ICTD International Centre for Training and Development
Incident and Accident Investigation: Root Cause Analysis
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About the course
Many organizations fail to learn from their mistakes and near misses, some organizations even fail to learn from their accidents. Often, one can see the same accidents happening over and over again. There are many reasons why organizations do not learn to prevent the recurrence of accidents. When an accident occurs, it is important that it be investigated thoroughly. The results of a comprehensive accident report can help organizations pinpoint the cause of the accident. This information can then be used to prevent future accidents, which is the primary purpose of accident investigation.
This course teaches how to lead investigations and root cause analyses using various techniques such as Fault Tree Analysis and Root Cause Charts. This is a “How To" course designed to teach skills.
Upon successful completion of this course, the delegates will be able to:
- Monitor and understand the regulatory requirements for incident investigations
- Develop and implement a structured program designed for learning from incidents
- Train others to recognize and report incidents that includes planning for trending of data
- Initiate and conduct an investigation
- Establish an effective team quickly
- Apply methods for collecting different types of data including effective interviewing skills
- Apply causal factor and root cause analysis for investigating process and non-process incident
- Develop appropriate recommendations to address root causes at various levels to avoid future incidents
- Design structure reports via actual industry examples and workshops, learn key points and practice new skills
### Day 1
Traditional Approach to Accident Prevention
- Why we prevent accidents?
- Major accident history
- Single factor theory
- Energy theory
- Multiple factor theory
- Domino theory
- Modern causation model
### Day 2
- Unsafe Acts
- Unsafe Conditions (Environmental)
- Unsafe Personal Factors
Accident Prevention Programme
- Principles of the accident prevention process success
- Key elements of an accident prevention program
- Principles of risk management for accident prevention program
### Day 3
- Why investigate?
- What to investigate?
- Who investigates?
- When to investigate?
- Phases in the investigation process
Root Causes Analysis
- What is RCA?
- Why do an RCA
- Where did it come from?
- RCA model
- When is an RCA done?
- Why is an RCA important?
- When not to do an RCA?
How RCA's Work
- Key RCA roles
- NORMS-based analysis of information
- Development of corrective and preventive actions
- Review findings, assess, and implement actions
- Writing a Good Report and lessons to be learned
- Action plan and follow up
A variety of methodologies will be used during the course that includes:
- (30%) Based on Case Studies
- (30%) Techniques
- (30%) Role Play
- (10%) Concepts
- Pre-test and Post-test
- Variety of Learning Methods
- Case Studies and Self Questionaires
- Group Work
Who should attend
This course is intended for everyone involved in the incident and accident investigation and root cause analysis including the managers, technicians, supervisors, engineers, safety professionals and operators.