Primary research results in the quality of accident investigation conducted by Australian tier-one construction companies.

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The Quality of Accident Investigation in the tier-one Australian Construction Industry
By Andrew Summers – Masters AINV (Central Queensland University)
October 2016
TABLE 1 – Industry representation: The data outlines that 78% of the total participants
work from the construction industry. This provides a good sample size when considering
transient employment.
TABLE 2 – Number of Investigations: This question asked to ensure that research wasn’t
targeting minority groups with little previous experience in accident investigation. Of the 33
participants, 51% have conducted seven or more investigations in the past twelve months
(September 2015 - August 2016).

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1. HST Manager
2. Super awesome HSE guy!
3. NSW Operations Manager of a safety consultancy
4. Safety Manager
5. WHS Manager
6. Safety Manager
7. Principal Safety Manager
8. Construction manager
9. Environmental Consultant
10. Safety Advisor
11. ANZ HSE Manager
12. HSE manager
13. General Manager EHS - International Businesses
14. Safety Advisor
15. WHS Consultant
16. Head of Safety
17. Group GM HSEQ
18. HS Manager
19. Principal Advisor – Safety
20. Senior Safety Advisor
21. Safety manager
22. Project Safety Manager
23. WHS & Risk Consultant
24. Safety Manager
25. Safety Manager
26. EHS Manager
27. Project Director
28. HSE Advisor
29. Safety Manager
30. Senior Safety Advisor
31. Construction Manager
32. Safety Manager
33. Ex-WorkSafe investigator
TABLE 3 – Job title: With the exception of participants #8,9,27 & 31, the job titles of the
research participants appear to come from a HSE background, equating to 29 (87%).

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TABLE 4 – Company size: 63% of the research participants comes from large Australian
organisations who employ greater than 1001 employees.
TABLE 5 – Historic employment: 57% of participants have worked for 3+ employers in the
last 10 years

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TABLE 6 – Investigation methods: The result demonstrates that the investigation scenarios
that are primarily conducted within the Australian construction industry vary, with only 15%
equating to simple linear investigations.
TABLE 7 – Employers investigation standards: A mixed result from participants with 48%
agreeing that their company do accident investigations well, while 30% believing their
company does not do accident investigations well.

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TABLE 8 – Employers investigation techniques: This outlines that 84% of participant
employers use the ICAM causation technique.
TABLE 9 – Workplace investigation procedure: 21% of participants do not have a procedure
or checklist for following/referring to when conducting accident investigations.

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TABLE 10 – Industry investigation standards: 40% of participants believe that the industry
does accident investigations well.
TABLE 11 – Peer reviewed investigations: 70% of the participants agree or strongly agree
with accident investigation get reviewed and approved by peers.

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TABLE 12 – Quality assurance techniques: 84% of research participants agree that a
minimal standard of quality should be met.
TABLE 13 – Quality assurance training: This data represents the view that participants agree
or strongly agree (80%) that a quality assurance process is needed in the curriculum for
teaching causation techniques.

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TABLE 14 – Investigation training: 96% of participants have undertaken accident training to
some extent.
TABLE 15 – National investigation curriculum: It is agreed and strongly agreed (85%) that a
national accident investigation curriculum should be in place for accident investigation
training.

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TABLE 16 – Investigation facilitators: 100% of participants agree or strongly agree that
facilitators of investigations should receive ‘appropriate’ training.
TABLE 17 – Training by RTO’s: 64% of participants agree or strongly agree that accident
investigator training should be done by Registered Training Organisations (RTO’s).

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TABLE 18 – Training duration: Short term Accident Investigation training equates to 45% of
the participants overall training.

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TABLE 19 – Causation techniques: 84% of research participants have undertaken ICAM
training, with TapRoot and Why Tree coming in 2nd and third respectively.

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TABLE 20 – Transient employment: 26 research participants (78%) agree or strongly agree
that prescribed accident investigation techniques would assist the transient construction
worker.
TABLE 21 – Prescribing fundamentals: 66% of participants either agree or strongly agree
that in order to get consistent quality investigations, that the WHS legislation should
prescribe fundamental investigation obligations.

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TABLE 22 – If not, Why not: The “if not, why not” clause was supported by 64% of research
participants either agreeing or strongly agreeing.
TABLE 23 – Minimum standards: 80% of participants either agree or strongly agree that
minimum accident investigation fundamentals should be reported on a prescribed template
to ensure certain event information is investigated.

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TABLE 24 – Completing investigations: The proposed idea of having an approved accident
investigator from a PCBU who would maintain accreditation so that a quality standard could
be met had 33% of respondents disagree or strongly disagree to the idea.
TABLE 25 – Amending legislation: Prescribing WHS legislation with minimum standards was
agreed or strongly agreed with 73% of participants.

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TABLE 26 – Investigation photos: 87% of research participants agree or strongly agree that
incident scene photographs with added commentary helps explain accident causation.
TABLE 27 – Logic diagrams: 79% of participants agree or strongly agree with the belief that
logic diagrams help explain causation logic, with 0% believing the contrary.

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TABLE 28 – Causation logic: Supporting table 26, 60% of research participants include logic
diagrams to help explain logic in their investigations.
TABLE 29 – Benefits of Logic Diagrams: 66% of participants say yes to logic diagrams being
needed to demonstrate logic in accident investigation reports.

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TABLE 30 – Participant perspectives: 87% of participants believe that Root cause can occur
multiple times within an event of an accident, with 18% disagreeing or strongly disagreeing
with this claim.

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1. Root Cause is the basic cause or the fundamental problem that resulted in the incident to occur. If we
are talking about energies, it is the path that allowed the energy to result in an incident or event.
2. An underlying condition or set of conditions that allowed the proximal causes of an incident to develop.
3. The underlying system failure that permitted the failures/errors to occur that lead to the event. The fifth
of the five whys
4. Identifying a reason that an incident occurred
5. One event that led to an incident occurring.
6. The fundamental cause, or causes, of an event or chain of events
7. My interpretation of root cause is the main cause of a particular incident. There may have been other
contributing factors that lead up to a specific incident, but there was a specific cause that resulted in an
incident
8. To find the key reason or more likely reasons why an accident or incident has taken place.
9. A viewpoint of the factors leading to an incident at a given point of time
10. Is the main cause after an incident occurred based on the investigation
11. Deeply embedded faults within an organisations or an individuals practice or process that if unfetted can
peculate to more likely cause or contribute to incidents
12. If controlled the event would not have happened
13. Identification of the primary cause/s of the event - those that if did not occur, would have prevented the
event from occurring.
14. The original causal factor that sets off a series of other causal factors, which align to create an event.
15. The last failure that occurred resulting in release of energy, could have many contributing factors
16. A misnomer as there are normally several causes if you dig deeply enough
17. . (no answer)
18. When the money runs out or we stop looking. Absence of best practise.
19. The primary causation of the event.
20. What directly caused the accident to occur
21. there is often more than one cause of an incident, as such i don’t think the root cause term adds merit
22. Root cause is a meaningful cause that leads to a sequence of events. Without the root cause the event
wouldn’t have occurred.
23. Identifying the systemic, management actions or behaviours which existed as the underlying cause
which created a situation for the event to occur
24. It’s the fundamental reason for the occurrence
25. The primary cause leading to the incident/near hit.
26. Drilling down to the actual cause which may not associated with site conditions
27. Fundamental reason for the occurrence
28. Failure of system that caused incident
29. Underlying reason/s that set the environment prior to or at the time of the incident
30. The basic definitive reason as to why the event happened
31. What is the one element, which if it did not exist, the incident would not have occurred.
32. The thing or thing that management has control over that if in a correct state, will not lead to an incident.
33. Not applicable in my methodology
TABLE 31 – Root cause: The research participant’s responses on their interpretation of the
meaning of root cause.