A Detailed Investigation on Apparent and Root Causes of Accidents in Manufacturing

This paper introduces the results of the analysis of 118 occupational accidents occurred in Italy between 2002 and 2015, in manufacturing. The aim was to identify apparent and root causes of such events. Apparent causes are derived from the description of the accidents on reports. Results show that the leading apparent cause was the voluntary adoption of an improper procedure, e.g. the bypass of a risk control measure, followed by the improper use of equipment and lack of coordination. The investigation of root causes was difficult because of the lack of information on human factors and other intermediate causes that lead to the occupational accident. A structured methodology that collects data for the identification of the accident root causes is missing. The collection of such data would allow the identification of leading indicators for occupational accidents in manufacturing and, more specifically, for the mechanisms that cause fatal and serious injuries.