Hazard Observation Cards Methodology as a Near Miss Management Tool

From a Plateau to New Tools: Why Near Misses Matter

Reducing occupational injury rates is a challenge faced by many large companies. Having reached a certain limit through the implementation of integrated HSE management systems, the injury curve often plateaus. In his presentation, Sergey Konovalov, Head of the Industrial Safety and HSE Department at LUKOIL, discusses how to break the deadlock by turning to the base of Heinrich's accident pyramid — working with unsafe acts, conditions, and near misses.

The speaker emphasizes that the traditional reporting system captures only the tip of the iceberg — incidents that have already occurred. However, thousands of precursors remain unnoticed underwater. The goal of the new methodology is to identify and eliminate these potential threats before they lead to real consequences.

Algorithm for Working with Hazard Observation Cards (HOC)

Implementing a near miss reporting system requires a systematic approach. The speaker details a four-step algorithm for working with HOCs implemented in the company:

• Observation and prompt measures: An employee or visitor who notices a hazard must immediately notify the supervisor and, if possible, safely eliminate the threat. Importantly, every employee has the right to stop unsafe work.
• HOC registration: A simple form (where, when, what happened, measures taken) is filled out on a paper blank and dropped into a special box. The data is then transferred to the corporate information system.
• Analysis and corrective actions: Managers assess the risk level, assign responsible persons, and set deadlines for elimination. All HOCs are regularly reviewed at specialized meetings.
• Feedback and lessons learned: Informing the team about identified threats and measures taken maintains a safety dialogue. Issuing "Lessons Learned" bulletins helps replicate experience and prevent similar situations.

Determining Root Causes and Process Automation

If a near miss indicates systemic problems, an investigation is necessary. The speaker shows by example how using the "Five Whys" method and "Bowtie" barrier analysis helps build cause-and-effect relationships and find the true causes of deviations, while avoiding excessive bureaucracy.

To manage the data array, the company developed its own module in the corporate information system. It allows registering HOCs, monitoring the implementation of measures, and generating analytics. Currently, more than 1,500 cards are registered in the system, most of which (80%) record unsafe conditions, providing a clear understanding of areas for improvement.

Staff Motivation and Overcoming Barriers

Implementing a new tool inevitably faces resistance. The main problems are low engagement and fear of responsibility ("fear of being a snitch"). To overcome them, the company uses a comprehensive approach:

• Training: Conducting briefings and targeted workplace training increases employee awareness and teaches them to notice risks.
• Financial incentives: A bonus regulation for active hazard identification has been developed, significantly increasing interest in the process.
• Non-financial motivation: Awarding certificates, presenting souvenirs, and the personal example of managers contribute to forming a positive safety culture.

What you will learn from this webinar:

• How to organize the collection and analysis of near miss data in a large company?
• What methods help determine the root causes of hazardous situations without creating unnecessary bureaucracy?
• How to overcome employees' psychological barriers and motivate them to fill out hazard observation cards?
• What role does automation play in managing the risk identification process?
• How to use lessons learned to prevent real incidents?