HUMAN FACTORS

 

The Dirty Dozen

The human condition is that we make mistakes. Mistakes are not only common they are universal. People make mistakes because they are people, not because they are deficient in some way. Error and success result from the same mental processes so we cannot experience one without the other. Since aviation is terribly unforgiving of human error, we cannot afford to allow mistakes to “escape” and erode the safety of our system. Briefly we will cover twelve common error preconditions and the error capture methods that may prevent them from having tragic consequences.

Gordon DuPont while working with Transport Canada developed the “The Dirty Dozen” The Dirty Dozen is a poster series highlighting 12 preconditions for unsafe acts. These twelve preconditions are not a comprehensive list. As illustrated by ICAO’s Circular 240, “Investigation of Human Factors in Accidents and Incidents” which lists over 300 such human error precursors. It is necessary openly discuss human error, and those things that influence people to make mistakes.

Take a note of the following 12 preconditions for unsafe acts:

• Lack communication

• Complacency

• Lack of knowledge 

• Distraction

• Lack of teamwork

• Fatigue

• Lack of resources 

• Pressure

• Lack of assertiveness

• stress

• Lack of awareness

• Norms

 

Perhaps more important than the 12 examples of preconditions to unsafe acts is the concept of safety nets designed to reduce the possibility an error will cause a problem. (click on the following PDF file)