When an incident happens, the goal isn’t just to assign blame — it’s to find out why it happened and prevent it from happening again.
Why It Matters:
Without a proper root cause analysis (RCA), we risk repeating the same mistakes. RCA digs deeper than surface-level reasons to identify what really caused the incident, which helps us develop better safety controls and training.
Key Points:
- Start with the facts. Review reports, photos, witness statements, and timelines.
- Ask “why” repeatedly. Go beyond the obvious: Why was the equipment faulty? Why was the guard removed? Why wasn’t training provided?
- Look for system failures. It’s rarely just human error — poor procedures, communication gaps, or missing safeguards often play a role.
- Involve the crew. Those closest to the work usually understand what really happened.
- Use findings to improve. Update training, procedures, or equipment based on the root cause.
✅ Solving the real problem prevents the next one.
Ask the Crew:
- Have we been involved in any incident investigations?
- What would help us prevent similar incidents on this site?
