Day 1: Accident Theory
- Why investigate accidents?
- Investigation as part of a Safety Management System
- Accident Causation
- “The Impossible Accident”
- Human Behaviour Model
- Error types: Slips, Lapses, Mistakes and Violations
- When to use Tripod Beta?
- Investigation Management: Process, Terms or Reference, Team
- (Exercises throughout)
Day 2: Fact Finding and Timeline
- Investigation Plan
- Fact Finding: Persons, Positions, Parts and Papers
- Interview: theory, practice and exercises
- Establishing the Timeline/Sequence Time Events Plot (STEP)
- Introduction to BowTieXP/IncidentXP
- Tripod Trios, Controls and Barriers
- (Exercises throughout)
Day 3: Day-to-day operational aspects
- Tripod Beta Core Diagram: Event-Object-Agent
- Causation Path: Immediate Cause, Precondition, Underlying Cause
- Basic Risk Factors
- Case Work
Day 4: Recommendations and Report; Case Work
- Case Work
- Recommendations and Remedial Actions
- The Investigation Report
- Bronze, Silver and Gold accreditation
- Knowledge assessment