Getting Serious About Preventing Fatalities & Injuries, Part VI: Best Practices & Conclusions

From the June 2017 Issue of Industrial Safety & Hygiene News.

August 22, 2017

Forward-looking companies ORCHSE has worked with have implemented some of these practices. International Paper’s “It’s About LIFE,” or Life-changing Injury and Fatality Elimination, program has helped the company identify and focus on critical tasks. A LIFE incident analysis conducted over three years identified five focus areas responsible for the majority of FSIs: machine safeguarding (30 percent), falls (27 percent), motorized equipment (17 percent), harmful substances or environments (6 percent), and driver safety (2 percent). The remaining incidents, classified as “other,” consisted primarily of acute trauma linked to materials handling (18 percent). Relying on project teams, International Paper has a data-driven LIFE strategy that focuses on: communicating effectively, engaging stakeholders, making safety a core value, learning from past mistakes, benchmarking best practices, improving training and education, changing the way it measures safety performance, and taking a global approach. ALCOA has implemented a pre-job brief and work assessment so work teams can identify the high-risk task of the day. A high-risk task is defined as one in which an identifiable function of a job or activity has one or more critical steps, which if omitted or performed incorrectly, create the potential for single-point vulnerability that can lead to fatal or life-altering consequences. A pre-task discussion focuses on ensuring each person involved in the task, regardless of his or her experience, is aware of the critical steps and what could go wrong, the potential hazards and error-likely situations along with the procedures that apply and the layers of protection available to them. Most importantly, the discussion provides a means to agree on clear “Stop Work” criteria. 

Best practices

To prevent fatalities and serious injuries, remember these key points:

  • Simply managing routine safety and OSHA recordables can leave a company vulnerable to fatalities and serious injuries.
  • Effectively managing the most serious hazards requires rethinking fundamental S&H concepts that may be barriers to serious injury prevention. This can include how we do risk assessments.
  • Take steps to identify FSI precursor situations – potentially serious hazards imbedded in tasks and processes and associated human and/or organizational factors that could undermine controls.
  • Mistake-proof the critical steps in a process; don’t rely on the worker never to make a mistake.
  • Recognize that people, programs, processes, the work environment, organization, and equipment are all part of a system. Flaws in the system impact the performance of individuals and flaws in individuals impact the system.
  • Integrate HOP factors into the risk assessment process.

3M identifies high-hazard activities at a facility, conducts observations and interviews, identifies critical high-hazard tasks, and evaluates the risk of the task as performed. If the task is determined not to be high-risk, the company simply monitors critical controls. If it is determined to be high-risk (with potential consequences that are life-threatening or life-altering), 3M explores gaps in the layers of protection (LOP), chooses the best LOP intervention option, takes action to reduce risk, and then monitors critical controls.

3M has a core list of higher hazard activities that includes: working around mechanical hazards where guarding is critical; handling toxic, reactive, corrosive, or flammable materials; mobile equipment or vehicle operations; loading and unloading bulk materials (high volume liquids or solids); working on energized systems or under lockout or tag-out procedures; confined space entry or trench/pit excavation; pipe or line opening operations; working at heights; mechanical lifting operations; and use of open flame. It also identifies “red flag” situations that occur in unusual and non-routine work, in non-production activities, where upsets occur, during on-site construction activities, and where sources of high energy are present. A risk assessment and prioritization tool measures the degree of control, frequency of exposure, and consequence severity to determine a risk level score for an activity.


Preventing FSIs requires adopting a new set of assumptions about risk, incident causation, complexity, and the role of human and organizational factors in creating FSI circumstances. Current preventive approaches are not sufficiently protective. ORCHSE’s six-step process for prevention provides guidance to prepare an organization to transition to a risk-based perspective; identify, assess, and control risk; integrate human and organizational performance principles into risk assessment and abatement; and drive continuous improvement. Safety and health professionals will make significant progress toward FSI prevention and save lives by adopting these practices.

 Authored with Dee Woodhull, CIH, CSP and Rosemarie Lally, JD

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