Why Accidents Occur

Why Accidents Occur

 

The purpose of an incident investigation is to find the root cause and any contributing causes. We do this so we can find ways to prevent future occurrences. An incident investigation is not conducted in order to assign blame, but to find the true cause. Remember, the Root Cause is that one thing, that if not present, would have prevented the incident.

While there may be many possible causes that have been determined by incident investigations in the past, each incident is unique and the only way to find the root cause is to carefully consider all of the evidence.

But even without looking at an actual incident investigation in process, we know from past research that there are a variety of reasons why accidents have occurred. By knowing what sort of things might lead to an accident, managers are in a better position to take actions that might prevent incidents from occurring in the first place.

Below are some of reasons that accidents occur. As you read through this list, think of the actions that you can take to prevent these reasons from leading to an accident in your group.

NOTE: The items below are not in any particular order and do not represent the frequency of occurrence.

Beliefs and Feelings

  • Employee did not believe accident would occur to them.
  • Employee liked working fast, showing off, or pretending to know it all.
  • Employee didn’t follow rules because he/she disliked rules and authority.
  • Employee worked unsafely as the result of peer pressure.
  • Employee was unhappy because of personal problems or problems on the job leading to conscious or unconscious decision to work unsafely.
  • Employee’s attitude is hostile, uncooperative, apathetic, etc.

Decision to Work Unsafely

  • A consequence of a person’s personal beliefs and learning
  • Through experience, people learn many possible behaviors.
    • They generally choose those behaviors that they perceive will bring them the greatest reward with the least negative consequences.
    • Unfortunately, some employees perceive that it is to their advantage to work unsafely in some situations.

Mismatch or Overload.

  • Occurs when the employee’s physical and/or mental capacity is not adequate to safely perform the task.
    • Poor physical condition of employee.
    • Fatigue or high stress level.
    • Mentally unfocused or distracted.
    • Task too complex or difficult.
    • Task too boring, repetitive, etc.
    • Physical environment is stressful (noise, dust, heat, etc.).
    • Inadequate training provided.

Systems Failure.

  • The term “systems failure” includes all the errors that management and its representatives make that are not grossly negligent or “serious and willful” in nature.
  • These systems failures are errors, mistakes or lapses in management control that allow or contribute to the occurrence of accidents.
    • Lack of clear policy, rules or procedures.
    • Poor hiring or placement procedures.
    • Inadequate inspections.
    • Failure to correct hazards.
    • Inadequate employee training.
    • Lack of in-depth accident investigation.
    • Rules not enforced.
    • Safe behavior not reinforced.
    • Adequate equipment or tools not provided.
    • Production requirements too high.
    • Poor safety communication (safety not publicized or promoted).
    • Poor safety management (problems with authority, goals, evaluations, coordination, responsibility, or accountability).
    • Inadequate knowledge and analysis of jobs and potential hazards (no job safety analysis).
    • Lack of full management and supervisory support for the safety program.

Traps

  • Traps are a type of unsafe condition created by poor workstation or job design that make it more likely an unsafe behavior will occur, thus increasing the probability of an injury.
    • Inappropriate or defective equipment provided.
    • Personal protective equipment not provided, maintained or replaced.
    • Confusing displays or controls.
    • Poor adjustability, layout or size of the work area.
    • Inadequate mechanical lifting equipment.
    • Uncontrolled slip/ fall hazards.
    • Excessive reaching, bending, stooping, twisting, contact pressure, vibration, repetition or force.
    • Awkward postures or movement as the result of poor tool or workstation design.
    • Excessive heat, cold or noise.
    • Insufficient lighting or ventilation.

Unsafe Conditions.

  • Unsafe physical conditions include the general environment, equipment, work facilities and ergonomic interaction between the employee and the job.
  • Unsafe conditions occur as the result of traps and individual behavior that makes the environment unsafe (Traps + Behavior = Unsafe Condition).
    • Unsafe condition created by employee who had accident.
    • Unsafe condition created by fellow employee or third-party individual.
    • Unsafe condition created or allowed by management.
    • Unsafe condition created by the environment (rain, ice, darkness, wind, sun, etc.).

Unsafe Acts.

  • The immediate cause of the accident may include some sort of error by the employee who had the accident.
    • Chose not to follow safety rule.
    • Horseplay or fighting.
    • Used drugs or alcohol.
    • Used incorrect or unauthorized equipment.
    • Improper work method chosen.
    • Did not ask for equipment, information or assistance that was needed to do job safely.
    • Did not remember rule or procedure.
    • Did not pay proper attention.
    • Improper body mechanics.

 

Even though an investigation may lead to the employee’s behavior as the cause of the accident, this behavior is often the result of ineffective or non-existent safety management systems. Effective safety management systems can lead to a change in behavior, which can lead to a change in beliefs and values.

 

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