Order TH-001-2019 to TC Energy pursuant to Section 109 of the Canadian Energy Regulator Act

INSPECTION OFFICER ORDER NO. TH-001-2019

IN THE MATTER OF THE CANADIAN ENERGY REGULATOR ACT,
AN ORDER UNDER SECTION 109

NAME OF PERSON(S)/COMPANY TO WHOM THIS ORDER IS DIRECTED

, Accountable Officer, Senior Vice President, Technical Centre TC Energy, is a person appointed by the following companies, TransCanada PipeLines Limited, NOVA Gas Transmission Ltd., Foothills Pipe Lines Ltd., TransCanada Keystone Pipeline GP Ltd., Trans Quebec & Maritime Inc., and Great Lakes Pipeline Canada Ltd. facilities located in Canada, to ensure that all regulatory obligations are met.

On or about 26-28 November 2019 the undersigned Canada Energy Regulator Inspection Officer conducted compliance verification activities of/at various TransCanada Compressor Stations, and found inconsistencies with the naming and labelling between equipment, paper drawings and the Supervisory Control and Data Acquisitions (SCADA), which poses an unreasonable risk to worker safety and is in contravention of sections 6 and 47 of the National Energy Board Onshore Pipeline Regulations (OPR).

RELEVANT FACTS

• Between 26-28 November 2019, the undersigned Inspection Officer (IO) conducted Safety Program inspections of TC Energy’s Compressor Stations (CS) at Nipigon (CS 75), Jellicoe (CS 77), Klotz Lake (CS 84), Hearst (CS 86), Kapuskasing (CS 95), and Smooth Rock Falls (CS 99).
• On 27 November 2019, the IO inspected the Control Room at Hearst CS 86 and noted that one Motor Control Center (MCC) was labelled “CROSSOVER VALVE BH-DC” on a permanent label and “2:3 DC” was handwritten in black marker immediately below it. When asked, TC Energy stated that when the Human Interface Panel SCADA was put into place a number of years prior “CROSSOVER VALVE BH-DC” was replaced with “2:3 DC” in the SCADA and on the physical device in the yard however, neither the MCC nor the paper prints were updated.
• On 28 November 2019, CER IO inspected the Control Room at Kapuskasing CS 95 and noted the following:
  • The MCC was labelled “CROSSOVER VALVE BH-DC” on a permanent label and “2:3 DC” was handwritten in black marker immediately below it;
  • The SCADA identified the valve as “L2:3-DC”;
  • One set of paper prints identified the valve as “2:3-DC”;
  • A second set of paper prints identified the valve as “BH-DC”;
  • The valve hut door was labeled as “L2:3 D-C”; and
  • The physical device inside the valve hut was labeled MLV 95-2:3 Discharge Cross-Over”.
• On 28 November 2019, CER IO noted other MCCs in the Control Room at CS 95 with similar labeling as the “CROSSOVER VALVE BH-DC”/”2:3 DC”.
• On 28 November 2019, at the IO’s request, TC Energy confirmed that it communicated this hazard to all personnel at all TC Energy owned or operated federally regulated facilities in Canada who may be exposed to a similar situation no later than 29 November 2019.
• On 28 November 2019, at the IO’s request, TC Energy confirmed that it would provide the CER with its interim measures to ensure the safety of personnel at all TC Energy owned or operated federally regulated facilities in Canada who may be exposed to similar situations until such time as preventive actions could be taken. The interim measures were to be submitted no later than 6 December 2019.
• On 6 December 2019 TC Energy advised the CER, via email, of the following:
  • An email was distributed to the leadership of its Canadian Gas Operation Regions on the evening of 29 November 2019 detailing its findings and highlighting the hazards identified during the inspection and requesting notification to their teams.
  • A Compliance Advisory (CDNCA2019-003) was created and distributed to all Canadian Gas and Liquids regional personnel for review and posting covering “All Canadian sites (Gas and Liquids) where naming and tagging inconsistencies may be present due to major equipment upgrade projects.”
• On 13 December 2019, CER staff conducted a conference call with TC Energy to further clarify any additional actions taken. TC Energy told the CER that the current interim measures have primarily consisted of communicating the hazards via email to approximately 600-700 persons, posting the Compliance Advisory near the MCCs, and reminding employees of the proper use of lock-out-tag-out (LOTO) procedure. TC Energy did not demonstrate that it had pro-actively taken definitive steps to identify if similar deficiencies existed at other TC Energy owned or operated federally regulated facilities in Canada in addition to the sites identified during the inspection.

Given the potential safety concerns associated with the labeling deficiencies, there currently exists an unacceptable risk to workers conducting operations and maintenance work, especially where they are currently utilizing critical LOTO procedures. The IO is not satisfied that TC Energy is adequately addressing this issue in an appropriate manner and finds the company to be, or likely to be, in contravention of the following OPR sections, including but not limited to:

• Section 6 – the company is not operating a pipeline in a manner that ensures the safety and security of the employees, the pipeline or the protection of the environment since identification on equipment is not consistent with prints/records and SCADA;
• Section 6.5(1)(i) – the company has not established and implemented an effective process for identifying and managing any change that could affect safety, security or the protection of the environment, including any new hazard or risk, any change in a design, specification, standard or procedure given the noted labeling deficiencies.
• Section 47 – the company has not developed, implemented or maintained a safety management program that prevents, manages or mitigates potentially dangerous conditions, and exposure to those conditions, during all activities related to the operation of their pipeline. Employees at the facilities and the environment are at risk of a potentially dangerous occurrence of a hazardous energy and/or substance release if the wrong valves or equipment are manipulated during the execution of a LOTO.

Based on the facts referenced herein, the Inspection Officer has reasonable grounds to believe that there is or is likely to be a contravention of Part 2 of the Canadian Energy Regulator Act (CER Act). Pursuant to s.109(1) of the Canadian Energy Regulator Act, the inspection officer may, by order, direct a person to:

1. stop doing something that is in contravention of Parts 2 to 5 or section 335 or cause it to be stopped;
2. take any measure that is necessary in order to comply with Parts 2 to 5 or section 335 or mitigate the effects of non-compliance;
3. stop doing something that may cause a hazard to the safety or security of persons, or damage to property or the environment or cause it to be stopped; or
4. take any measure that is necessary to prevent or mitigate the hazard to the safety or security of persons or damage to property or the environment.

MEASURES TO BE TAKEN

TC Energy is ORDERED pursuant to subsections 109(1) and 109(2) of the CER Act to:

Specified Measures^{Footnote 1}:

TC Energy, on behalf of all of its TransCanada owned or operated federally regulated facilities in Canada:

Immediate Interim Actions:

Immediate interim actions shall be implemented no later than 15 January 2020 and verification shall be provided to the CER.

1. Identify where all lock-out-tag-out (LOTO) naming and tagging inconsistencies exist;
2. Until such time as safe working conditions are restored at facilities where naming and tagging inconsistencies may be present, do not undertake any LOTO using the existing ‘Lockout and Tagout Energy Isolation TOP’ procedures;
3. Develop a separate ‘LOTO Isolation’ procedure specific to the assets that are subject to naming and tagging inconsistencies. This procedure shall include measures to manage simultaneous LOTO of the same valve ex .2:3 D-C at more than one station;
   1. Ensure that all those required to conduct LOTO activities at facilities where naming and tagging inconsistencies may be present are trained;
4. The following actions shall also be taken:
   • Remove all inconsistent paper prints;
   • Ensure the Management of Change (MOC) process is engaged during interim action implementation; and

Preventive Actions:

1. 5. Conduct a root cause investigation to identify immediate/direct and basic/root causes and proposed corrective and preventive actions;
2. 6. Develop a detailed Corrective and Preventive Action Plan (CAPA) to address the root cause investigation findings; the CAPA plan must include implementation dates for each planned corrective and preventive action;
3. 7. TCE must submit the CAPA plan for approval no later than 14 February 2020.

EFFECTIVE DATE OF THE ORDER

This Inspection Officer Order takes effect immediately on 18 December 2019 at the time of delivery of the order to the person/company to whom it is directed. Nothing in this order shall be construed as reducing, increasing, or otherwise affecting what may be required of the person/company to whom it directed to comply with all applicable legislative or legal requirements.

COMPLIANCE WITH THIS INSPECTION OFFICER ORDER IS MANDATORY

Failure to comply with an inspection officer order issued under section 109 of the CER Act is an offence under section 112 of the CER Act.

Inspection Officer

Inspection Officer	IO Designation # 2648	Original signed by __________________________________ Signature __________________________________ Name (printed)
	Date 18/12/2019
	IO Designation # 2646
	Date 18/12/2019
	210-517 10 Ave SW, Calgary AB  T2R 0A8

Please note that in compliance with the CER’s Enforcement Policy, this Order will be posted on the CER’s website.

CVA or incident #: CV1920-213
Order No.: TH-001-2019

Date modified:

2023-05-18