人為失誤辨識技術整合與應用－以化學品鋼瓶更換作業為例

鄭慶民

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人為失誤辨識技術整合與應用－以化學品鋼瓶更換作業為例

Integration and Application of Human Error Identification Techniques on Chemical Cylinder Change Task

鄭慶民 , Masters　　Advisor：黃雪玲　　

英文

人為失誤；人為失誤；人為可靠度分析；失誤偵測；安全管理； human errors ； error modes ； human reliability analysis ； error detection ； safety management

Abstract │ Reference (53) │ Altmetrics

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This paper outlines the human error identification (HEI) techniques currently existent to assess and analyze latent human errors. Even if many formal error identification techniques have existed for years, few have been validated to cover latent human errors analysis in different domains. This study considers lots of possible error modes and influential factors that include external error modes, internal error modes, psychological error mechanisms and performance shaping factors, and integrates a number of execution procedures and frameworks of human error identification techniques, including hierarchical task analysis, task classification, error analysis, consequence analysis, reliability analysis and remedy analysis, to identify the latent human errors and to evaluate the human reliability in a case plant. The case study in this research is the operational process of changing chemical cylinder in the manufactory. In addition, the integrated HEI method is used to assess the operational processes and system reliability. It is concluded that the integrated method and analysis procedure is a valuable aid to develop much safer operational processes and can be used to predict human error rates of critical tasks in the plant.

Reference ( 53 ) 〈TOP〉

Baber, C. & Stanton, N. A. (1996). Human error identification techniques applied to public technology: predictions compared with observed use. Applied Ergonomics 27(2), 119-131.
連結：
Brigette, M. H. & Peter J. P. (2006). The checklist - a tool for error management and performance improvement. Journal of Critical Care, 21, 231- 235.
連結：
Cacciabue, P. C. (2004). Human error risk management for engineering systems: a methodology for design, safety assessment, accident investigation and training. Reliability Engineering and System Safety, 83, 229-240.
連結：
Cacciabue, P. C. (2000). Human factors impact on risk analysis of complex systems. Journal of Hazardous Materials, 71, 101-116.
連結：
Chen, J. R., Tsai, H. Y., Chen, S. K., Pan, H. R., Hu, S. C., Shen, C. C., Kuan, C. M., Lee, Y. C. & Wu, C. C. (2006). Analysis of a Silane Explosion in a Photovoltaic Fabrication Plant. Process Safety Progress, 25(3), 237-244.
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