Lessons learned from occurrences involving procedures at Los Alamos National Laboratory in 1994

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Description

This study used the Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS) data to investigate occurrences reported during one year at Los Alamos National Laboratory (LANL). ORPS provides a centralized database and computerized support for the Collection, distribution, updating, analysis, and validation of information in occurrence reports about abnormal events related to facility operation. Human factors causes for occurrences are not always defined in ORPS. Content analysis of narrative data revealed that 33% of all LANL 1994 adverse operational events have human factors causes related to procedures. Procedure-caused occurrences that resulted in injury to workers, damage to facilities ... continued below

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6 p.

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Frostenson, C.K. July 1, 1995.

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Description

This study used the Department of Energy (DOE) Occurrence Reporting and Processing System (ORPS) data to investigate occurrences reported during one year at Los Alamos National Laboratory (LANL). ORPS provides a centralized database and computerized support for the Collection, distribution, updating, analysis, and validation of information in occurrence reports about abnormal events related to facility operation. Human factors causes for occurrences are not always defined in ORPS. Content analysis of narrative data revealed that 33% of all LANL 1994 adverse operational events have human factors causes related to procedures. Procedure-caused occurrences that resulted in injury to workers, damage to facilities or equipment, or a near-miss are analyzed.

Physical Description

6 p.

Notes

OSTI as DE95015301

Source

  • Human Factors and Ergonomics Society meeting, San Diego, CA (United States), 9-13 Oct 1995

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  • Other: DE95015301
  • Report No.: LA-UR--95-2084
  • Report No.: CONF-951092--3
  • Grant Number: W-7405-ENG-36
  • Office of Scientific & Technical Information Report Number: 104948
  • Archival Resource Key: ark:/67531/metadc619818

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Office of Scientific & Technical Information Technical Reports

Reports, articles and other documents harvested from the Office of Scientific and Technical Information.

Office of Scientific and Technical Information (OSTI) is the Department of Energy (DOE) office that collects, preserves, and disseminates DOE-sponsored research and development (R&D) results that are the outcomes of R&D projects or other funded activities at DOE labs and facilities nationwide and grantees at universities and other institutions.

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  • July 1, 1995

Added to The UNT Digital Library

  • June 16, 2015, 7:43 a.m.

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  • Feb. 25, 2016, 8:18 p.m.

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Frostenson, C.K. Lessons learned from occurrences involving procedures at Los Alamos National Laboratory in 1994, article, July 1, 1995; New Mexico. (digital.library.unt.edu/ark:/67531/metadc619818/: accessed November 22, 2017), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.