Investigation of road traffic accident should be accomplished based on human factors engineering (ergonomics) consideration, which is mostly has been ignored. This presentation helps people to be more familiar with. Also, it could be useful for traffic managers to deeply go through the real causes of driver error.
8. 2016:
Human Factors in the Chemical and Process
Industries
Edmonds J, editor. Human Factors in the Chemical and Process Industries: Making it Work in
Practice. Elsevier; 2016 Sep 17.
Ch 8:
Human factors in incident investigation
E. Novatsis and J. Wilkinson
8
9. 1. Reporting of the incident
2. Setting the investigation terms of reference
3. Mobilizing the investigation team
4. Investigating and collecting evidence (including planning
and carrying out interviews)
5. Establishing a timeline of events
6. Conducting the analysis
7. Formulating the recommendations
8. Providing feedback and reporting
9. Implementing the recommendations (including checking
they are completed and sustained)
10. Sharing the learning
9
10. Common FailingsInvestigation Stage
• Not reported quickly enough, compromising accurate information
being collected; for example, due to people’s memory fading
Reporting
Common FailingsInvestigation Stage
• Not reported quickly enough, compromising accurate information
being collected; for example, due to people’s memory fading
Reporting
• Exclude looking at human and organizational issues
• Findings are specified in advance
Terms of reference
Common FailingsInvestigation Stage
• Not reported quickly enough, compromising accurate information
being collected; for example, due to people’s memory fading
Reporting
• Exclude looking at human and organizational issues
• Findings are specified in advance
Terms of reference
• Human factors expertise is not included in or available to the
• investigation team
Mobilization
Common FailingsInvestigation Stage
• Not reported quickly enough, compromising accurate information
being collected; for example, due to people’s memory fading
Reporting
• Exclude looking at human and organizational issues
• Findings are specified in advance
Terms of reference
• Human factors expertise is not included in or available to the
• investigation team
Mobilization
• Major assumptions are made on why people behaved as they did
and these are not challenged within investigation team
• Interviews are not planned
• Key people not interviewed or badly interviewed
• Evidence is not corroborated with other data
Investigation and
evidence collection
10
11. Common FailingsInvestigation Stage
• Intentional/unintentional distinction not made
• Search for blame conducted
• Human factors that influenced performance are not identified
Timeline and
analysis
Common FailingsInvestigation Stage
• Intentional/unintentional distinction not made
• Search for blame conducted
• Human factors that influenced performance are not identified
Timeline and
analysis
• Poor symmetry between behavioral causes and recommendations
• Unrealistic or impractical recommendations made
• Reasons for the recommendations are not made
• sufficiently clear
Recommendations
Common FailingsInvestigation Stage
• Intentional/unintentional distinction not made
• Search for blame conducted
• Human factors that influenced performance are not identified
Timeline and
analysis
• Poor symmetry between behavioral causes and recommendations
• Unrealistic or impractical recommendations made
• Reasons for the recommendations are not made
• sufficiently clear
Recommendations
• Findings challenged without due cause, especially when they
highlight management failures
Feedback/reporting
Common FailingsInvestigation Stage
• Intentional/unintentional distinction not made
• Search for blame conducted
• Human factors that influenced performance are not identified
Timeline and
analysis
• Poor symmetry between behavioral causes and recommendations
• Unrealistic or impractical recommendations made
• Reasons for the recommendations are not made
• sufficiently clear
Recommendations
• Findings challenged without due cause, especially when they
highlight management failures
Feedback/reporting
• Lessons not shared with all relevant parties
• Little thought given to the method used to share the lessons
• Underlying organizational factors are not identified or shared
Sharing learning
11
ونزولا
تایلند
مصدومیت در حوادث رانندگی یک مسئله عمده در حوزه سلامت عمومی و توسعه جوامع است.
مجروحان حوادث رانندگی فشار بسیار زیادی بر بودجه بهداشت عمومی وارد میکنند. همچنین هرکشته، مجروح و معلول ناشی از حوادث رانندگی تاثیر عمیقی بر وابستگان خود میگذارد. بسیاری از خانوادهها بهدلیل پرداخت هزینههای معالجه یا ازدست دادن نانآور خود و یا نیازمند شدن به کمکهای حمایتی برای نگهداری از فرد معلول، به ورطه فقر میافتند. بازماندگان حوادث رانندگی، خانواده، دوستان و سایر وابستگان آنها اغلب از تاثیرات سوء اجتماعی، جسمی و روحی رنج میبرند.
در این ارائه سعی شده در همه موارد از نمایش گرافیکی استفاده شود.
ممکن است اعداد تفاوت کند:
سال های مختلف
کشورهای مختلف
سازمان های مختلف
اما اولویت ها بهنسبت یکسان است؛ بهجز مصرف الکل و موادمخدر
