TBT 11: ROOT CAUSE ANALYSIS HILLS’ ETHOS: IMPROVEMENT ENGAGEMENT PREVENTION ACCOUNTABILITY PROGRESSIVE FRONT FOOT ROLES AND RESPONSIBILITIES HWS – Toolbox.

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Presentation transcript:

TBT 11: ROOT CAUSE ANALYSIS HILLS’ ETHOS: IMPROVEMENT ENGAGEMENT PREVENTION ACCOUNTABILITY PROGRESSIVE FRONT FOOT ROLES AND RESPONSIBILITIES HWS – Toolbox Talk 11 Root Cause Analysis v

TBT 11 ROOT CAUSE ANALYSIS 1.ROOT CAUSE ANALYSIS FOR PROBLEM SOLVING A.Nonconformity B.Accident / Incident / Near-miss / Near-hit C.Process Problems D.Environmental Problems E.Complaints F.Missed Targets/Goals 1 of 9

TBT11 ROOT CAUSE ANALYSIS 2. : HOW TO CARRY OUT INVESTIGATIONS A. Gathering information B. Analysing the information C. Identifying risk control measures D. The action plan and its implementation 2 of 9

3. GATHERING INFORMATION / THE INVESTIGATION: A. The investigation team B. What happened? C. Where and when did it happen? D. Why did it happen? E. Who was involved? 3 of 9 TBT11 ROOT CAUSE ANALYSIS

4 ANALYSING THE INFORMATION: A.Systematic analysis of causes and consequences B.What information is missing? C.Immediate causes D.Root causes 4 of 9

TBT11 ROOT CAUSE ANALYSIS 5. LIKELY RESULTS OF THE ANALYSIS: A.Job factors B.Human factors C.Human failings D.Organisational factors E.Plant and equipment factors 5 of 9

TBT11 ROOT CAUSE ANALYSIS 6. IDENTIFYING RISK CONTROL MEASURES A.Draw up a list of possible control measures B.Evaluate each of the possible control measures C.Prioritise the possible control measures D.Have similar adverse events happen before? E.Can the control measures be applied elsewhere? 6 OF 9

7. THE ACTION PLAN AND ITS IMPLEMENTATION: A.Who is involved? B.SMART objectives C.Risk assessments update D.Safe working procedures update E.Full recording and analysis F.Further investigations 7 of 9 TBT11 ROOT CAUSE ANALYSIS

8. COMMON PROBLEMS IN RCA INVESTIGATIONS: A.Inexperienced investigators B.Defensive/forgetful employees C.Failure to find immediate cause(s) D.Failure to find the root cause(s) E.Unable to find / devise a solution 8 of 9

TBT11 ROOT CAUSE ANALYSIS 9. REVISION 1.Root cause analysis for problem solving 2.How to carry out investigations 3.Gathering information/the investigations 4.Analysing the information 5.Likely results of the analysis 6.Identifying risk control measures 7.The action plan and its implementation 8.Common problems in RCA investigations 9 of 9

TBT 11: ROOT CAUSE ANALYSIS Statistically, waste management and recycling has a very high accident rate Do NOT walk on by! Report accidents, incidents & near-misses! “See it – sort it” Do NOT become a statistic! HILLS’ ETHOS: IMPROVEMENT ENGAGEMENT PREVENTION ACCOUNTABILITY PROGRESSIVE FRONT FOOT ROLES AND RESPONSIBILITIES