Can Human Error Be Eliminated or Only Minimized in Energized Electrical Inspections?
In our last blog titled Can You Explain the New Safety Regulations from NFPA 70E 2018 to Your Team?, we learned that, for the first time, NFPA states that human error must now be considered as part of the Risk Assessment Procedure (RAP). Can human error be eliminated or only minimized in electrical inspections? Let’s find out!
Workplace electrical accidents such as shock, electrocution, arc flash and arc blast, claim hundreds of lives and cause thousands of burn injuries each year In the United States. In the 2018 edition of NFPA 70E, a guideline was added that human error must now be considered as part of the RAP and must address the potential for human error and its negative consequences on people, processes, the work environment and equipment. The NFPA 70 E document includes a helpful segment titled Informative Annex Q which is not part of the requirements but provides information on what to consider when evaluating the RAP as it pertains to human error and offers tools for incorporation into the RAP to minimize the occurrence of human error.
Studies have reported that human error is often the root cause of incidents in high-risk industries. In the last blog, we learned about the Hierarchy of Controls established by NFPA 70E to reduce the likelihood of an incident occurring or to prevent/mitigate the severity of consequence should an incident occur. No control is infallible – therefore, human error most likely can only be minimized but not eliminated in every situation.
Information Annex Q defines Error Precursors as situations where the demands of the task or the environment the task is performed in exceed the capabilities of the individual or the limitations of human nature. There are four types of error precursors:
1. Task demands: when specific mental, physical or team requirements to perform a task either exceed the capabilities or challenge the limitations of the individual doing the task
2. Work environment: describes influences of the workplace, the organization or cultural conditions that affect an individual’s performance
3. Individual capabilities: when an employee’s mental, physical and emotional characteristics do not match the demands of the task
4. Human nature: when a person’s traits, disposition or limitations common to all people cause an individual to err under unfavorable conditions
Once error precursors are recognized, an organization can review their procedures to determine what precautions or necessary steps can be implemented to reduce the occurrence of incidents caused by human error.
Human Performance Tools
Some helpful suggestions in Informative Annex Q are called Human Performance Tools that could help reduce the likelihood of error when applied to error precursors. Incorporation of some or all of these tools into an organization’s processes and procedures could result in best practice work and help minimize human error.
1. Job Planning/Pre-job Briefing: A job plan along with briefings helps employees focus on the task, the performance of the task and their role in executing the task. Critical steps of the task need to be explained in detail along with the risk and consequences should human error occur. Contingency plans should include steps to prevent or recover from an error.
2. Job Site Review: A physical viewing of the job site with employees and pointing out the hazards and barriers could be performed before initiating the job.
3. Post-Job Review: This is a perfect opportunity for employees and managers to share feedback and discuss lessons learned making future jobs safer or less risky. This review could also provide as a learning tool for new or less experienced employees.
4. Procedures: Using a written step wise procedure to complete a task and having the employee read and understand the purpose, scope and intent of the task will prepare the employee for the work and hopefully reduce the risk of human error.
5. Self-Check: STAR is a great self-check tool and stands for – STOP, THINK, ACT and REVIEW. Using this approach before, during and after a task helps keep the employee focused on the work at hand and hopefully increases their awareness of any hazards associated with the task.
6. Three-Way Communication: If applicable, this is a verbal issuance of a command from a sender to a receiver followed by the receiver repeating the command back to the sender confirming accuracy of the message.
7. Stop When Unsure: Enables an employee to stop working on a task if they are unable to understand a procedure or if something unexpected occurs. It also can be used if the employee has a gut-feeling that something is not right.
8. Flagging or Blocking Tools: Marking or labeling a piece of equipment to properly identify it ensures that the actual piece of equipment can be visually identified by employees. This is important if there are many pieces of equipment in the space or multiple pieces of equipment that are different but may look alike. Blocking tools are ways of physically preventing access to an area or piece of equipment. Examples of blocking tools could be hinges, switches, barricades, fences, etc.
NFPA 70E is the “work code” that defines how personnel should work on electrical equipment safely. Workplace culture is controlled by the management team. A management team that embraces procedures that help prevent errors, values employee safety, encourages open communication among all employees and incorporates human performance tools will cultivate a safer work environment.