Posted By Dave Wilson
Danny this is a really big ask mate! I have something called MORT which would take up about 20 pages of A3 which I believe NASA have used to identify root causes.

Better to ask Accident type as you could write a book on this.!

Try the HSE www they have some free leaflets on this.

Posted By Danny Swygart
Not on to root causes yet Dave.

Any help on Primary / Immediate / Direct causes of accidents?

Posted By Raymond Rapp
Meanwhile...back in he reald world. I could suggest the HSEs guidance HSG (48) would give you a more balanced insight into the relationship between latent failures (design & management) and active failures (operator error).

Ray

Posted By John Johnston
Hey Danny,

I would agree entirely with ALL of the above posts!

However, I have found it useful to appreciate a more indepth look using Heinrich's Domino Theory, where he postulated his famous theory of accident causation that 'people not things cause accidents' and with the updated version of Heinrich’s theory also as a thoughtful approach.

Big question indeed!

Best regards,

John

Posted By Raymond Rapp
Danny

You must be disappointed with some of the disparaging remarks which do not properly address your serious question. So I will have another go in the hope that it might prompt someone else into providing a sensible debate. God forbid these people should ever have to conduct an accident investigation!

Accidents are often attributed to human error and I have seen figures as high as 80%. However this figure masks many underlying causal factors. Of course it is often very convenient to blame human error. After all, management would not have any repsonsibility and would not have to use resources to ensure that the problem does not re-occurr. The concept is succinctly summed up with 'Human error - root cause or last line of defence.'

Accidents are normally divided between two concepts; latent failures (design, training, supervision etc) and active failures (operator error). Human error is further divided into domains such as lapses, slips, violations etc. Even with these there are subtle variations such as the concept of 'permitted violations,' which could be described as double standards, them and us etc.

The reason for an accident investigation is to ensure that an objective and impartial investigation takes place in order identify primary and secondary causes. Stating the obvious perhaps. However, 'reality is socially constructed as opposed to being objective' (Smith & Elliot, 2002). Therefore establishing the true causes is sometimes more difficult than anticipated.

There are many good works on accidents and disasters and their causes such as Turner's Man Made Accidents and others such as Jim Reason, Jonhson, Pidgeon, Smith etc. One particular book makes very good reading, although not strictly to do with just accidents - Accident and Design (contemporary debates in risk management) by Hood and Jones. A must for all safety professionals.

Regards

Ray

Posted By Chris. R.
Hi Danny,
It seams that you are getting a lot of info not directed towards your question.
The point being accidents can be put down to either;
1)an unsafe act or,
2)an unsafe condition.
The interesting fact comes when you look at who's fault the accident was. According to the CCNSG figures they teach on their safety passport course the figures come out as:
50% are down to Management failure
18% Worker error
12% Joint
The remainder being classed as random or not forseeable.
Hope this is of some help
Chris

Posted By jacqueline
Hi Danny, in relation to your question about the primary cause of accidents, it's worth your while looking at the following models/theories, for example, Heinrich's Domino Theory and Heinrich's accident causation triangle/ratio model, Reason's 'Swiss cheese' model (an excellent cradle to grave theory) and Bird and Loftus (updated version of the Heinrich accident triangle/ratio's. Accidents normally fall into the following two categories - direct (instant) and latent, but circumstance dictates that human error and management failure co-exist in both caregories. Hope that helps you in your VERY broad question. The above theories and models are readily available on the net - esp. NASA pages. However, the most documented cause of workplace accidents is - wait for it - Slips, Trips and Falls!!!!!

Posted By Jim Walker
Danny,

HSE published a very nice workbook earlier this year - for some reason it did not get much publicity.

Investigating Accidents & Incidents (HSG 245).
At less than 10 quid I think it's value for money.

In it, it repeats HSG65 (appendix 5) that lists immediate & underlying causes of accidents & incidents.