June 5, 2019
How to Validate Your Incident Investigations Using Job/Process Hazard Analysis Results
David Jones, Director, Process Safety Services, JCL Safety Services, LLC & Jeffrey Ansel, CSP, Senior Safety Specialist, JCL Safety Services, LLC
To prevent incident recurrence, an investigation must be broad enough to identify all the causal factors and deep enough to analyze the root cause(s) for each causal factor. Causal factors are contributors involving deviations in equipment/human performance that, if eliminated, would have either prevented the incident, or reduced its severity. They involve hazardous conditions from missing, inadequately designed, or ineffectively implemented risk controls. Using results from relevant JHAs/PHAs during development of the incident cause and effect tree can help to validate that all causal factors are identified. By analyzing evidence for the incident’s “hazard source” (What?), “hazardous event” (Why?), “hazard zone” (Where?), “hazardous situation” (Who?), and “harm” (When?), the team can identify as relevant causal factors those “hazardous conditions” (How?) associated with each of the above. Examples will be presented for both personal and process safety incidents.