Analysis of Accidents Causes in an Auto-Glass Manufacturing Company using the Comprehensive Human Error Analysis Model

To prevent similar accidents with the basis of industrial accidents already occurred in industrial plants, it would be possible only after true causes are grasped. Unfortunately, however, most accident investigation carried out with the basis of legal regulation failed to grasp them so that similar accidents have been repeated without cease. This research aimed to find out differences between results from conventional accident investigation and those from human error analysis, and to draw out effective and practical counter-plans against industrial accidents occurred repeatedly in an autoglass manufacturing company. As for analysis, about 110 accident cases that occurred for last 7 years were collected, and by adopting the Comprehensive Human Error Analysis Technique developed by the previous researchers, not direct causes but basic fundamental causes that might induce workers to human errors were sought. In consequence, the result showed that facility factors or environmental factors such as improper layout, mistakes in engineering design, and malfunction of interlock system were authentic major accident causes as opposed to managerial factors such as personal carelessness or failure to wearing personal protective equipments, and/or improper work methods.