Research to Determine the Contribution of System Factors in the Occurrence of Underground Injury Accidents

摘要

A systems approach to accident investigation was applied to 338 underground mining accidents. A taxonomic model of contributing factors in accident causation was developed, and expert raters assessed the degree to which each factor played a role in each accident case. The model contained 10 factors. The report contains a literature review on the analysis and classification of human error, including the role of human error in accidents. Results indicated that 88% of the cases involved more than one causal factor. Injured employee perceptual-cognitive-motor error was involved, to some degree, in 93% of the cases and when involved, averaged about 33 (of 100) points of causality. The factor was considered a primary causal factor in almost 50% of the cases and a secondary causal factor in another 24%. Management was the second most important causal factor. It was considered a primary factor in 22% of the cases and a secondary factor in another 12%. Recommendations are presented and discussed.