安全事故根源分析图中英文.ppt

人非圣贤 孰能无过 To error is human, to divine is God 调查准备 Preparing Investigation 记录事故的类型和严重程度 Document the type/severity of event 包括所涉及的人、事件、地点和目前的进展 Include the who/what/when/where/how known at the time 成立事故调查小组investigation team establishment 根源分析第1步：收集证据 RCA Step 1:Data collection 收集证据collect evidence 人证、物证、位置和文件People/parts/positions and paper 保护证据preserve evidence 根源分析第2步：找出关键起因 PCA Step 2: identify critical factors 分析收集的信息 Analyze information 重建起因事件链 Causal factor charting 识别事故关键起因 Identify critical causal factors 条分缕析 前车可鉴To make a root cause analysis, to learn lessons from the past 1. 疏忽/缺乏安全意识 1.1位置不当 1.2无意识的人为差错 1.3忽视周围环境 1.4注意力分散 1.5未向他人提供警告 1.6不假思索的常规活动 1.7嬉闹/暴力等不当行为 1.8使用药物或酒精 1.9其它因素 可能的直接原因Possible immediate causes 行为Behaviors 1. 疏忽/缺乏安全意识Inattention/Lack of awareness 1.1位置不当Position in danger 1.2无意识的人为差错Unintentional human error 1.3忽视周围环境Inattention to surroundings 1.4注意力分散distracted by other concerns 1.5未向他人提供警告No warning provided to others 1.6不假思索的常规活动Routine activity without thought 1.7嬉闹/暴力等不当行为 Horseplay/violence or other inappropriate workplace behaviors 1.8使用药物或酒精Use of drugs or alcohol 1.9其它因素Other 2.遵守工作程序Following procedures 2.1例外违规exceptional violation by individual/group/supervisor 2.2个人/班组/主管习惯性违规 routine violation by individual/group/supervisor 2.3个人/班组/主管故意破坏 Acts of sabotage by individual/group/supervisor 2.4无程序可用procedure was not available 2.5不理解程序 Procedure was not understand 2.6采用了错误的程序 Use of improper procedure 2.7其它因素Other 3.工具或设备使用 Use of tools or equipment 3.1设备/车辆使用不当 Improper use of equipment/vehicle 3.2工具使用不当 Improper use of tools 3.3使用有缺陷设备（明知)Use of defective equipment(aware) 3.4使用有缺陷工具（明知） Use of defective tools(aware) 3.5工具、设备或物料放置欠妥 Improper placement of tools, equipment or materials 3.6设备/车辆操作速度欠妥operation of equipment/vehicle at improper speed 3.7对正在运行的设备进行维修 Servicing of equipment