Hi everyone - several of the papers here discuss the reporting and
human `error' and interaction desing problems.
Workshop on the Investigation and Reporting of Incidents and Accidents
17th-20th July 2002, The Senate Room, University of Glasgow.
Wednesday 17th July
09.30-10.00 Welcome and Introduction, Chris Johnson, University of
10.00-11.00 Keynote: Normal Accidents-Yesterday and Today
Barry Strauch, National Transportation Safety Board, USA.
11.30-13.00 Paper Session 1: Rail Reporting
A Human Factors Analysis of Highway-Rail Grade Crossing Accidents
J. Caird, J.I.Creaser,C.J.Edwards,and R.E.Dewar, University of
Validating the Visualisation of Incident Statistics: A SPAD Case
F. Spiers and C. Johnson, University of Glasgow, UK.
The Application of Why-Because Graphs to Railway Near Misses
J. Braband and B. Brehmke, Siemens AG Transportation Systems,
14:30-15:30 Paper Session 2: Forensic Engineering (1)
Using Accident Data to Forecast Societal Cost within the
Framework of an Axiomatic
Safety-Critical Assessment Process (ASCAP) Simulation
D. E. Brown and J. Stile, University of Virginia, USA.
Learning from Incidents Involving
Electrical/Electronic/Programmable Electronic Safety-
M. Bowell, Technology Division, Health and Safety Executive, UK.
G. Cleland and L. Emmet, Adelard, UK.
16:00-17:00 Paper Session 3: Forensic Engineering (2)
The Role of Natural Language in Accident Investigation and
K. S. Hanks, J.C. Knight, University of Virginia, USA.
C.M. Holloway, NASA Langley Research Center, USA.
Error Classification for Safety Management - Finding the Right
S. Shorrock, Det Norske Veritas (DNV), UK.
Thursday 18th July
09.00-09.30 Poster presentation session
09.30-10.30 Invited talk 2: Re-cycling the past for the future - issues
in the use of incident data
Barry Kirwan, EUROCONTROL.
10.45-11.45 Paper Session 4: Air Traffic Manegement and Safety
Safety Reporting and Aviation Target Levels of Safety
G. M. Graham and S. Kinnersly, AEA Technology Aviation, UK.
A. Joyce, EUROCONTROL Centre Expérimental, France.
`Automatic Safety Monitoring' in Air Traffic Control -
Achievements and Perspectives
A. Joyce EUROCONTROL EUROCONTROL Centre Experimental, France.
Christine Fassert, CETCOPRA (Paris-1 Sorbonne), France.
12.00-13.00 Paper Session 5: Theory and Practice in Air Traffic
Human Error in European Air Traffic Management: From Theory to
A. Isaac, EUROCONTROL, Belgium P. Engelen and M. Polman, ATC,
EPOQUES: Proposing Tools and Methods to Treat ATM Safety
Hélène Gaspard-Boulinc, Centre dEtudes de la navigation Aérienne,
14:30-15:30 Paper Session 6: Aviation Operations
Safety Data Collection in British Airways Flight Operations
M. O'Leary, British Airways Safety Services, UK.
Assessing the Risks of Flight Safety Incident Reports
C. Macrae, N. Pidgeon, University of East Anglia, M. O'Leary,
British Airways, UK.
16:00-17:00 Paper Session 7: Transportation reporting
Incident investigation method for cooperative safety management
Y. Murayama, Maritime Labour Research Institute, Japan.
Y. Yamazaki, Toyama National College of Maritime Technology,
Integrated Safety Investigation Methodology (ISIM) -
Investigation for Risk Mitigation
M. Ayeko, Transportation Safety Board (TSB) of Canada.
Friday 19th July
09.00-09.30 Poster presentation session
09.30-11.00 Paper Session 8: Medical Systems
Reporting Adverse Events in Hospitals
H.B. Andersen, M. Dyrløv Madsen, Risø National Laboratory,
N. Hermann, T. Schiøler, DSI Danish Institute for Health Services
D. Østergaard, Herlev University Hospital, Dept Anaesthesiology,
Development of a Region Wide Process for the Investigation of
J. M. Davies, University of Calgary, and B. Young, Calgary Health
A Survey of Safety Culture in Hospitals Including Staff Attitudes
on Incident Reporting
K. Itoh, Tokyo Institute of Technology, Japan.
T. Abe, Tokyo Medical and Dental University, Japan.
H. B. Andersen, Risø National Laboratory, Denmark.
11.30-13.00 Paper Session 9: Reporting Cultures and Organisational
Learning by Reporting System of Organizational Accidents in Japan
K. Tanaka, University of Electro-Communications Chofu, Japan.
A Study of Incident reporting in Air Traffic Control - Moral
Dilemmas and the Prospects
of a Reporting Culture Based on Professional Ethics
M. Dyrløv Madsen, Risø National Laboratory, Denmark.
Forensic Software Engineering and Stories of Failure
Darren Dalcher, Middlesex University, UK.
14:30-15:30 Paper Session 10: Analytical Tools
A New Model of Accident Causation Based on Control Theory
N. Leveson, MIT, USA.
A Framework for Re-examining Accident Reports to Support
Interaction Design Processes
A. Bruseberg, I. Solodilova, R. Hourizi and P. Johnson,
University of Bath, UK.
16:00-17:00 Closing Keynote: to be confirmed
Saturday, 20th July
This will provide the opportunity for informal discussions about the
issues raised during the workshop. The day will be spent on the Isle of
Arran, off the west Coast of Scotland.
For any further details contact:
Prof. Chris Johnson,
Department of Computer Science, University of Glasgow.