Objective:

The course will describe failure and investigations principles utilising the tools and 5 whys when applying their root causes. The course also provides an insight into Risk Assessment is included as the basis of prevention. Methods of fact finding the processes and procedures and interviewing as well as the final report of conclusion will be discussed.

Day 1- Introduction to RCFA/RCA

• Why investigate Accidents& Incidents
  • Objective of investigations
  • Barriers to investigations

• Identifying the reasons for failure of the process equipment
  • Equipments
  • Devices
  • Machines
  • Human errors

• The investigation team
  • Terms of reference
  • Single person
  • Team
  • Team composition
  • Forming objectives and report deadlines

Day 2- Making the necessary analysis and identify the root cause of the incident

• TPM and Predictive Maintenance Techniques
  • Use different techniques of root cause analysis
  • Fish Bone Analysis Techniques
  • 5 Questions Analysis and Conclusions
  • Work in a group (team work) in order to achieve the required goals
  • Report the conclusion

Day 3- Investigative Procedures

• Equipment
• Records – training, maintenance, operating procedures, permits
• Computer data
• Pictures
• Maps , drawings
• Conducting interviews
  • What questions
  • Where to interview
  • Recording the interview
  • Re- enactment

Day 4- Reporting  Procedures

• The Background
• The accident or incident documentation
• The causes
• Corrective action
• Review of findings
• Compiling and presenting findings

Day 5- CMMS and recommended Root Cause Systems

• Case studies
• Discussions & Video ( Piper Alpha)
• Exercises
• Course Evaluation
• Course summary