Engineering Safer Workplace Solutions Rio Tinto Lead Investigator’s Course 8Steps Why the Lead Investigators Course? Rio Tinto identified opportunities to improve process for investigations of major and catastrophic incidents. In many investigations the focus has been on the immediate circumstances of the incident with inadequate considerations given to the cultural and leadership aspects that may have contributed to the incident. As a result, multiple investigations were often carried out. These created delays, additional cost and, inevitably, concerns were raised regarding the investigation process. The 2 day Lead Investigators Course was prepared by InterSafe at the request of Rio Tinto as support training for their TapRooT® analysis methodology. Who is the Course for? The course was designed for General Manager level capability participants who may be called upon to lead a major or catastrophic investigation. The Rio Tinto 24 hour Reporting of major and catastrophic incidents Work Practice is also reviewed and discussed with particular focus on the role of the Lead Investigator. Course notes, case studies, checklists and audit criteria tools are provided to ensure critical issues are more likely to be addressed at each step of the process when real life situations are faced. ™ OF EFFECTIVE INCIDENT INVESTIGATION Why are InterSafe’s Models so Powerful and Effective? Our individual belief systems, or models, dictate our perceptions. We see things not as they are, but as we believe or expect them to be. Our beliefs or models can be either empowering or limiting depending on whether they help or hinder us in achieving our goals. Nowhere is this more evident than in incident investigation, where prejudices, preconceptions and value judgements reign along with limiting beliefs such as ‘most accidents are caused by human error / unsafe acts’. Such models, subconsciously, restrict the flow of information and result in many relevant factors in an incident sequence being missed. InterSafe’s models guide an objective observation of the incident sequence by introducing useful frames of reference which: • • • • are conceptually clear are cohesive and logical are scientific help maximise the identification of relevant factors and, therfore, potential points of control Effective incident investigation can only occur once limiting beliefs are challenged and superseded. Common feedback drawn from course assessments delivered by InterSafe include ‘dynamic and entertaining’, ‘engaging’, ‘eye opening’, ‘useful and practical’, ‘paradigm shifting’. What the Course Covers The 2 day course covers the following models and concepts which underpin effective investigation process. 1. Rio Tinto Work Practice 2. Scientific Process and Incident Investigation Other Services 3. Egocentric vs. Ergonomic model InterSafe is also able to assist with site incident investigations in the following ways: 4. Thinking vs. Feeling model 5. ART-T™ Timeline Model for Incident Sequences • Independent investigation 6. Essential Factors Thinking • Lead Site team 7. Hypothesis forming and testing • Coach / mentor site team leader • Provide process or content expertise 8. Taxonomy and its implication for recommendations • Review incident investigation reports 9. Collective Insights Model for establishing / modifying group performance 10. Organisation model – Policy / System / Procedures / Standards 11. Culture model – Shared values / beliefs / behaviours ep 8 Identify Recommendations / Actions ep 7 Identify TapRooT® Root Causes ep 6 Identify TapRooT® Casual Factors ep 5 Prepare SnapCharT ep 4 Write Incident Description ep 3 Form and Test Hypothesis ep 2 Collect Information / Data ep 1 Scope and Prepare for Investigation St 12. System model – authorised / unauthorised and productive / non-productive St PART B 13. VAACS model for effective recommendations St St Next Steps St If you would like to discuss a Lead Investigator’s Course or how InterSafe could assist you please contact one of our team on: St PART A St St THE INCIDENT +61 7 3895 8111 Who is InterSafe? InterSafe specialises in incident investigation to Engineer Safer Workplace Solutions. InterSafe has assisted our clients in effectively controlling the future through preparation of more than 10,000 comprehensive incident reports (dealing mostly with fatal/permanently disabling occurrences) throughout 60 years of collective experience. This experience has led to a unique way of thinking about, investigating and preventing incidents. InterSafe shares these powerful and effective investigation models and techniques through a range of courses and services. Level 1, 905 Stanley Street East Phone: +61 7 3895 8111 [PO Box 7338] Fax: +61 7 3895 8222 East Brisbane, Qld 4169 Australia [email protected] InterSafe ABN 53 071 971 376 www.intersafe.com.au InterSafe – Lead Investigators Course Flyer - v1a - 2012 or [email protected]