Root Cause Analysis Blog

We finished up out course on a sunny mild Spring Friday. But earlier in the week it looked and felt like Winter.

Looking out the window from our classroom at the Ardoe House in Aberdeen.

Class working on first computerized exercise…

Class working on team exercise…

For more information about our 5-Day TapRooT® Advanced Root Cause Analysis Team Leader Training see:

http://www.taproot.com/courses.php?d=2

Malcomb Gresham - one of our TapRooT® Instructors from Risk@Workplces in Australia (see: http://www.workplaces.com.au/events/training_info.asp) sent me the following pictures from one of our clients. Taken during a recent Typhoon, I see a bad day at sea…

For more info see:

http://www.taproot.com/blog/2007/03/csb_to_release_root_cause_anal.html

Hotel space is filling up fast! There are still some rooms available at the Crowne Plaza Riverwalk at the special rate for the TapRooT® Summit.

Remember, it is Fiesta Week in San Antonio during the Summit. Therefore rates are higher and the good deal on the Summit rooms means rooms available are shrinking FAST!
Click here for lodging info…

Click here for Fiesta info…

If you are attending the 2007 IOSH Conference in Telford, UK, on March 27-28, stop by the System Improvements booth at the exhibit and I would be glad to discuss any of the many controversial subjects that we tackle here on this blog, including:

- Best root cause analysis techniques,
- Accidents and their causes,
- How to improve human performance,
- The new TapRooT® Book (coming out this summer),
- Equipment troubleshooting,
- The upcoming TapRooT® Summit,
- What’s wrong with 5-Whys, Cause-and-Effect, and Fault Trees when trying to find the root causes of an accident.

And while you are there, you can pick up your very own “Spin-a-Cause™” - the worlds fastest root cause analysis system!

Or drop in on my talk on Wednesday in Track E - Best Practices for Health & Safety, 14:45-15.15:

“Why the changing world of work needs advanced root cause analysis and a systematic safety improvement programme.”

So please stop by and say hello…

PS: While I’m over in the UK I’ll be teaching 2 root cause analysis courses:

2-Day TapRooT® Incident Investigation and Root Cause Analysis Course in  Manchester, England, on March 29-30.

5-Day TapRooT® Advanced Root Cause Analysis Team Leader Training in Aberdeen, Scotland, on March 19-23.

There’s still space available in both courses and time left to sign up. Hope to see your there!

It’s been almost two years since the March 23, 2005, explosion and fire at the BP Texas City Refinery, but the bad news hasn’t stopped. Continuing bad publicity is just one of the many ignored costs of a major accident.

The most recent bad publicity came from BP’s recently released 2006 Annual Report. BP had several references to the explosion, including: federal investigations (EPA, OSHA, and CSB), the Baker Commission Report, and an ongoing criminal investigation by the US Department of Justice. Newspapers picked up on a paragraph on Page 28 of the Annual Report that revealed that the Justice Department had issued subpoenas to BP for documents and testimony in a grand jury criminal investigation.

Also detailed in the report was pay for high level executives at BP. Again, reporters picked up on the fact that even though financial performance at BP was excellent for the year, outgoing CEO John Browne’s total compensation was cut by almost $2 million dollars (28% according to an AP story in the Houston Chronicle).

The Chemical Safety Board had announced that it will release it’s long awaited investigation root cause analysis report on March 20. This will no doubt mean another round of negative stories.

So what do you need to do to convince your management team to improve safety performance? Perhaps an example of potential criminal investigations and big pay cuts for executives will get their attention. Certainly these are more reasons among the many obvious reasons that companies should do everything in their power to prevent major accidents by using advanced root cause analysis proactively to improve performance before accidents occur.

For more on PROACTIVE use of root cause analysis to prevent accidents click on the button for the schedule of the Proactive Improvement Best Practices Track at the TapRooT® Summit.

Procrastination - the root cause of failure. That’s what you’ll say if you don’t book your hotel room ASAP!

The room block at the San Antonio Crowne Plaza Riverwalk will expire on March 22. After that, room will be difficult to obtain because it is Fiesta Week in San Antonio during the Summit.
So, BOOK YOUR ROOM NOW!!!!

Click here for lodging info…


(Sky Cam of San Antonio from web site)

Board to Convene March 20 Public Meeting in Texas City, Texas, to Release and Vote upon Final Report on BP Refinery Disaster

March 7, 2007 - The U.S. Chemical Safety Board (CSB) announced today that it will convene a public meeting on the evening of Tuesday, March 20, 2007, at the Nessler Center in Texas City, Texas, to release its final investigation report on the explosion at the nearby BP refinery that took 15 lives and injured 180 on March 23, 2005.

The meeting will begin at 6 p.m. central time at the Nessler Center’s Wings of Heritage Room, 2010 5th Avenue North, Texas City, TX 77590, (409) 643-5990.  The Nessler Center is adjacent to the Doyle Convention Center, near city hall.
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“Figures often beguile me,
particularly when I have the arranging of them myself;
in which case the remark attributed to Disraeli
would often apply with justice and force:
‘There are three kinds of lies:  lies, damned lies, and statistics.’”
Mark Twain autobiography, 1904

While the individual man is an insoluble puzzle,
in the aggregate he becomes a mathematical certainty.
You can, for example, never foretell what any one man will be up to,
but you can say with precision what an average number will be up to.
Individuals vary, but percentages remain constant. So says the statistician.
Arthur Conan Doyle

An except for the upcoming revision of the TapRooT® Book…
(Copyright © 2007)

Trending

Many people think they can spot a trend by looking at a bar or line graph. They can’t. Dr. Walter Shewhart’s work at Bell Labs proved that people can’t “eyeball” trends (Economic Control of Quality of Manufactured Product, D. Van Nostrand Company, 1931). If you try to manage by eyeballing trends, you actually make the process worse. This is the first way that trending gets a bad name.

How should trending be used? You should use statistics properly to measure performance, select targets for improvement, and detect significant trends.

How should you target areas for improvement? By using numerical measures of performance based on statistical analysis of either reactive or proactive data based on the measures previously described in this chapter.

How should you measure performance changes and detect significant trends before major accidents, quality problems, or plant upsets occur? By using methods developed for statistical process control to determine which trends are part of normal process variation and which trends are the result of actual significant changes in the system.

Thus, trending goes far beyond common practice of looking at a bar graph and saying, “up is good and down is bad.” This new way to trend can help you prove that performance has significantly improved or taken a turn for the worse. These graphs aren’t just someone’s opinion. This “new” way to trend is based on rules for optimizing performance that have been proven by Shewhart since the 1920’s.

Trending can:

•Use reactive measures to show the actual impact and payback of your improvement programs.
•Use proactive measures of key performance elements to predict where problems might occur so that you can take action before the problems cause major production outages, quality issues, or accidents.
•Use reactive data and show the areas where you will get the most “bang for your buck” when you spend time, money, and effort to improve performance.
•Show you that there aren’t any areas that will provide amazing returns for the effort invested.

You may ask, “If these statistical rules are so good, why haven’t I heard of them and why isn’t my company using them?” The answer is twofold:

1. Most mathematicians don’t understand the simplicity of this trending. They make things much too complex. Too hard. They get lost in p-charts, t-tests, and normal distributions. And they adopt formulas that just don’t work in the real world to predict performance.
2. You may have heard of the techniques but, once again, they seemed too hard. The techniques shared in this chapter are the basis for Statistical Process Control and Six Sigma.

There is one more way that trending gets a bad name. Managers, without statistical training, get frustrated with the unintelligible voodoo analysis of mathematicians. They can’t understand the basis for the trends and they just don’t want to waste their time. So what do they do? They “simplify.” How simple? How about up is good and down is bad. Then every reporting period people scurry around trying to find reasons to justify the normal variation that every process experiences. And we are right back to the bad practices that are proven NOT to work that we started this section discussing.

What if you don’t believe me? Let’s look at an “example” trend…

(To see the graphs - you’ll have to buy the book - they wouldn’t post here)

The figure above shows a graph of safety related incidents per month. Since safety related incidents are bad, up is bad on this graph. And if we used the normal straight-line approximation to “trend” and predict performance, we are at a crisis stage.

What should we do? Hire consultants. Fire the Safety Manager. Conduct a one-day safety stand down. Have the CEO make a video where he emphasizes that safety is a top priority. But wait … what was last month’s top priority? Oh, don’t bother me with details! This is a crisis! We need improvement and we need it fast before something really bad happens. Why? Because safety is out of control! Anybody can see from this graph that bad things are going up at an alarming rate. We must act now and act decisively!

And that’s the way trends are interpreted at thousands of companies and facilities around the world. Unfortunately, the answers we just interpreted from the graph by using a straight-line approximation are wrong. Wrong? How can they be wrong? Look at the figure below. The four points from the figure above are the same as the first four points in the figure below. No real action was being targeted to change safety performance. So the variation we are observing is just part of the random variation that happens all the time. There really was NOT a crisis.

(To see the graphs - you’ll have to buy the book - they wouldn’t post here)

What is wrong with reacting as if there was a crisis when there isn’t one? The attention to safety doesn’t hurt does it? Yes it does! Every child knows the story of the boy who cried: “Wolf!” and the story of Chicken Little crying: “The sky is falling! The sky is falling!”

Look at the results in the false trend example.

1. The Safety Manager lost his job unnecessarily. (Certainly not a positive outcome for the Safety Manager.) The new Safety Manager is more likely to overreact to future trends and cause even more unnecessary emergency changes.
2. Money was wasted hiring consultants and implementing fixes that probably were a waste of time. Since time, money, and effort are scarce resources, they had to be taken away from some other work. This other work (that may have been necessary) was not completed on time. Therefore, an opportunity was lost.
3. Employees become jaded. Why? Because every month (day or week) there’s a new crisis. A new set of priorities. A new video from the CEO. Sooner or later, people lose their sense of urgency. They lose faith in their management. They stop reacting to new initiatives because they know that these will blow over just like the last management fad. They become complacent.

You might think that this is bad. But we’ve seen worse. Much worse. We’ve seen millions of dollars wasted on improvement programs that were scrapped just months after they were completed with NO payback on the investment. We’ve seen hundreds of people transferred or “right-sized” during a crisis transformation program in reaction to imagined trends.

Finally, we’ve seen people stop reacting. Why? Too many crises. People who cried wolf too often. And there wasn’t a way to clearly communicate the lessons that could have been learned from the real trends. A real crisis was at hand but nobody reacted appropriately. They were simply overwhelmed by false crises and didn’t react to the real crisis.

We believe that this was one cause of the BP Texas City Explosion and Fire. There was a data warning management of a process safety problem, but it wasn’t analyzed and presented appropriately. The result? The loss of 15 lives. Turmoil in management. Increased gasoline prices due to even tighter refinery capacity. These fatalities and losses didn’t have to happen. It was a waste of human life. A disaster that could have been avoided. The result of poor measures, poor trending, and reacting to random variation. The result? A real failure that could have been avoided if proper measures and trending had been in place.

So we are convinced … reacting to random variation has a negative impact. But what if you aren’t convinced? Then you still don’t understand the impact of natural variation. And you need to play the marble dropping game developed by Dr. Lloyd S. Nelson and described in Dr. W. Edward Deming’s book, Out of Crisis (MIT, 1982).

Would you like to learn more about trending? Attend the Advanced Trending Techniques Course just prior to the Summit.

Interested in databases of pipeline incidents? See the PHMSA web site:

http://ops.dot.gov/stats/IA98.htm

See what lessons you can learn from others mistakes.

I handpicked 8 special courses for people interested in improving performance (especially TapRooT® users) and scheduled them on Mon/Tues before the 2007 TapRooT® Summit.

PRE-SUMMIT COURSES - San Antonio, TX - April 23-24, 2007

Advanced Trending Techniques

Stopping Human Error

Risk Analysis & Risk Management Best Practices

How to Interview & Gather Evidence

Innovation & Creative Solutions

TapRooT® Incident Investigation & Root Cause Analysis

TapRooT®/Equifactor® Equipment Failure Root Cause Analysis

Getting the Most from Your TapRooT® Software

Pick one to attend.

The cost? Just $995.

Register 3 or more people to save $100 per person.

Save $200 off the course tuition by registering for the Pre-Summit Course & the Summit.

See http://www.taproot.com/courses for course info or click on the specific course links above.

Keynote Speakers
Experts Share Their Secrets of Success

Who will you hear from?

Performance Improvement Lessons from the Cockpit to the Surgery Suite, 
John Nance
Military & Commercial Pilot, Aviation & Medical Safety Expert, & ABC Aviation Safety Analyst


Olympic Success Lessons Learned 
Josh Davis
Olympic Gold Medal Winner


Character First! 
Beverly Chiodo
Award Winning Educator


Creating a Vibrant Safety Culture 
Richard Hawk
Safety Expert


Accident Investigation Lessons from the Courtroom Judge Andrew Napolitano
Judge Andrew Napolitano
New Jersey Supreme Court Justice and Fox News Legal Analyst

Need more info?

See: http://www.taproot.com/summit

If you’ve ever wondered how we started holding the TapRooT® Summit, what the Summit is, or why you might want to attend, read this blog entry…

You might confuse the TapRooT® Summit with the many excellent courses we sponsor each year. After all, what is the difference between a Summit and a course?

Although the Summit shares the TapRooT® name with the courses, the focus of the Summit is quite different. So perhaps a quick Summit history lesson will show you the difference between the Summit and our great root cause analysis courses.

I organized the first Summit in 1993 (to be held in 1994) because, after attending, and even helping organize, many conferences over the years, I saw a need for a conference with a focus on performance improvement, human factors, incident investigation, and the latest improvement technology. A conference that was NOT oriented to research (although I appreciate good research). A meeting oriented toward practical applications that could be implemented at industrial facilities and in service organizations.

Wow! That’s a mouthful!

I also saw that there was MUCH to be gained by sharing information and ideas ACROSS INDUSTRY BOUNDARIES.

Thus this summit could not be held by one professional organization (with only a safety, quality, or equipment focus) or by a society oriented toward one industry (nuclear, refining, healthcare, aviation, pharmaceuticals, semiconductors, utilities, mining, shipping, oil exploration, …). And it had to be international — as most companies were expanding to worldwide operations.

This was a problem.

I had to start from scratch to organize, publicize, and pay for a meeting that needed to be held, but didn’t have an already established audience nor did I have a conference staff.

Some said I was nuts!

But I knew it needed to be done. And nobody else was going to do it. So I become a conference organizer.

So in 1994 we held our first Summit in Gatlinburg, TN (with just 30 attendees).

It was a start. We learned quite a lot.

Feedback was very favorable.

And we decided to do it again.
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These pictures are from Oswego County in Upstate New York.  I’m from Watertown, not too far away.  This is a 2–lane road in relatively open, flat rural country.  I guess this almost qualifies under the “Natural Disaster” selection on the Root Cause Tree®!

EDIT by Ken
I’ve received several emails informing me that these pictures are not, as a matter of fact, Oswego, NY. I apologize for the error. However, I also found it interesting that the 4 emails “insist” that the pictures are actually:

1. The Trans Canada Highway
2. Just outside of Denver, Colorado
3. Near Mt McKinley
4. In the mountains of Utah

Just goes to show how tough it can be to get “just the facts, ma’am!” Still, cool pictures, huh?

Interested in databases of pipeline incidents? See the PHMSA web site:

http://ops.dot.gov/stats/IA98.htm

See what lessons you can learn from others mistakes.

Keynote Speakers
Experts Share Their Secrets of Success

Who will you hear from?

Performance Improvement Lessons from the Cockpit to the Surgery Suite, 
John Nance
Military & Commercial Pilot, Aviation & Medical Safety Expert, & ABC Aviation Safety Analyst


Olympic Success Lessons Learned 
Josh Davis
Olympic Gold Medal Winner


Character First! 
Beverly Chiodo
Award Winning Educator


Creating a Vibrant Safety Culture 
Richard Hawk
Safety Expert


Accident Investigation Lessons from the Courtroom Judge Andrew Napolitano
Judge Andrew Napolitano
New Jersey Supreme Court Justice and Fox News Legal Analyst

Need more info?

See: http://www.taproot.com/summit

April 25, 2007 from 5pm- 8pm

Remember the Alamo!

There were more people from Tennessee than Texas defending the Alamo.  To celebrate the Alamo history during Fiesta Week, we are bringing a taste of Tennessee to the Summit.  How?  With Tennessee’s award winning bluegrass band: Pine Mountain Railroad to play at Wednesday’s reception.

And there’s more . . . a full dinner, refreshments, an exhibit by performance improvement experts, a chance to meet the day’s speakers, and a drawing to win an Apple iPod.

Wear your best “OLD WEST” outfit (or comfortable jeans) . . . there is a prize (iPod Shuffle) for best costume!

The event is FREE with your Summit attendance!  And bring your spouse (no charge).

Don’t miss the fun!

Get registered at www.taproot.com/summit

Don’t let the root cause of not getting a room for the TapRooT® Summit be procrastination!

The room block at the San Antonio Crowne Plaza Riverwalk will expire on March 22.

After that, room will be difficult to obtain because it is Fiesta Week in San Antonio during the Summit.

So, BOOK YOUR ROOM NOW!!!!

Click here for lodging info…


(Sky Cam of San Antonio from web site)

People are busy. Some say they can’t take time to attend the Summit.

Let me explain why you can’t afford not to attend the Summit.

Reason #1: Career Advancement.

Learning & knowledge have never been more important to your career than they are now. With the workplace changing so rapidly and with so many mergers, corporate restructuring, and movement of jobs, knowledge is essential to those that want to be indispensable. You need new, quality ideas to keep your star rising.

Where can you get new ideas … Ideas that are ahead-of-the-pack? At a Summit of performance improvement leaders. Specifically, the TapRooT® Summit.

Reason #2: Learn a Diverse Mixture of Best Practices from Around the World.

Benchmarking is a good idea. Your company needs to know how it is doing among its peers in its industry.

But you need MORE than just best practices from your industry and your profession. To be creative, you need best practices from other industries, professions, and countries. Therefore, industry conferences are too insular and professional conferences trade the same old ideas.

Where can you get new ideas from a diverse group of industry leaders? The Summit of course!

Go to the Summit web site and see the diverse list of past attendees and speakers. The professions represented? Operations, Maintenance, Safety, Quality, Training, Healthcare, IT, Engineering, Consulting, Legal, Human Factors, Aviation, Risk Management, Environmental, Military, + many others … a diverse group interested in performance improvement.

Reason #3: Avoid Burnout.

You need a source of motivation to keep you in the performance improvement fight. The Summit is the place to experience great motivational speakers and re-energize!

Reason #4: Your Next Job Contact.

Once upon a time you landed a good job and stayed there the rest of your life. Now you need a network to keep your options open. And the Summit is a great network of contacts to help you find your next job - or next great employee!

Don’t miss the Summit and miss all that you can learn and apply.

For complete Summit info see: http://www.taproot.com/summit

Summit Golf

Will a new team step up to win the coveted TapRooT® Summit Cup or will Ken Turnbull’s Team return to dominate the tournament?

Part of the TapRooT® Summit in San Antonio is meeting new people and having fun. Spend an afternoon in the Texas sunshine:

• at a great course (Republic Golf Club)
• in a “scramble” (best ball) tournament
• making friends with your teammates
• contributing to your team’s success!

The tournament is a scramble format. Each team member takes their turn and then the team plays from the best shot. Each team turn is a “stroke”. That means that even beginners can contribute to the team effort by having a lucky shot or a good putt. And the competition for the trophy is intense. And you can win individual trophies on particular holes:

  • Longest drive
  • Closest to the pin

Spots in the tournament are limited so sign up for the Summit and register for the tournament soon. For more info see the Golf Tournament link.

There are eight great pre-Summit courses to pick from on April 23-24, 2007, in San Antonio, Texas. They are:

• Getting the Most from Your TapRooT® Software
• TapRooT®/Equifactor® Equipment Failure Root Cause Analysis
• TapRooT® Incident Investigation & Root Cause Analysis
• Advanced Trending Techniques
• Stopping Human Error
• Risk Analysis & Risk Management
• How to Interview & Gather Evidence
• Innovation & Creative Solutions

What one should you attend? That depends on which one will provide you and your company with the most value (ROI). To help you decide, I’ve provided a short course description for each course and some ideas how each course could help you improve performance at your site.

Just click on the “continue” link below to learn more…

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Should you attend the Summit?

Ask yourself these questions:

1. Does your facility/company need to improve in any of these areas:

• incident investigation and root cause analysis
• safety and risk management
• human performance and behavior
• lean, quality, process improvement
• healthcare quality
• equipment reliability and maintenance
• proactive improvement

2. Are you a Certified TapRooT® Instructor that needs to maintain their certification?

3. Do you want to be more motivated to improve performance?

4. Would you like to get a team of people from your facility excited about performance improvement?

5. Do you need knew ideas to take your improvement program to the next level?

6. Do you need to refresh your TapRooT® knowledge?

7. Would you like to go to San Antonio during Fiesta Week?

8. Would you like to meet a bunch of new valuable contacts that can help you improve performance at your facility and advance your career?

9. Are you interested in benchmarking your improvement efforts against other industry leaders?

10. Are you interested in best practices from other industries that can be applied to improve performance in your industry?

If you said yes to any of these questions, you should sign up for the 2007 TapRooT® Summit.

To register, click here.

For more information, click here.

To download the complete Summit video, click here.

For the Summit Schedule, click here.

For video comments from Summit Attendees, click on their name below:

Debbie Baird, Ameren

Gerald Starling, StarMor

Daniel Gaffney, Qantas Airways

Phillip Curtis, Halliburton Scandinavia

Joey Willis, TODCO

Mark Devall, PCS Nitrogen

For Comments About the Summit and the Pre-Summit Training, click on the persons name below (and click on the course name for more course info):

Mike Rodriguez, ConocoPhillips Alaska - Getting the Most from your TapRooT® Software

Mark Cade, Consultant - Advanced Trending Techniques Course

Shannon Burns, Irving Oil Canada - Innovation and Creative Solutions

Bethany Butler, Irving Oil - Advanced Trending Course

Click here for Pre-Summit Course pictures.

Click here for some Summit Pictures…

Click here for some Summit Golf Tournament pictures.

Below is a Safety Flash that was released after a minor incident. Let me know what you think.

What was the root cause of this minor incident?

Was the corrective action adequate?

What else might you have done to improve on this safety flash?

Thanks for your comments and for the person who sent the safety flash to me for this blog.

ENVIRONMENT, HEALTH SAFETY & SECURITY - SAFETY FLASH

October 2006

Subject : Burst Vehicle Tyre (Manufacturer FALKEN )

What Happened:

A tractor and trailer arrived onsite to off load materials. The vehicle and trailer was parked for approx. 3 hrs prior to unloading .

During unloading of shell plate three (3) employees were standing alongside the trailer near the underbed carrying frame of the spare wheel. Without warning the spare wheel burst causing minor scratches to the thighs of the 3 employees.

Description of Product: Vehicle tyre manufactured by FALKEN 12.00R 24- 18PR.156/153 k Radial

Safety Warning : Always check spare wheel and tyre for damage or overinflation.

A check of the tractor and trailer operational tyres revealed all MICHELIN radials were in good condition. Lessons to be Learned: The seperation and release of wire strands and / or parts of the main tyre component at high pressure has the potential to cause damage, puncture of the skin, damage to property.

Recommendations:

1. Daily inspection of vehicle tyres including the spare may seem onerous or over the top to some drivers. The stringent requirements have been developed to safeguard personnel from faulty equipment if they are followed .
2. Ensure equipment is fit for use and conforms to approved standards
3. Vulnerable components guarded to protect others against impact damage, puncture of the skin damage to property.

Here is a Picture from the Knoxville News Sentinel:

See anything wrong?

Of course, standing on the top rung of a ladder is a common unsafe act (or at-risk behavior if you prefer that terminology).

But the other amazing fact was that they printed it with a story on the front page of the paper.

See: http://www.knoxnews.com/kns/local_news/article/0,1406,KNS_347_5217727,00.html for the story.

Many people don’t see unsafe acts even when they are taking pictures of them.

From Reuters:

“Two U.S. pilots said Friday they were not at fault for a collision between their small plane and a Brazilian airliner, which subsequently crashed over the Amazon and killed all 154 people aboard.”

For the complete article see the CNN web site:

http://www.cnn.com/2006/WORLD/americas/12/15/brazil.crash.reut/index.html

NUCLEAR WINTER WONDERLAND

I can’t help but post this song every December.

If you are in the nuclear industry (or just have a good sense of humor), hear the song (mp3 format) by clicking on this link:

http://www.taproot.com/blog/WorkinginNPP.mp3

I don’t know where it originally came from but a nuke industry guy sent it to me by e-mail 3 or 4 years ago.

It brings a whole new meaning to Nuclear Winter!

Happy Holidays to All (especially those that keep the lights and heat on when it’s cold outside)!

Mark

working in a nuclear power plant song

First one tire blows …

Then another …

Hang on for a wild ride!

Any landing you can walk away from is a good landing…

Having a tire blow isn’t lucky … But walking away without a scratch from this near-miss (near-miss to a more serious accident) is lucky. The question in my mind is … Did they do a thorough root cause analysis and learn all they could have learned?

This sequence was recorded by a photographer for AirshowTraveler.com - a great place to visit for military and civilian air show photographs. The pictures were originally published at ARC Air Discussion Forums.

Thanks to Gary Snyder (retired from the Navy and now working at Fluor - and a TapRooT® User) for pointing these great accident/near-miss photos out.

One more question …

Would YOU say this was an accident of a near-miss?

Click on the comment link below to leave your opinion.

Thanks

Mark