THE INVOLVEMENT OF HUMAN-BEHAVIOR IN OCCUPATIONAL ACCIDENTS - ERRORS IN CONTEXT

The information surrounding the occurrence of all traumatic work-relat ed fatalities in Australia over the years 1982 to 1984 was analyzed. P revious analysis of patterns of accident causation revealed that pre-e xisting poor work practices were the most common precursors of human e rrors precipitating fatalities, and that, overall, this combination of causal factors was the most common one leading to fatalities. The pre sent paper examined further the nature of work practices involved in t hese fatalities and their relationship to subsequent behavioural event s in the accident sequence. The most common work practices were those associated with procedures, either originating from management or indi vidual practices. Examination of the association of particular work pr actices with the occurrence of subsequent human errors revealed that t he origin of the unsafe practice varied for different error types. Ind ividual worker practices, safety equipment and personal protective equ ipment practices were all associated with later skill-based errors. In contrast, management practices were associated with knowledge-based e rrors, while general equipment practices were associated with rule-bas ed errors. These findings provide evidence for the view that aspects o f work organization provide the circumstances in which later events ma y precipitate the accident. Moreover, the data suggest that being able to identify the precursors of critical events, and, in particular, th ose events that are difficult to directly target, can provide a specif ic focus for prevention. Knowledge-based errors can be directly target ed for prevention, whereas for skill-based errors the only avenue for prevention lies in targeting the surrounding circumstances. (C) 1997 E lsevier Science Ltd.