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Supporting Site Investigation Team

May 8, 2020

Chemical plant


The issue: The Keil Centre was asked to deploy human factors specialists to assist in the investigation of a serious incident.​

The approach: The Keil Centre worked as part of the investigation team and conducted human factors analyses on a number of behaviours involved in the incident. Witness interviews, physical evidence, photographs and management testimony were all used in combination with our Human Factors Analysis Tools (HFAT®) to help determine why people behaved the way that they did.

The outcome: The Keil Centre’s recommendations for addressing human error and non-compliance were incorporated into the investigation report. We also made observations on the maturity of the safety culture at this site.​

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