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Here is a link to the significant incident report:

http://www.dmp.wa.gov.au/Documents/Safety/MSH_SIR_230.pdf

It seems from the report that the appropriate seat belt was present. Therefore the only applicable action in the “Action required” section is:

Workers should be instructed, through training and inductions, regarding the importance of using the seatbelts provided in vehicles to reduce the impact of potential collisions.” 

In my instant root cause analysis using the Root Cause Tree®, I wonder why there wasn’t a Standards, Policies, and Administrative Controls Not Used Near Root Cause. That would get me to dig more deeply into the Enforcement NI root cause. 

What do you think? Was this a training root cause that needs a training corrective action?

Leave your comments below…