RIVM Report 2019-0042 - Fifteen years of incident analysis

[Source: RIVM, https://www.rivm.nl/publicaties/vijftien-jaar-incidentanalyse-oorzaken-gevolgen-en-andere-kenmerken-van-incidenten-met ]


RIVM analysed 326 incidents involving hazardous substances that occurred at major chemical companies between 2004 and 2018. In these incidents, the safety of employees was at stake. In total, 215 people died, five of them fatal. The nature, scope and causes of the incidents remained the same during the period under review. The annual number of incidents with relatively serious consequences did not change significantly during the period either.

In 90 percent of the incidents, hazardous substances were released. In 28 percent of cases, a fire or explosion occurred. Three times (1 percent) employees entered an installation containing hazardous substances. Incidents mainly occurred during normal working hours (60 percent) or during maintenance (20 percent). Victims breathed in toxic or harmful substances or suffered burns from chemical reactions or heat. Incidents during maintenance resulted in proportionally more victims.

Chemical companies are responsible for ensuring that installations are in order and that production processes and activities are carried out safely. The incidents occurred because things went wrong in the regular process. The resulting deviations were not noticed in time. Safety can be improved by introducing suitable measures to identify and rectify these deviations in time. This reduces, among other things, the chance of incidents occurring as a result of undesirable human actions or material degradation.

For this analysis, incident studies of the Inspectorate SZW were used. Commissioned by the Ministry of SZW, the RIVM examines the similarities and differences between the incidents investigated. Inspection services can use the analysis for their inspection and enforcement strategies. Companies can use the insights to improve safety.


Date of publication:

4 July 2019



Number of pages:




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