Please describe the role of human-being (human factor) in HSE accidents?
Indicators of Human Factors Problems
• Accidents where “human error” is a cause
• Occupational health reports of mental or physical ill-health
• High absenteeism or sickness rates
• High staff turnover levels
• Low level of compliance with h&s rules
• Behaviour issues identified in risk assessments
• Complaints from staff about working conditions or job-design
Common Human Failures in Accidents
• Job Factors: Illogical design of equipment & instruments, Constant disturbances or interruptions, Missing or unclear instructions, Poorly maintained equipment, High workload, Noisy & unpleasant working conditions
• Individual Factors: Low skill & competence levels, Tired staff, Bored or disheartened staff, Individual medical problems
• Organisation & Management Factors: Poor work planning, leading to high work pressure, Lack of safety systems and barriers, Inadequate responses to previous incidents, Management based on one-way communication, Deficient co-ordination and responsibilities, Poor management of health & safety, Poor health & safety culture
• Errors (not intended)
– Slips -: “Actions-not-as-planned”Examples: Performing an action too soon in a procedure, Carrying out an action with too much or too little strength (e.g. over-torquing a bolt), Switching the wrong switch, Moving switch up rather than down, Carrying out the wrong check on the right item
– Lapses : Forgetting to carry out an action, Lose our place in a task, Can be due to interruptions or distractions. Example:Forgetting to fill switchgear with oil?
– Mistakes: Doing the wrong thing, believing it to be right. Consist of: Rule-based, Knowledge-based
• Violations (deliberate)
– Routine: Breaking the rule has become a normal way of working within the work group. This can be due to: Desire to cut corners to save time & energy, Perception that rules are too restrictive, Belief that rules no longer apply, Lack of enforcement of the rule, New workers starting a job where routine violations are the norm and not realising that this is not the correct way of working
– Situational: Breaking rule is due to pressures from the job such as: being under time pressure, insufficient staff for the workload, right equipment not being available, extreme weather conditions
– Exceptional: Rarely happen and only then when something has gone wrong. To solve a new problem you feel you need to break a rule even though you are aware that you will be taking a risk
Influences on behaviour at Work
• Personality: The study of what makes each of us a distinct person. Some characteristics are shared by all human beings, Each person is different in some respects
• Attitude: A person’s point of view, or their way of looking at something. Influences the way a person reacts in a certain situation. Both good and bad attitudes are contagious
• Motivation: That which makes an individual act as they do - their reason for doing something. A drive can be either: Appetitive - towards something we want, Aversive - avoiding something unpleasant, An event that is followed with reward is likely to recur (positive reinforcement), An event that is followed with punishment is likely to desist (negative reinforcement)
• Experience: With increasing experience we expect more competence and an increase in ability to cope with situations
• Intelligence: There needs to be enough mental stimulation, but not too much. A person with low intelligence may find even a routine, mundane job very taxing. If a person of high intelligence is set a mundane task, he will probably employ himself in finding new and less arduous, but not necessarily safer, ways of completing a task
• Perception: Factors involved in perception: Signals from sensory receptors, Expected information from memory. Signals from sensory receptors and memory can be misleading, particularly if we are affected by stress, alcohol, drugs, fatigue or just familiarity
6. Please provide an example of HSE accident from your practice
According to an OSHA/Chemical Safety Board safety video, hot work accidents typically happen every week, are “one of the most significant types of accidents the CSB investigates in terms of deaths (and) frequency,” and have caused fires and explosions that have led to 60 deaths since 1990.
Hot work is any work that uses an open flame or that generates heat or sparks that could cause a fire. It often involves welding, soldering, cutting, or brazing. It also includes work processes that do not use a flame but that could create a fire, including drilling, grinding, and the use of powder-actuated tools. Workers are potentially at risk not only in the oil and gas industry, where flammables are handled regularly, but also in many other sectors within general industry, such as food production, paper, and wastewater treatment. Hot work examples: Welding, Burning, Grinding, Blasting, Cutting, Brazing, Soldering, Opening energized electrical junction boxes
Classified area: Areas where combustible concentrations of hydrocarbons or other flammable vapors may accumulate: Storage tanks, valves, pipeline connections, well heads
Seven of the accidents have occurred since July 2008. While each accident has unique features, all resulted from a flammable vapor coming in contact with an ignition source created by welding or cutting that was performed in, on, or near tanks that contained flammables. In some cases, the presence of a flammable material was completely unknown to the workers; in all cases, the workers had no knowledge that an explosive amount of flammable vapor had accumulated.
EMC Used Oil Corporation: Miami, Fla., December 2, 2008: 1 worker killed, 1 injured
An explosion killed a contract welder who was repairing a two-compartment oil tanker and injured another worker at the EMC Used Oil facility. The welder was in the process of welding transfer piping onto the tanker when residual hydrocarbon vapor from the 2,500-gallon rear compartment ignited, causing a powerful explosion. The surviving worker stated that the contractors did not perform combustible gas monitoring and relied upon the host company to assure that tanks were safe for hot work. However, EMC indicated that it relied on contractors to monitor for gas; although the company owned a multiple gas detector, it was used only for confined space entry. EMC did not have a formal hot work permitting or authorization system. Applicable key lessons: Use alternatives; analyze the hazards; monitor the atmosphere; test the area; use written permits; supervise contractors.
Seven key lessons from recent accidents are as follows:
Analyze the Hazards
Monitor the Atmosphere
Test the Area
Use Written Permits
Although the hazards of hot work are well established and both regulatory and good-practice guidance exist, frequent deaths and serious injuries continue to occur in hot work-related fires and explosions. The CSB has found that hot work is one of the most common causes of worker deaths among accidents it investigates. Following the seven key lessons – along with other good safety practices – can prevent deaths and injuries from hot work.
In particular, host companies, contractors, permit writers, welders, and other maintenance workers should effectively analyze the hazards and conduct combustible gas monitoring before and during hot work to provide advance warning of flammable atmospheres. Training on the proper use of such devices is imperative for future hot work accident prevention.
7. Please describe the concept of risk assessment and risk management
• Risk Management Definition:
– The resources expended to understand, control and minimize the probability and consequence of an undesired event.
– A diagnostic decision tool that enhances project management effectiveness and provides program/project managers information to evaluate choices and keep the program on track.
– Just one of many tools in the PM’s toolkit to run the project
Risk assessment is a step in a risk management procedure. Risk assessment is the determination of quantitative or qualitative value of risk related to a concrete situation and a recognized threat (also called hazard). A risk assessment is simply a careful examination of what, in your work, could cause harm to people, so that you can weigh up whether you have taken enough precautions or should do more to prevent harm. Workers and others have a right to be protected from harm caused by a failure to take reasonable control measures. Accidents and ill health can ruin lives and affect your business too if output is lost, machinery is damaged, insurance costs increase or you have to go to court. You are legally required to assess the risks in your workplace so that you put in place a plan to control the risks.
How to assess the risks in your workplace. Follow the five steps in this leaflet:
Step 1Identify the hazards
Step 2Decide who might be harmed and how
Step 3Evaluate the risks and decide on precautions
Step 4Record your findings and implement them
Step 5Review your assessment and update if necessary
8. Please define the principle components of risk management.
Risk management has become part of lots of management systems. The information security management system for example uses risk management to assess the risks associated with the audit findings of the information security management system. The same way the occupational health and
safety management system makes use of risk management to assess the risk associated with hazards.
This gives the frame for the process in occupational health and safety:
1.Identifying hazards. Sources for hazard identification can be:
- Past incidents and accidentsInput by employees
- Examining workplaces or work areas
- Review of safety instruction for equipment and materials
- Any kind of creative thinking such as brainstorming
- Advice from legislation, standards, checklists or external consultants.
2.Assessing associated risks.
The following aspects may be helpful to determine the likelihood of a risk:
- Other risks that add to the increase of likelihood
- Frequency of occurrence
- Duration of risk occurrence
- Number of people being exposed
- Likely dose of exposure
- Required exposure levels
3.Taking actions to mitigate actions. There is a hierarchy in different solutions whereby the most effective usually is also the most difficult and sometimes most expensive to realise:
- Actions that remove the hazard and eliminate the risk.
- Actions that replace the hazard by a less dangerous one.
- Actions that modify the product or process design.
- Actions that isolate the hazard from people.
- Actions that use engineering solutionssuch as a new machinery or plant.
- Actions that use administrative controls, e.g. new procedures.
- Actions that protect through personal equipment from hazards.
4.Monitoring the effectiveness.
The outcome of each risk mitigating action has to be reviewed on two levels:
- To ensure that the actions taken are effective and continue to be effective.
- To ensure that no new hazard/risk was introduced by the actions taken.
Any control measures have to be maintained in order to ensure that they are kept in working order. As well procedures have to be audited to ensure they are being followed as intended.