An independent review spanning four and a half years was conducted at a major mining operation to assess governance, reporting effectiveness, and critical control efficacy in high-risk activities.  The review analysed 660 recorded incidents, near misses and injuries reported from 2018 to 2023, with deeper scrutiny of 92 SIFp incidents focusing on corporate reporting, critical control effectiveness, and thematic analysis of human, local, and organisational contributing factors.

Results

The key findings highlighted opportunities for improvement in governance, critical control management, incident management system, and people capability. These insights were communicated to crews, operational leaders, executives, and board members to shape the safety improvement strategy. For instance, the analysis revealed that 71 SIFp incidents were "under classified", while 11 non-SIFp incidents received disproportionately high investigation efforts due to inconsistent corporate standards. This inconsistency hindered learning and control enhancement as resources were distracted withlow severity incident investigations.

The review identified 92 incidents with potential for SIF outcomes, particularly in areas like working at heights, motor vehicle use, falling objects, and energy release, where critical control management was inadequate. Consequently, the operation initiated work streams to enhance operational reliability and proactive focus where controls required strenghthening.

Learning was used to inform revising incident classification standards, conducting bowtie analysis for critical control identification, updating risk management protocols, and fostering a culture of incident reporting and learning. This data was used to pinpoint critical control vulnerabilities and sharpen the focus of the verification processes to the test the system and field application of critical controls.

The initiative reduced initial SIF exposure over several years by close to 30% exceeding global benchmarks and more importantly, improving ongoing critical control strategies in the field.

Conclusion

In summary, there are significant benefits in learning from SIFp incidents and the proactive verifiction of critical controls in the field.

Meta Incident Analysis has proven effective in prioritising and enhancing critical control strategies as well as informing a new lead indicator for the operation. This helped to identify opportunities to strengthen critical controls; highlight leadership, management and cultural impacts on field operations and enhance incident reporting and investigation of high severity incidents.

Throughout the analysis period, impactful interventions were implemented, measurably reducing SIFp exposure. The operation continues to work on its commitment to strengthen critical controls and used the MIA proces to provide ongoign assurance.