Conduct an Effective Incident Investigation

Readers who were listening to the radio or watching television on the morning of February 1, 2003, will remember the loss of the Space Shuttle Columbia over Texas. Within an hour of losing contact with the Columbia, NASA's Mission Control declared a "contingency" to ensure that all mission data were preserved. This was the start of NASA's incident investigation procedure. Information that can reveal the root cause of an incident resides in many places - within the plant or process unit, and in control rooms, offices and witnesses' minds. This paper will review how to find the data and conduct effective Witness interviews.


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