000			01399nab a2200181 4500
005			20260520003916.0
008			260224s2009 xxu
100	1		_aMackenzie, Cheryl _940689
245	0	0	_aInvestigating beyond the human machinery _bA closer look at accident causation in high hazard industries
260			_a _b _cmar. 2009
270			_a2009-03-31 ; 2009-03-31
300			_a6 p. ; 84-89
520			_aHuman error is not a cause of an accident - it's a symptom of underlying problems. Attempting to modify operator behavior to prevent human error will not rectify those underlying problems nor will it prevent major catastrophic accidents. This article will provide evidence to support why an organization's safety focus should not be solely on behavior-based safety. It will demonstrate how an equal emphasis and focus needs to be placed on the safety systems of the organization, as these aspects of safety provide a more accurate assessment of a company's true safety state. By taking another look at the US Chemical Safety Board's completed investigations, this article will demonstrate how one must go beyond the actions and decisions of frontline operators to truly understand the causes of any given incident and to safeguard against major accident hazards.
581			_a1
773	0		_tProcess safety progress _g28
942			_cARTICULO
999			_c169399 _d169399