Near miss reporting system described

Following the previous point, the ideal should be a complete soeio-technical system model of the organisation involved forming the heart of the NMMS. Since such a model will not be readily available, the next best option is to select a suitable model describing individual behaviour in a complex technical environment, as the "information processing part" of the NMMS. This model then determines not only the required input data (taken from the near miss report) but also the methods of analysing and interpreting its results in terms... 

Ail of the insights and suggestions mentioned in this dissertation are primarily based on two major sources an international workshop on near miss reporting, held in Eindhoven in 1989, and a three-year contract research project (1988-1991) to design and implement an actual near miss management system for a chemical plant in Rotterdam, Furthermore, the thesis describes a first step towards validation through a series of discussions with safety managers in the Dutch (chemical process) industry. 

The following document is an example of an organization s near miss incident system standard that describes the organization s commitment to near miss incident reporting and investigation, and also clearly spells out responsibilities. 

The critical incident technique was first described by Flanagan (1954) and was used during World War II to analyze "near-miss incidents." The war time studies of "pilot errors" by Fitts and Jones (1947) are the classic studies using this technique. The technique can be applied in different ways. The most common application is to ask individuals to describe situations involving errors made by themselves or their colleagues. Another, more systematic approach is to get them to fill in reports on critical incidents on a weekly basis. One recent development of the technique has been used in the aviation world, to solicit reports from aircraft crews in an anonjmrous or confidential way, on incidents in aircraft operations. Such data collection systems will be discussed more thoroughly in Chapter 6. 

Although the system is not specifically mentioned in the overall safety and health policy, in most cases, its function and responsibilities are spelled out in a safety management standard on near miss incident reporting, which is a stand-alone document. A safety standard is defined as a measurable management performance. Each element of the safety management system should have a written standard that describes the actions, duties, goals, objectives, and responsibilities for each element. 

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