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April 8, 2013 | Mark Paradies

Monday Accident & Lessons Learned: Single Human Error Causes Near-Miss

The UK Rail Accident Investigation Branch wrote a report about a crossing guard that was raised just as a train was approaching the crossing. See the report here:

https://assets.publishing.service.gov.uk/media/547c8fc1e5274a428d000145/130311_B012013_Four_Lane_Ends.pdf

The lesson to be learned is not in the report. Rather, it is a question:

Have you evaluated you safety critical systems
with a single safeguards that could fail due to a single human error?

Interesting concept. If you do an evaluation, you many find more than one case where the only thing between your employees and death is one person doing something right every time.

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Root Cause Analysis
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