One breakout on Casting Machine 2, followed through every feature.

The incident, step by step

1. 01
   Shift B, 03:40

   The warning nobody acted on

   The top-row thermocouples in the mould on Casting Machine 2 suddenly drop while the bottom row climbs. The breakout prediction alarm on this machine is switched off, and the casting speed isn’t reduced. Four minutes later, steel breaks out under the mould. The machine is down for six hours and the first secondary-cooling rollers are damaged.

   • Shift-report extraction

   Ganjoor pulls the key points out of the shift report and drafts a knowledge item, already suggesting the equipment (CCM-02, mould) and two similar lessons.

2. 02
   Next morning

   Capture what the crew saw

   The operator adds photos of the torn shell and a short voice note. A senior caster sits for a structured interview about the signs he watches for in the thermocouple readings.

   • Video, audio, photos
   • Expert interview
3. 03
   Day 2

   Find the root cause

   The process engineer runs 5 Whys and FMEA on the standard templates. Casting speed had been raised, but the mould powder wasn’t changed to suit it. Lubrication fell short, the shell stuck to the mould wall and tore below it. The root cause: the mould-powder selection procedure had never been updated.

   • RCA · 5 Whys
   • FMEA · RPN
   • Corrective actions

   Corrective actions get an owner and a due date: update the powder-selection procedure, and bring the breakout prediction alarm back into service.

4. 04
   Day 2

   Attach it to the machine

   The lesson lands on the mould’s knowledge profile: Steel Complex › Main Site › Continuous Casting › Line 2 › CCM-02 › Mould. Two earlier breakout lessons and the reference procedure are linked automatically. The glossary ties the crew’s shop-floor words to “breakout”, so any of them finds it.

   • ISA-95 hierarchy
   • Asset profile
   • Glossary
5. 05
   Day 3

   Review and approve

   The draft reaches the reviewer’s inbox. Her comment: add the reference procedure number to the first action. The author fixes it, she approves, and the updated procedure, SOP-CC-114 “Mould powder selection by casting speed” v3.2, is published with an owner and a review date.

   • Review inbox
   • Owner and review date
6. 06
   Weeks later

   The next crew asks

   Another shift asks Ganjoor Assistant why breakouts keep happening on Casting Machine 2. It searches 12,480 approved items and answers: most were sticker breakouts after speed increases with the wrong mould powder; select powder per SOP v3.2 and treat a sudden top-row thermocouple drop as a warning. Every point is cited, and the model runs on the plant’s own server.

   • Semantic search
   • Ganjoor Assistant
   • Cited sources

   A search for “breakout” also matches three shop-floor synonyms and returns 23 results in 0.4 seconds. Crews rate the fix: 24 “worked”, 2 “didn’t work”, 4.7 out of 5.

7. 07
   Six months on

   Managers see the gap close

   Knowledge coverage reaches 78%, up nine points in six months, and average repair time is down 21%. Failed searches show what’s still missing, and the critical-knowledge assessment flags know-how held by a single person, so more interviews get scheduled.

   • Management dashboard
   • Failed searches
   • Critical knowledge
8. 08
   When the mould is replaced

   The knowledge stays true

   The mould is swapped for a new one. Everything written for the old one is flagged for review automatically: the optimal oscillation frequency settings, the mould change procedure and the oscillator troubleshooting guide. Nobody acts on advice for equipment that’s gone.

   • Equipment-change flag
   • Lifecycle