Risk management and the prevention of serious accidents are key tasks in modern industry. Any incident is preceded by a series of potentially dangerous situations and minor flaws. During a session dedicated to modern challenges in HSE, Margarita Anokhina, Director of the Incident Investigation Department at Nornickel, examines one of the toughest but most necessary tools: Cardinal Safety Rules (CSR).
The speaker begins with historical context: attempts to regulate human behavior have existed for millennia, starting with the Code of Hammurabi. However, people continue to break the rules. Why does this happen? The presentation details the main reasons: confidence in impunity (positive-negative experience), insufficient risk analysis, a sense of freedom of choice, and, most importantly, the influence of a "bad example" from experienced employees. In addition, the speaker emphasizes shifting the focus from "human error" to "system failures" — non-compliant behavior is often the result of insufficient barriers.
A cardinal rule is not just an instruction. It is a requirement that personally affects the worker, the violation of which can lead to a fatal injury. A person must clearly understand the consequences of their actions, both physical (risk of death) and administrative.
Using the All-Russian CSR rating as an example, the speaker shows that the top 10 occupational risks in many large companies coincide. The undisputed leader is working at heights. Despite the fact that this rule is obvious and violations are easy to spot, it remains the most frequent source of incidents. The top list also includes moving loads, moving machinery, transport, and electrical current.
The implementation of updated CSRs at Nornickel (transitioning from a long list to six "golden rules") yielded concrete results. The speaker provides statistics: before updating the rules, the share of accidents related to CSRs was 47%. After implementation, it dropped to 33%, then to 14%, 5%, and eventually, the company achieved a zero fatal injury rate for reasons related to CSR violations.
However, the system requires constant adjustment. When reviewing the rules, the working group discussed the possibility of mitigating punishments (warnings, reprimands instead of dismissal). The conclusion was unequivocal: only dismissal. Why is this important? Statistics show that employees with more than 15 years of experience often become malicious violators. If they are forgiven, they will continue to violate, setting a bad example for the youth, which will ultimately lead to new tragedies.