osha top fatalities/serious injury and fatality (sif) activityesafetyline.com/eei/conference...
TRANSCRIPT
Gregg Slintak, Consolidated Edison Co.
Lee Boulanger, Par Electrical Contractors, Inc.
OSHA Top Fatalities/Serious
Injury and Fatality (SIF) Activity
2
Severe Injury and Fatality Prevention,
Precursor Implementation
Version: 041217
2
3
Injury Prevention Considerations
• Traditional improvement strategies are based on Heinrich’s Law
• Ratios describe event frequency
• Reductions at base of triangle translate to reductions at top
• Current research demonstrates lack of correlation between low and high severity events
• Reducing less serious incidents may not necessarily reduce SIF event frequency
Fatalities
Severe Injuries
Lost Time Injuries
Medical Treatment
Near Misses
Conditions & Behaviors
3
ConEd Examples Management Tools
• Gas on the fly • Live electrical work • Trenching • Transmission tower work • Crane operations
Standards and Planning • Specs and Procedures • Job Planning • Job Briefing
• Damaged equipment • Backfeed condition • Changing plan on the fly • Infrequent task • Uncontrolled line of fire
• Arc flash event due to no testing
• Dropped load due to damaged winch line
• Fall from roof edge
Performance Expectations • Positive Recognition • Rules We Live By
Breaking the Event Sequence
4
Is this a high- energy job or
task?
Should work
proceed?
What precursors are
present?
CII Precursor Analysis Approach
Identify Precursors
Experiment to Test
Precursors
Validate with Multiple Groups
Simplified Tool
Predicting Severe Events
Note: Material from CII RT-321’s “Using Precursor Analysis to Prevent Low-frequency High-impact Events, Including Fatalities,” August 2016
5
Program Alignment and
Interconnection
•Reference JSA
•Identify additional energy/barriers
•Post-job review
•Feedback
•Reference JSA/JB
•Identify energy/barrier gaps, and opportunities
•Data Platform
•Feedback
•Identify energy and barriers
•Challenge and validate controls
•JSSE results
•Post-job reviews
•Event outcomes
•Close Calls
•Research Findings
Corrective Actions
Job Safety Analysis
Job Briefing Job Site Safety
Exchange
6
Precursors
7
Step 1: Precursor Use in JSSEs
7
Poor Work Planning
Unfamiliar with applicable procedure/specification
Unclear that changes require stop for re-briefing
Job briefing not performed, or low quality
Productivity Safety Stressors
Any safety violations visible
Physically fatigued; <9-hrs sleep in previous 48-hrs
Unusual management or customer focus on job
Shift exceeds 12-hrs
Associated with RWLBs and significant events
Vulnerability to High Energy
High energy hazard not recognized or understood
Accessible high energy hazard not controlled
Deviating from work plan / briefing
Outside Safety Influences
Multiple crews performing work in parallel
Eyes/mind on other than task at hand
Safety Rep. not party to planning or briefing; no visit
Supervisor not party to planning or briefing; no visit
Single person operation in high energy environment
CII
RT3
21
Pre
curs
ors
Key JSSE Factors
Translates
8
Precursors in JSSE System
8
Figure 1: Existing JSSE data collection approach (excerpt) Figure 2: New approach (excerpt)
• Free-form text for comments about given job aspects • Descriptors highlight items of concern (e.g., precursors) for observers
9
Step 2: Precursor Use in Job Briefings
9
Poor Work Planning
Understand applicable procedures/specifications
Will stop for changes to rethink and re-brief
Final questions asked and answered
Productivity Safety Stressors
Any safety violations visible
Rested and physically ready for task demands
No perceptions of unusual emphasis or push
Shift duration <12-hrs; prior shift <16-hrs
--
Vulnerability to High Energy
High energy hazards second-checked
High energy lines of fire understood
Committed to the work plan
Outside Safety Influences
Coordinated with all crews working in parallel
Everyone focused; eyes and mind on task
--
Discussed job and reviewed plan with supervisor
--
CII
RT3
21
Pre
curs
ors
Su
ccess Factors
Translates
Precursors in Job Briefing Forms
10
What we will do
during work:
Specific error
prevention
tools are
identified for
job at hand,
and reviewed.
Precursors
restated as
positives for
final check of
crew dynamic
before briefing
conclusion.
Sample Job Briefing Form, Excerpt
Next Steps Toward Zero Harm
• Reposition high severity injuries for more dedicated focus
• Align existing program elements to leverage precursors
• Build awareness for precursors among workforce
• Identify actionable precursors, specific to utility industry work
• Develop metrics that support the severity-based focus shift
11
Good Catch Program
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•••
ARE PREVENTABLE.
•
•
•
••••••
•
•
•
•
•
•
• GOOD CATCHES WILL BE SUBMITTED THROUGH THE
EMPWR SYSTEM.
• WILL
•
•
•
•
•
•
•
Good Catch Program
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•••
ARE PREVENTABLE.
•
•
•
••••••
•
•
•
•
•
•
• GOOD CATCHES WILL BE SUBMITTED THROUGH THE
EMPWR SYSTEM.
• WILL
•
•
•
•
•
•
•