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Abstrakty
In the present study, the Eastern Star ferry accident was analyzed via 24Model. 24Model, as an accident causation model based on system thinking, holds that all causations of the accident are hazards and all hazards in the system need to be identified and comprehensively controlled in accident prevention. The result showed that five factors were the main causes of the accident. First, the direct causes: bad weather, the bad condition of the hull and the unsafe acts of the captain. Second, the indirect cause: the lack of safety awareness and safety knowledge of both the captain and the company’s senior management. Third, there were loopholes in safety management system, including the training, supervision and execution of the company. Forth, the root cause: the company didn’t establish a good safety culture. Last, the external causes: the severe market pressure, excessive regulatory authorities with puzzled relations and responsibilities—seriously hindered effective supervision. In order to prevent this kind of accident and to secure shipping system, the shipping companies and the relevant regulatory units should draw lessons from the five factors mentioned above, and take measures to identify and control those hazards.
Czasopismo
Rocznik
Tom
Strony
116--122
Opis fizyczny
Bibliogr. 17 poz., rys., tab.
Twórcy
autor
- School of Resources & Safety Engineering China University of Mining and Technology (Beijing) Beijing 100083 China
- State Key Laboratory of Coal Resources and Safe Mining China University of Mining and Technology (Beijing) Beijing 100083 China
autor
- School of Resources & Safety Engineering China University of Mining and Technology (Beijing) Beijing 100083 China
- State Key Laboratory of Coal Resources and Safe Mining China University of Mining and Technology (Beijing) Beijing 100083 China
autor
- School of Safety & Environmental Engineering, Capital University of Economics & Business, China
autor
- School of Resources & Safety Engineering China University of Mining and Technology (Beijing) Beijing 100083 China
- State Key Laboratory of Coal Resources and Safe Mining China University of Mining and Technology (Beijing) Beijing 100083 China
Bibliografia
- 1. J. Reason, 1990. Human error. Cambridge university press, New York.
- 2. Ö. Uğurlu, E. Köse, U. Yıldırım, et al., 2015. Marine accident analysis for collision and grounding in oil tanker using FTA method. Maritime Policy & Management, 42(2), 163-185.
- 3. M.A.I. Branch, , House C., and Place C., 2004. Bridge watchkeeping safety study. Department for Transportation, Marine Accident Investigation Branch, Southampton.
- 4. J. Ylitalo, 2010. Modelling marine accident frequency. Aalto University, Helsinki.
- 5. P. Checkland, 1981. Systems thinking, systems practice. John Wiley & Sons, New York.
- 6. X. Qian, J. Yu, and R. Dai, 1993. A New Discipline of Science-The Study of Open Complex Giant System and Its Methodology. Journal of Systems Engineering & Electronics, 4(2), 2-12.
- 7. Z.H. Qureshi, 2007. A review of accident modelling approaches for complex socio-technical systems. In: Proceedings of the twelfth Australian workshop on Safety critical systems and software and safety-related programmable systems. Adelaide. pp. 47-59.
- 8. State Council of the PRC investigation team of “Eastern Star” ferry capsized accident, 2015. The investigation report of Eastern Star ferry capsized accident. http://www.chinasafety.gov.cn/newpage/Contents/ Channel_21356/2015/1230/262992/content_262992.htm.
- 9. G. Fu, Lu B., and X. Chen, 2015. Behavior Based Model for Organizational Safety Management. China Safety Science Journal, 15(9), 21-27.
- 10. G. Fu, W. Yin, J. Dong, et al., 2013. Behavior-based accident causation: the “2-4”model and its safety implications in coal mine. Journal of China Coal Society, 38(7), 1123-1129.
- 11. G. Fu, Y. Fan, R. Tong, et al., 2016. A Universal Methodology for the Causation Analysis of Accidents(4th Edition). Journal of Accident Prevention, 2(1), 7-12.
- 12. H.W. Heinrich, D.C. Petersen, and N.R. Roos, 1980. Industrial accident prevention: A safety management approach. 5th ed. McGraw-Hill Companies, New York.
- 13. N. Leveson, 2011. Engineering a safer world: Systems thinking applied to safety. MIT press, Cambridge.
- 14. E. Hollnagel, 2012. FRAM, the functional resonance analysis method: modelling complex socio-technical systems. Ashgate Publishing, Ltd, Farnham.
- 15. International Organization for Standardization, 2016. ISO/DIS 45001:2016(E) Occupational health and safety management systems.
- 16. G. Fu, Y. Dong, S. Zhang, et al., 2013. Further Discussions on Definition of Safety Culture and Its Assessment Indicators. China Safety Science Journal, 23(4), 140-145.
- 17. National Enterprise credit information publicity system. 2017. http://www.chinasafety.gov.cn/newpage/Contents/ Channel_21356/2015/1230/262992/content_262992.htm.
Uwagi
PL
Opracowanie rekordu w ramach umowy 509/P-DUN/2018 ze środków MNiSW przeznaczonych na działalność upowszechniającą naukę (2018).
Typ dokumentu
Bibliografia
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