This article from Safety Toolbox Topics (http://safetytoolboxtopics.com/General/seven-common-accident-causes-2.html) recently came to our attention and we would like to bring it to your attention. The article Seven Common Accident Causes (quoted) relates to industry, but we have followed it with some examples extracted from the Department of National Defence (DND) and Canadian Armed Forces (CAF) Ammunition & Explosives Safety Program (AESP).  There is a surprisingly close correlation.

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SEVEN COMMON ACCIDENT CAUSES

Consider this statistic: 80 out of every 100 accidents are the fault of the person involved in the incident. Unsafe Acts cause four times as many accidents & injuries as unsafe conditions.

Accidents occur for many reasons. In most industries people tend to look for “things” to blame when an accident happens, because it’s easier than looking for “root causes,” such as those listed below. Consider the underlying accident causes described. Have you been guilty of any of these attitudes or behaviors? If so, you may have not been injured-but next time you may not be so lucky.

• Taking Shortcuts: Every day we make decisions we hope will make the job faster and more efficient. But do time savers ever risk your own safety, or that of other crew members? Short cuts that reduce your safety on the job are not shortcuts, but an increased chance for injury.
• Being Over Confident: Confidence is a good thing. Overconfidence is too much of a good thing. “It’ll never happen to me” is an attitude that can lead to improper procedures, tools, or methods in your work. Any of these can lead to an injury.
• Starting a Task with Incomplete Instructions: To do the job safely and right the first time you need complete information. Have you ever seen a worker sent to do a job, having been given only a part of the job’s instructions? Don’t be shy about asking for explanations about work procedures and safety precautions. It isn’t dumb to ask questions; it’s dumb not to.
• Poor Housekeeping: When clients, managers or safety professionals walk through your work site, housekeeping is an accurate indicator of everyone’s attitude about quality, production and safety. Poor housekeeping creates hazards of all types. A well maintained area sets a standard for others to follow. Good housekeeping involves both pride and safety.
• Ignoring Safety Procedures: Purposely failing to observe safety procedures can endanger you and your co-workers. You are being paid to follow the company safety policies-not to make your own rules. Being “casual” about safety can lead to a casualty!
• Mental Distractions from Work: Having a bad day at home and worrying about it at work is a hazardous combination. Dropping your ‘mental’ guard can pull your focus away from safe work procedures. You can also be distracted when you’re busy working and a friend comes by to talk while you are trying to work. Don’t become a statistic because you took your eyes off the machine “just for a minute.”
• Failure to Pre-Plan the Work: There is a lot of talk today about Job Hazard Analysis. JHA’s are an effective way to figure out the smartest ways to work safely and effectively. Being hasty in starting a task, or not thinking through the process can put you in harm’s way. Instead, Plan Your Work and then Work Your Plan!

“It is better to be careful 100 times than to get killed once.” (Mark Twain)

End of quoted article

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How does this relate to DND and the CAF?

• Taking shortcuts. Burning surplus gun propellant during a disposal activity…, inside the ammunition compound and without the use of a burn tray, damaging a concrete pad and setting fire to the grass within the compound.
• Overconfidence. Member sustains burns while installing a C6 Trip Flare…, not having installed one since 1998.
• Starting a task with incomplete instructions. The use of improper procedures by ship’s staff for loading exercise torpedoes… resulting in torpedo failing to activate upon entering the water. Similar occurrence repeated twice four and five months later…
• Poor housekeeping. While preparing to burn old packaging, three Shielded Mild Detonating Cord (SMDC) lines were discovered. During initial processing, packaging had overflowed into the area where SMDC lines were located and the lines were inadvertently gathered for disposal.
• Ignoring safety procedures. Inappropriately use of a smoke grenade…, resulting in an eye injury.
• Mental distraction. A member left items awaiting inspection in a vehicle. Another member taking the vehicle removed the items and left them on the ramp, forgotten.
• Failure to pre-plan. A CATM-9 missile is a three person lift. Lacking a third person, two tried to carry-out a load, in a congested area, resulting in damage to the missile. 

Over the past ten years, “human error” has been cited as the primary cause factor for 70% to 80% of reported occurrences. While human error may seem to be the obvious cause factor, it is often a mere symptom of a deeper rooted problem.  An investigator must be thorough in his or her analysis and look into the conditions that may have led to the incident or accident.  Was the occurrence a result of: an error in drill; an error of drill; inaccurate procedures; insufficient or inadequate training; a lack of supervision; skill fade; etc.?  “Human error” may just be scratching the surface and the starting point for a more thorough investigation.  If the root cause is not identified and addressed, a recurrence can be expected, but may result in a catastrophic outcome.

Cause factor analysis is now being emphasized in the Ammunition and Explosives Safety Program – not with the aim of assigning blame, but as the start of the process to identify effective preventive measures.