Presented by Heather Jackson.

The webinar presents the results of an analysis of 51 NSW mining incidents that occurred between 2004 and 2019 using published regulatory investigation reports and prosecution summaries. Control failures are examined using the University of Queensland UQR!SK taxonomy that integrates human factors and engineering. The UQR!SK method draws on the International Council on Mining and Metals Critical control management guide. The analysis also tested if pattern failures conformed to Michael Quinlan’s Ten Pathways to Death and Disaster. This work and other sociotechnical system approaches are used to examine other factors outside the direct control of the work health and safety management system.

Participants will gain a broad perspective on incident causation including human and organisational factors in complex systems. The presentation will challenge safety practitioners to extend the Incident Cause Analysis Method (ICAM) and other root cause methods of incident investigation to include operational and strategic decisions. They should also consider the influence of production pressures, commodity prices & profitability on management decisions. The speaker argues that worker errors occur in the context of work demand and worker capacity mismatch. Also work pressures can be linked with management operational and strategic decisions.