Contribution of human factors to incidents in the petroleum refining industry

Human factors consider how effectively and safely personnel interact with processes. It can cover a variety of issues, from facility design to procedures to overall management systems. In order to minimize human factors as potential causes for incidents, the causal relationship of human factors to safety incidents must be understood. An examination of previous incidents and incident investigations can provide valuable insight into the types of human factors that most often contribute to human error and, ultimately, to loss events. The contribution of human factors to previous incidents in the U.S. petroleum refining industy are described in this paper. First, the data collection effort, which resulted in the documentation of over 130 incidents that occurred during the past 8 years, is examined. Next, the analysis approach is discussed, including a description of the characterization scheme used to identify cause-contribution factors with specific incidents. Lastly, the results of the analysis are presented and valuable insights into the most common contributors are discussed.