철도 인적오류 사고분석에 대한 시사점

Abstract

The basic concept of analysis of human error that induced railway accident is that errors are consequences, not causes. But in most cases, it is likely that direct causes of the accident could be concluded as real causes, which make it difficult to find out root causes. Design, training, staffing, culture and condition are general category applied to investigate human error. In order to examine how those approach could help accident analysis, this paper studied accident investigation reports of UK RAIB(Rail Accident Investigation Branch). Rather than consider specific investigation method, we focus investigation result on how to describe causal factors and how to indicate recommendations to prevent similar accident. The reports show that they try to find out causes more in organizational, environmental and job factors, which implies the necessity to improve investigation process of human error accident in Korea.