample,thecontrolperformancestandardsorobjectivescouldneedupdating,orthecontrol’s“critical”statuscouldbereviewed.

Aformalassurancemechanismshouldincludeactivitiesatdefinedintervals(egquarterlyorbiannually).Thisassuranceprocessshouldassesswhether:

• verificationactivitiesaresuitableforassessingthehealthofacontrol

• theverificationactivitiesarebeingundertakeninarobustandthoroughmanner

• thecriticalcontrolownerismakinganaccurateassessmentofthehealthofthecriticalcontrol

• theMUEownerismakinganaccurateassessmentonthehealthoftheMUE.

Thisprocessshouldallowscoringofdifferentaspectsoftheprocess,providingcommentsonitssuitabilityorhowitcouldbeimproved.TheoutcomesshouldbeconsideredalongsidereviewsofcriticalcontrolandMUEreportswhenlookingatlong-termperformance.

Table7:Trafficlightreportingcriteria

Table8:MUEtrafficlightreportexample


WHAT DID EAST COAST COAL OBSERVE IN THEIR VERIFICATION AND REPORTING ACTIVITIES?

Whodoesverification–linemanagersorHSE?

TheECCworkinggroupdecidednottoassignaccountabilitiesfortheMUEs,criticalcontrolimplementationandverificationofthecontrolsuntiltheyhadmoreexperienceofidentifyingandimplementinganumberofcriticalcontrols.

Theworkinggrouphasamixtureoflinemanagers,technicalsubject-matterexpertsandHSEpersonnel.TheinitialviewofmostoftheworkinggroupmemberswasthattheHSEteamwouldberesponsibleforcarryingouttheverificationactivities.TheHSErepresentativedisagreed.ThediscussioncentredontherespectiveresponsibilitiesoflinemanagersandsupportpersonnelsuchasHSE.

Theworkinggroupquicklyagreedthatitwaslinemanagers’responsibilitytoimplementthecriticalcontrols,buttherewasstilldisagreementabouttheverificationactivities.SomememberssaidthatHSEalreadydidaudits,andtheverificationwasjustanothertypeofaudit,sotheyshouldberesponsiblefortheverificationofcriticalcontrolsaswell.

Theoppositeviewwasputbytheseniormanagerandprojectsponsor

whowaspresent.Theprojectsponsorarguedthatanessentialpartofanylinemanager’sjobwastocheck(orverify)thattaskswithintheirsphereofresponsibilitywerebeingdoneasintended.Thisappliedtocriticalcontrolstoo.HSEshouldnotbeexpectedtodothelinemanager’sjobforthem.

Thiswasacceptedbytheworkinggroup.However,thequestionwasraisedastowhatwastheroleofHSEifitwasnottoverifythecontrols?HSEsaidthatastheCCMprogrammedealtwithverysignificant(material)risks,internalauditwoulddesignanassuranceprogrammeonbehalfofthecompany’sauditandriskcommittee.HSEwouldworkwithinternalaudittodeterminewhatwasauditedaspartofthatprogrammeoncetheCCMprocesswasimplemented.ThisassuranceprogrammeisnotcoveredbytheCCMprocess.

EastCoastCoal’sverificationexperience

Thesite-specificCCMprocesshadbeenimplementedon-site,andECChasbegunverificationactivitiesandreporting.Thecriticalcontrolowner(LineManager1)forsharppicksonshearerswasconductingaroutinereviewoftheverificationactivitieswith

therespectiveowners:thesheareroperator,thelongwalloperatorandmaintenancestaff.Thecriticalcontrolownerhadfoundtheverificationactivitiesincluded:

• reviewoftheshearerinspectionrecords–theinspectionrecordshadfoundallvisualinspectionshadoccurredasintended;however,Shearer5wasoverdueforaninspection

• reviewofmaintenancerecords–Shearer3hadbeenflaggedformaintenanceinthefollowingweek,whileallmaintenanceforthepastthreeweeks(includingthemaintenanceinspectionsforShearers6,7and8)hadbeendelayedduetourgentmaintenanceontheventilationsystem

• reviewofquartzcontentinspectionrecordweekly–regularsamplingofthequartzcontentinthecoalseam,withsamplestakenatevery50mtodetermineifthequartzcontentisabove5%(therecordsshowedthequartzcontentremainedabove5%andtherewasstillahighriskofsparking).

LineManager1collatedtheweeklycriticalcontrolreportasfollows:

Criticalcontrol:Sharppicksonshearers Overallcontrolhealth

Related MUE: Underground fire and coal dust explosion

Verification activities Owner Health Comments

Reviewtheshearer Shiftsupervisor Onesheareroverdueforinspection.inspectionrecords Inspectionplannedfornextweek.

Reviewofmaintenance Maintenance Maintenancedelaysonthreeshearersforthreeweeksduerecords supervisor toemergencymaintenanceneededonothercriticalsystems.

STEP 8: CASE STUDY


Theoverallhealthofthecriticalcontrolwasred.ThelinemanagerdidacriticalassessmentofthereportandthenreportedthefindingstotheMUEowner.TheMUEowner’sreportofcriticalcontrolsconsistedof:

MUE:Undergroundfireandcoaldustexplosion OverallMUEhealth

Critical controls Owner Health Comments

Sharppicksonshearer LineManager1 Action:clearmaintenancebacklog

Watersprayson LineManager1 Action:finalvisualinspectionreportshearerhead

Removalofcoalfines LineManager3 Action:reviewrecordingofdaily/weeklyinspectionsfromunderrollers

STEP 8: CASE STUDY

TheMUEreportswerethencollatedbytheCCMsitemanagerwhowastheallocatedreviewowner.Thereportswerethenassessedforhigh-potentialincidents,andasummaryofthesites’MUEhealthwasreportedatthemonthlyseniormanagementmeeting.


STEP 9: RESPONSE TO INADEQUATE CRITICAL CONTROL PERFORMANCE

Targetoutcome

CriticalcontrolandMUEownersareawareofcriticalcontrolperformance.Ifcriticalcontrolsareunderperforming,orfollowinganincident,investigateandtakeactiontoimproveperformanceorremovecriticalstatusfromcontrols.

TheresponsetoinadequatecriticalcontrolperformancewillbedeterminedbytheoutcomesoftheverificationandreportingactivitiesdiscussedinStep8.Thisresponseisimportantasitassistswithreviewingcriticalcontrols,andassistswithinimprovingtheCCMapproachoverall.

Actionsinresponsetocriticalcontrolperformance

Action 1Take action when critical control performance is inadequate

Action 2Investigate causes of critical control underperformance

Action 3Use the investigation outcomes to improve the CCM process

Action1:Takeactionwhencriticalcontrolperformanceisinadequate

Theimmediateresponsetoinadequatecriticalcontrolperformanceisinitiatedwhenthecriticalcontrolperformancereachesbelowthetriggerthresholddefinedinthecriticalcontrolinformationsummary(tailoredtobesitespecificinStep7).Theresponsetothetriggermayincludesuspensionorshuttingdownapartoftheoperation,processmaterialsbeingdivertedorreducingtherateofproductionwhilethenextactionsareundertaken.Theabsenceofaccidentsorincidentsmustnotbetakenasevidencethatcontrolsareworkingadequately.Commonmethodsofwherethefailureofcriticalcontrolsaredetectedinclude:

• ahazardorat-risksituation(usuallyassociatedwithahumanaction/error)

• afailureofthecriticalcontrol

• aneventthatresultedinseriousharmorthepotentialtocauseseriousharm.

Action2:Investigatecausesofcriticalcontrolunderperformance

Onceacriticalcontrolisunderperforming,investigatethecausestounderstandwhyithasunderperformed.Notethattheoutcomesofthisinvestigationmayrequirethedesignofthecriticalcontroltobeimproved.TheGoodPracticeGuideincludesalistofquestionsthatcanassistwiththisinvestigation.

Action3:UsetheinvestigationoutcomestoimprovetheCCMprocess

ContinualimprovementoftheCCMprocessprovidesassuranceandintegrity.AsCCMisacyclicalprocess,controlsneedtobeassessedandupdatedasoperationschange.Consider:

• Assesstheoutcomesoftheinvestigationforseriousnessandurgency.

• Aninvestigationmayfindadegreeof“creep”intheperformanceofacontrolthathasbecomegradualovertime.Thiscanbe

referredtoasa“normalisationofdeviance”.Anexampleofthismaybeanincreasinglydelayedactiontoremoverainwaterwithinabundthroughoutasite’swetseason,whichaffectstheperformancestandard(iecapacity)ofthebund.Theslippingofperformancestandardsinthiswaymayresultfromeitherlaxreporting,afailureoftheassuranceprocessoraculturalissueon-site.

• Investigationoutcomesmayrequirerevisitingoneormorestepsinthisprocess.Forexample,theoutcomesmayinitiateareviewofMUEs(Step2),thecontrol’sdesign,objectivesorperformancerequirements(Step3)oraverificationactivityanditsperformance(Step5).Afteryouhaveimplementedthenecessarychanges,monitorandassessthecontrolsforimprovedperformance.

• Ifrequired,escalatetheinvestigationfindingstothecorporateareaofthecompany.Thiswillallowforthereviewofothersitesinthecompanywithsimilarcontrols,whomayneedtoimprovetheirCCMbasedontheoutcomesoftheinvestigation.Thisallowsforcommonmodefailurestobeassessedacrosssites.


EAST COAST COAL’S RESPONSE TO INADEQUATE CRITICAL CONTROL PERFORMANCE

Therewasdisagreementwithintheworkinggrouponhowtohandletheresponsetoinadequatecriticalcontrols.Onelineofargumentwasthatitshouldbehandledinthesamewayasabreachofafatalriskcontroloragoldenruleandpromptaninvestigationasahigh-potentialincident.Anothermembersaiditshouldpromptdisciplinaryaction.Otherswerelesssure.Itwaspointedoutbyothersintheworkinggroupthathandlinginadequatecontrolperformancethroughdisciplinaryactionwasalmostguaranteedtoreducereporting,andyoucannotmanagewhatyoudonotknowabout.Anotherworkinggroupmemberwasconcernedthattheydidnothave

sufficientexperienceofimplementingCCManduntiltheyhadmoreknowledgetheyshouldbecarefulnottoimplementblackandwhiterulesonwhatwouldhappenwhensubstandardcontrolperformancewasfound.Theyarguedthatintheearlystagesofimplementinganewapproachitwasalmostinevitablethatsubstandardperformancewasfound.Theydidnotwanttodeteropenandfrankreporting.Withoutthis,improvementwouldbedifficult.

Afterdiscussion,theworkinggroupdecidedthat:

• therewouldnotbeanyautomaticorfixedresponsetodetectinginadequatecriticalcontrol

performanceinthefirstyeartoavoidunintendedconsequencessuchasdeterringreporting

• linemanagerswouldbeexpectedtoaddressanydetecteddeficiencies

• thereasonsforthisapproachwouldbewidelycirculatedwithinthecompany

• approvalforthisapproachwouldbesoughtfromtheleadershipteamandexplainedtotheboard

• thisdecisionwouldbereviewedafter12monthsofexperience.

STEP 9: CASE STUDY


AFTER THE PROCESS

OncereachingtheendoftheCCMprocess,theactivitiesthatsupportitoutlinedinSteps2–9shouldbeembeddedinbusiness-as-usualprocessesandprocedures.ThisincludeshandingoverfulloversightoftheCCMprocessfromtheprojectimplementationteamtothesitemanager.

ItisimportantforsitestomaintaintheirfocusontheCCM.Youmaychoosetomaintaindedicatedstafftohelppromoteit.Actionstoconsideraftertheprocessinclude:

• implementingaprocesstoreviewtheexistingMUEsandscanforneworemergingonesthatmayarisethroughnormalbusinessoperations

• providingassuranceandreviewofthereporting

• updatingtrainingintheCCMasnecessary

• recognisingwhenbusinesschangesmayrequiretheCCMapproachtoberevisited(egifacompanyacquiresnewassets,orchangestosystems,technologyorratesinproduction)

• reviewingthebenefitsofimplementingtheCCMprocessinyourorganisation.

Whatdoessuccesslooklike?

AreviewshouldbeconductedatanappropriatetimefollowingCCMimplementation.Consideriftheorganisationhasachieved:

• integrationofscheduledactivitiesintothecurrentsystem–asuccessfulCCMprocesswillhavemonitoringandreportingcomponentsembeddedintobusiness-as-usualoperations(thisincludesintegratingscheduledverificationactivitiesandreportingintocurrentmaintenanceandinspectionsystems)

• afundamentalunderstandingoftheCCMapproachatalllevelsoftheorganisation

• integratedinternalcapacityofCCMknowledgeintheorganisation

• aniterativeprocessofreview–aprocesswhereMUEsandcontrolsarereviewedandupdated(theremustbescopetorecognisewhereexternalexpertiseisneeded).


APPENDICES

53Critical Control Management Implementation Guidance

APPENDIX A DEFINITIONS AND ABBREVIATIONS

BowtieanalysisAnanalyticalmethodforidentifyingandreviewingcontrolsintendedtopreventormitigateaspecificunwantedevent.

CauseAbriefstatementofthereasonforanunwantedevent(otherthanthefailureofacontrol).

ConsequenceAstatementdescribingthefinalimpactthatcouldoccurfromtheMUE.Itisusualtoconsiderthisintermsofthemaximumforeseeableloss.

ControlAnact,object(engineered)orsystem(combinationofactandobject)intendedtopreventormitigateanunwantedevent.

CriticalcontrolAcontrolthatiscrucialtopreventingtheeventormitigatingtheconsequencesoftheevent.Theabsenceorfailureofacriticalcontrolwouldsignificantlyincreasetheriskdespitetheexistenceoftheothercontrols.

Inaddition,acontrolthatpreventsmorethanoneunwantedeventormitigatesmorethanoneconsequenceisnormallyclassifiedascritical.

Criticalcontrolmanagement(CCM)AprocessofmanagingtheriskofMUEsthatinvolvesasystematicapproachtoensurecriticalcontrolsareinplaceandeffective.

DieselparticulatematterAcomplexmixtureoforganiccompounds,sulphates,nitrates,metalsandothertoxinsthatformacohesivelayerontheparticulatefromdieselexhaust.

HazardSomethingwiththepotentialforharm.Inthecontextofpeople,assetsortheenvironment,ahazardistypicallyanyenergysourcethat,ifreleasedinanunplannedway,cancausedamage.

Health,safetyandenvironment(HSE)

InternationalCouncilonMiningandMetals(ICMM)Amembershiporganisationrepresentingminingandmetalscompaniesandassociations.

Losttimeinjuryfrequencyrate(LTIFR)Ameasurementofthenumberofinjuriesthatrequiretimeoffworkpermillionhoursworked.

Materialunwantedevent(MUE)Anunwantedeventwherethepotentialorrealconsequenceexceedsathresholddefinedbythecompanyaswarrantingthehighestlevelofattention–forexample,ahigh-levelhealth,safetyorenvironmentimpact.

MitigatingcontrolAcontrolthateliminatesorreducestheconsequencesoftheunwantedevent.

Occupationalhealthandsafety(OHS)Thedisciplineconcernedwithprotectingthehealthandsafetyofworkers.

PreventingcontrolAcontrolthatreducesthelikelihoodofanunwantedeventoccurring.

RiskThechanceofsomethinghappeningthatwillhaveanimpactonobjectives.Itisusuallymeasuredintermsofeventlikelihoodandconsequences.

Safetycriticalelement(SCE)Similartocriticalcontrols,anSCEisacomponentwhosefailurecouldleadtoamajoraccident.Thistermisusedprimarilyintheoilandgasindustry.

Subject-matterexpertApersonwhoisanauthorityinaparticularareaoftopic.

UnwantedeventAdescriptionofasituationwherethehazardhasorcouldpossiblybereleasedinanunplannedway,includingadescriptionoftheconsequences.

VerificationactivitiesTheprocessofcheckingtheextenttowhichtheperformancerequirementssetforacriticalcontrolarebeingmetinpractice.CompanyHSEmanagementsystemsmayuseavarietyoftermsfor“verification”activities.Commontermsinuseincludeaudit,review,monitoringoractivemonitoring.

Anoteonterminology:majorunwantedevents,majoraccidenteventsandprocesssafetyThereisnoonetermusedinthewesternindustrialworldtodescribethoserarebutdisastrousincidentsthatcanoccurintransport,especiallyaviation,marineandrailtransport,thepetroleumindustries(upstreamanddownstream)andthechemical-processingindustries.Eachindustrytendstodevelopitsownlanguageandlabels.Theminingindustryhasadaptedthetermmaterialunwantedevent.Majoraccidentevents(orhazards)isthetermwidelyusedinsafety-caseregulatorysystems,butprocesssafetyisprobablythemostwidelyusedtermglobally.However,despiteitsfamiliarity,itdoesnotresonatewithallindustriesandisoftenmisunderstoodintwomainareas.Firstly,inrelationtothesafetyword,processsafetyisusuallydefinedasbeingaboutpreventingeventswiththepotentialforcatastrophicincidentsthatmaykillorinjurepeople,theenvironmentandequipment(aswellasdamagereputationsandcostalotofmoney).Secondly,theterm“process”isfrequentlymisunderstoodasreferringtobusinessprocessesasopposedtochemicalprocesses,whichiswherethetermoriginated.


APPENDIX B A GUIDE TO BEHAVIOURS TO FOSTER A POSITIVE RISK MANAGEMENT CULTURE

Leadersandmanagerscanpromoteaneffectiveriskmanagementculturewithinanorganisationbytheirbehaviour.Thissectionsuggestsleadershipbehavioursthatstaffcanadopttopromoteaneffectiveriskmanagementculture.AdoptingthesebehaviourswillhelpimplementtheCCMprocessandsupporteffectiveMUEmanagementintothefuture.

Leadersshouldnot…

• waitforsomethingtogowrongbeforemakingenquiriesabouttheMUEandthecriticalcontrols

• assumecriticalcontrolsareworkingwellinpracticewithoutdirectobservationandotherevidence.

• trustthatmonitoringandreportingsystemshavebeenestablishedandareactivewithoutevidence.

• showdispleasurewhengivenbadnewsaboutanMUE,criticalcontrolorverificationactivity(eitheronaone-to-onebasisorinmeetings)–showingdispleasurewillreducethechancethatpersonnelwillreportcontrolfailure.

• blameindividualsforinadequatecriticalcontrolbutfocusonhowthecriticalcontrolsystemcanbeimproved.

• acceptunsupportedassertionsthatalliswellwithcriticalcontrolsforMUEs–expectverifiableevidence.

• acceptunsupportedassertionsthatalliswellwithcriticalcontrolsforMUEs.Expectverifiableevidence.

Leadersshould…

• activelyseekevidenceaboutthefunctioningandeffectivenessofcriticalcontrolsandverificationactivities

• conductformalmeetingstoseehowcriticalcontrolsandverificationactivitiesworkinpractice*

• makeinformal“visits”toseehowcriticalcontrolsandverificationactivitiesworkinpractice

• focusfeedbacktopeople(positiveornegativerecognition)onhowCriticalcontrolsareworkinginthefield.

• expecttheirownsupportstafftoestablishmonitoringandreportingsystemstoassistthemtoactivelymonitortheeffectivenessofcriticalcontrolsandverificationactivities.

• welcomeinformationthatindicatesmonitoringandreportingsystemsarenotworkingaswellastheyshould

• usethisinformationtocontinuallyimprovethemanagementoftheMUE.

• recognisethereceiptofinformationoninadequatecriticalcontrolsasanopportunitytoimprovecontrolofMUEs.

• asktoseetheevidencewhenadvisedthatalliswellwithaMUEorthatacriticalcontrolisworkingwell.

• asktoseetheevidencewhenadvisedthatalliswellwithaMUEorthatacriticalcontrolisworkingwell.


Projectplanningtasks

Whatistheorganisationalcontext?Arethereexistingprojectsatacorporate,businessunitorsitelevelthatcomplementorconflictwiththiswork?Ifso,assessyourcurrentprojectsandhowtheymightbeusedortailoredtotheCCMprocess.

HowwilltheimpactoftheCCMinitiativebemeasured?

Isthereaclearobjectiveandwhatarethespecificdeliverablesoftheproject?

Whatbusinessunitswillbeinvolved?

Whowillneedtobeinvolvedfortheprojecttosucceed?

Whatresources,andtowhatextent,willresourcesbeneeded(time,financial,personnel)?

Whatmethodswillbeusedtoassesstheriskoftheidentifiedunwantedevents,includingthecriteriaforanMUE?

WhatmethodwillbeusedtoreviewMUEcontrols?Whatwillthecriteriabeforcriticalcontrolselection?

Howwillthecriticalcontrolsbechecked?

Howwillownershipandaccountabilitybedefined?

Howcancriticalcontrolinformationbeadaptedtobecomesite-specific?

Howwillcriticalcontrolperformancebeverifiedinpractice?

Whatmethodswillbeusedtoinvestigatecriticalcontrolunderperformance?

APPENDIX C PROJECT PLANNING CHECKLIST

Checkwhencomplete


APPENDIX D THE BHP BILLITON CRITICAL CONTROL DECISION TREE

Health and safety critical control management Good practice guide 13

CRITICAL CONTROL MANAGEMENTSTEP 4: Select the critical controls continued

Figure 4: BHP Billiton critical control decision tree

Source: Adapted from BHP Billiton.

Does control prevent, detect or

mitigate a materialrisk?

Does control prevent event

initiation?

Does control prevent or detectevent escalation?

Is control effective for multiple

risks?

Is controlindependent?

Is control the only barrier?YES

NONO

NO

YES

NO

NO

Not a critical control

Identified control

Critical control

YES

YES

YES

YES

NO

Thecriticalcontroldecisiontreeisatooltohelpidentifyifacontrolisacriticalcontrol.ThetreeisfromtheGoodPracticeGuidepage13.

Figure7:BHPBillitoncriticalcontroldecisiontree


ACKNOWLEDGEMENTS

Thedevelopmentofthisguidancewouldnothavebeenpossiblewithouttheinputandsupportoftheindividualsbelow.ICMMgratefullyacknowledgesthefollowingcontributions:

ICMMmembers

ThedevelopmentofthedocumentwasoverseenbyanICMMworkinggroupwithadditionaltechnicalsupportprovidedthroughouttheprocess.ICMMisindebtedtothefollowingfortheircontributionstotheresearchandtheirengagementoniterativedraftswhichledtothefinaldocument:

Workinggroup

Chair:AndrewLewin(BHPBilliton)

NerineBotesSchoeman(AfricanRainbowMinerals)

CasBadenhorst(AngloAmerican)

FrankFox(AngloAmerican)

GeorgeCoetzee(AngloGoldAshanti)

CraigRoss(Barrick)

AndréFey(Hydro)

Additionaltechnicalsupport(includingnon-ICMMmembers)

RobMcDonald(BHPBilliton)

GerardTiernan(BHPBilliton)

AndrewMcMahon(MineralsCouncilofAustralia)

MartinWebb(MMG)

AnthonyDeakin(RioTinto)

KylieAhWong(Glencore)

HenryMushonga(Glencore)

LucyRoberts(Glencore)

AlanMiskin(Peabody)

NevilleMcAlary(Peabody)

AdrienneLaBombard(CMEWA)

PeterSmith(CentennialCoal)

Consultingteam

TheguidewasdevelopedbyaconsultingteamfromNoeticRiskSolutions.Fortheirexpertinputinthedraftinganddevelopmentofthetoolkit,ICMMisindebtedtotheNoeticteamwhichcomprisedthefollowingmembers:

• PeterWilkinson

• SpencerStubbins

• JordanPetrie

ICMMteam

HannesStruywegandMarkHolmesledtheprocesstodevelopthisdocumentonbehalfofICMM.

Photographs

ICMMwishestothankAngloAmericanandRioTintofortheuseoftheirimagesinthisguidance.


Disclaimer

Thispublicationcontainsgeneralguidanceonlyandshouldnotberelieduponasasubstituteforappropriatetechnicalexpertise.Whilereasonableprecautionshavebeentakentoverifytheinformationcontainedinthispublicationasatthedateofpublication,itisbeingdistributedwithoutwarrantyofanykind,eitherexpressorimplied.

InnoeventshalltheInternationalCouncilonMiningandMetals(“ICMM”)(oritsaffiliatesorcontributors,reviewersoreditorstothispublication)beliablefordamagesorlossesofanykind,howeverarising,fromtheuseof,orrelianceonthisdocument.Theresponsibilityfortheinterpretationanduseofthispublicationlieswiththeuser(whoshouldnotassumethatitiserror-freeorthatitwillbesuitablefortheuser’spurpose)andICMMassumesnoresponsibilitywhatsoeverforerrorsoromissionsinthispublicationorinothersourcematerialswhicharereferencedbythispublication.

TheviewsexpresseddonotnecessarilyrepresentthedecisionsorthestatedpolicyofICMM.ThispublicationdoesnotconstituteapositionstatementorothermandatorycommitmentwhichmembersofICMMareobligedtoadoptundertheICMMSustainableDevelopmentFramework.

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PublishedbytheInternationalCouncilonMiningandMetals(ICMM),London,UK.

©2015InternationalCouncilonMiningandMetals.

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ISBN:978-1-909434-21-9

Availablefrom:ICMM,www.icmm.com,[email protected]

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AboutICMMTheInternationalCouncilonMiningandMetalsisanorganisationofleadingminingandmetalscompaniesthatcollaboratetopromoteresponsiblemining,withasharedcommitmenttorespectpeopleandtheenvironment.

ICMMisgovernedbytheCEOsofthefollowingcompanies:AfricanRainbowMineralsAngloGoldAshantiAngloAmericanAntofagastaMineralsArevaBarrickBHPBillitonCodelcoFreeport-McMoRanGlencoreGoldcorpGoldFieldsHydroJXNipponMining&MetalsLonminMitsubishiMaterialsMMGNewmontPolyusGoldRioTintoSouth32SumitomoMetalMiningTeck

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