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Identifying Hazards

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On January 28, 1986, NASA launched the space shuttle Challenger from Kennedy Space Centre in Cape Canaveral, Florida. The launch had already been delayed several times. The mission had drawn massive public interest, largely because the crew included a civilian, a New Hampshire schoolteacher named Christa McAuliffe. The night before the launch, NASA held a long teleconference call with engineers who had built the Challenger's solid-fuel rocket motors, Allan McDonald among them. It was unusually cold in Florida - a predicted overnight low of 18F, so McDonald recommended the launch be postponed again. The cold weather, the engineers explained, might damage the rubber O-rings that kept hot gases from escaping the shuttle boosters. The boosters had never been tested below 50F, and the morning forecast indicated temperatures much lower than that.

During the call NASA pushed back against McDonald's decision to postpone. He was surprised. "This was the first time that NASA personnel ever challenged a recommendation that was made that said it was unsafe to fly," he later wrote. "For some strange reason we found ourselves being challenged to prove quantitatively that it would definitely fail, and we couldn't do that."

The launch was officially back on. McDonald was livid, but he had been overruled. NASA asked him to sign off on the decision to launch. McDonald refused; his boss signed instead. The next morning, Challenger took off as scheduled and blew apart in mid-air 73 seconds later, killing everyone on board. The cause, as was later established by a presidential commission, was the failure of O-rings due to the cold weather.

What makes this story remarkable - and even more tragic - is that the people in the know had forecast the exact cause of failure. That's the idea behind a 'premortem', as the psychologist Gary Klein calls it, to find out what might go wrong before it's too late. You gather up everyone connected with a project and have them imagine that it launched and failed miserably. Now they each write down the exact reasons for its failure. Klein has found the premortem can help to flush out the flaws or doubts in a project that no one had been willing to speak aloud.

The above text was taken verbatim from the book “Think like a Freak: How to Think Smarter about Almost Everything,” written by Steven D. Levitt and Stephen J. Dubner.  This story can be related to safety in the workplace in a few ways; before a project during a premortem, and while pausing to identify any potential hazards in the workplace.  At the next big meeting before starting a project, it is important to ask, “What would this project look like if it failed miserably?”  or “What would a serious accident here look like?” 

It just takes just one person to correctly identify the hazard. Although in the story above, McDonald was overruled and tragedy was not averted, the takeaway is clear.  We each have a responsibility to identify hazards and communicate them to the team.  You may be the only one on a project who has the insight to identify a particular hazard.  Make sure you take the time to clearly communicate that to everyone involved. 

To find out how August Mack can help with your safety needs, visit our website here!


Post Date: 2/14/2018

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