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Sample Human Factors Checklist Incident Investigation Guideline Investigator Name: Event Assessed: Date of Assessment:

Did the incident involve a human error related to...? (See Chapter 6) Inadvertent Operation Of electric switch, or control device Access too difficult Access too easy allowing for accidental activation Not clearly labeled - ambiguous Arranged such that errors are more likely Error in Executing Procedure Written procedure was not appropriate Procedure was not available System physical changes not incorporated into procedure New method or sequence not used Original procedure overlooked a hazard Original procedure overlooked a precaution Original procedure was incomplete, overlooked a step As written, the desired action is not clearly described Consequences of safety deviations not included Responsibilities of tasks/assignments are unclear Written procedure not understood Original training inadequate and/or no verification of understanding Refresher training not done Written procedure no longer matches the actual actions in the field Written procedure does not match physical equipment or control philosophy Written procedure does not match verbal instructions and/or company current philosophy Procedure correct, but not followed this time Inconsistent enforcement Worker knowingly deviated from SOP In a hurry Perceived that the action he took was actually more appropriate than what written SOP states Temporary emotional state Temporary physical state Response to peer pressure Response to perceived supervisor/management expectations Following supervisors instructions Communications breakdown