TapRooTŪ Friends & Experts e-Newsletter
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International Edition
July 20, 2010
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In This Issue
Investigations and Accidents/Lessons Learned
Certified TapRooTŪ Instructors: Maintain Your Certification
Need an Investigator?
Career Development: Employment Opportunities for Candidates with Root Cause Analysis Training
Wisdom Quote
2010 Summit News: Don't Miss These Weekly Updates!
TapRooTŪ Around the World
Special 2-Day Courses! Summit Discounts! Wow!
Register for a TapRooTŪ Course
J.O.K.E. of the Week
Editor's Note: Win an iPad!
Connect With Us ...
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Find us on Facebook

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TapRooTŪ Root Cause Analysis Users and Friend Group (On LinkedIn)

Join Our Mailing List!
President's Question
mark1Dear Readers,

This week I have two questions for you.

The first question:

With all the investigations done so far what can we learn from the BP Deepwater Horizon accident?

To get an overview of all the information that is publicly available, I suggest reviewing the links at:

http://www.taproot.com/wordpress/2010/07/12/monday-accident-lessons-learned-bptransocean-deepwater-horizon-explosion-spill/

and then leaving your comments there.

The second question goes back to an issue we first raised in June ... the qualifications of the President's Independent Commission that is charged with investigating the BP Deepwater Horizon well blowout, explosion, and spill.

The President has requested $15 million to complete this independent investigation, so one would hope that the money is spent wisely to understand the true root causes of the accident and to plot a path forward that could prevent future accidents of this type. But the qualifications of the Commission members could make an independent observer wonder:

Are they qualified to investigate the accident and recommend actions to improve deepwater drilling? Or do they come to the game with an agenda - to stop offshore oil drilling?

A recent article in the Wall Street Journal (WSJ) once again pointed out the biases and weak qualifications of the Commission members. Then the new Executive Director of the Commission, attorney Richard Lazarus, wrote a letter to the editor criticizing the WSJ's article, saying that it "...borders on the irresponsible." He also said: "This is no time for misdirected attacks that promote an 'us against them' mentality." He pointed out that the Commission had hired a consultant, Richard Sears, with an oil industry background (he was a VP at Shell) and implied that this would make their findings fair and impartial.

Therefore, I thought it was once again time to dig out some biographies and see where Mr. Lazarus and Sears were coming from. For the details, see:

http://www.taproot.com/wordpress/2010/07/15/wall-street-journal-takes-up-qualifications-of-the-presidents-independent-commission-to-investigate-the-bp-deepwater-horizon-accident/

and leave your comment if this has changed your opinion about the qualifications of the President's Independent Commission.

That's all the questions for this week.

Thanks for your efforts to keep your companies accident free.

Best regards,

Mark

Mark Paradies
President
System Improvements, Inc.

http://www.taproot.com

P.S. (Read the Editor's Note at the end of this article to learn how to have a chance to win an iPad and share best practices at your facility!)
Investigations and Accidents/Lessons Learned
Union Calls for Root Cause Analysis of Fatal Accident in Guyana (Read More).

How Many Accidents Before a Corrective Action is Needed? 
A road in Nevada had a truck "run away" in 1990. The runaway ramp failed to stop it. No corrective actions were taken.
Now a similar accident happens with a bigger truck and there's more damage (Read more).

Skimmers Finally Approved
(View link).

NTSB Press Release:  Dr. Earl F. Weener Sworn in as NTSB Member
(Read release).

Dr. Rafael Moure-Eraso Confirmed and Appointed as New Chairman and Mark Griffon as Board Member of the U.S. Chemical Safety Board
(Read CSB Press Release).

Link to the Executive Order that Establishes the National Commission on the BP Deepwater Horizon Oil Spill and Offshore Drilling (View link).

Columnist Laura Parker Comments on Multiple Deepwater Horizon Investigations:  Laura Parker, an independent columnist, has written an interesting article about the problems with multiple investigations of the BP Deepwater Horizon accident (View link).

CBS News Reports: "BP's Disaster: No Surprise to Folks in the Know" (Read more).

The Wall Street Journal Reports: "Safety and Cost Drives Clashed As CEO Hayward Remade BP" (View link).

BP Investigation Presentation from the Deepwater Horizon Accident:  Here's a PDF of the preliminary BP Investigation downloaded from the House of Representatives Energy and Commerce web site.  Review the slides and see what you think (Review slides).

BP Deepwater Horizon Fault Tree:  A TapRooTŪ Instructor forwarded this to me. What do you think? Does this add to your knowledge of the accident? (Read more).


thumbsupYour opinion counts! Leave your comments to the articles above on our weblog, and when you find that one is particularly helpful, press the "thumbs up" icon so we have a better idea of what information is relevant to you for future e-Newsletters.  Questions?  Contact the Editor at editor@taproot.com.
Certified TapRooTŪ Instructors: Maintain Your Certification
What does it take to maintain your TapRooTŪ Instructor certification? Every two years you must attend the TapRooTŪ Summit and one of the pre-Summit Courses.

Why?

Because instructors need to understand the latest improvements in TapRooTŪ and not let their improvement skills rust away. TapRooTŪ Instructors are training the leaders of performance improvement in their companies. They need to continually sharpen their skills. After all, Capt. William Rodriguez said:

If you're not peddling, you're going downhill.

(Read more.)
Need an Investigator?
MhorvanAlan Smith and Mhorvan Sherret are retired Senior Detectives located in Scotland. They are also Certified TapRooTŪ Instructors. That makes a great combination if you need unbiased help facilitating a difficult investigation. Mhorvan and Alan are close by for any investigation in Europe & the Middle-East. But they will travel anywhere you need them around the world.


Need someone closer to your site? We have excellent TapRooTŪ Facilitators in:

Africa
Australia
Brazil
Canada
Columbia
Korea
Mexico
and the United States

To get help fast, call 001-865-539-2139. Or e-mail info@taproot.com.
Career Development
Employment Opportunities for Candidates with Root Cause Analysis Training

Bethesda MD - United BioSource Corporation - Director, Quality Assurance - Needs Root Cause Analysis Skills (View opening.)

North Georgia - Southern Company - Senior Maintenance Specialist - Participates in Root Cause Analysis (View opening).

Goldstrike, NV - Barrick - Health and Safety Training Coordinator - Ensures people are trained in TapRooTŪ incident investigation and root cause analysis system (View opening).

Mahwah, NJ - Stryker Orthopaedics - Sr Reliability Engineer - Needs Root Cause Analysis Experience (View opening).

P.S. Thinking about registering for a course to add to your personal resume?  Our worldwide calendar of public courses can be found at:  http://www.taproot.com/courses.php
Wisdom Quote

If I had eight hours to chop down a tree, I'd spend six hours sharpening my ax.
 ~ Abraham Lincoln


2010 TapRooTŪ Summit News
Tie StringDates to Remember

TapRooTŪ Summit:  October 27-29, 2010
Special 2-Day PreSummit Courses:  October 25-26, 2010
Live Music/Costume Party:  October 27, 2010
TapRooTŪ 7th Annual Scramble Charity Golf Tournament:  October 29, 2010

The Summit Hotel and Host City are:
The Westin Riverwalk, San Antonio, Texas
Learn more:  http://www.taproot.com/summit.php

Summit

The Summit is just three months away!  Don't miss the important weekly updates in this e-Newsletter.  Check out the following "2010 Summit News" articles in our recently archived e-Newsletters to catch up:

Why We Chose San Antonio as Host City

Which Track is Right for You

Planning your Schedule:  Special Topics NEW This Year!

TapRooTŪ Around the World

Saudi

Advanced Root Cause Analysis Training in Riyadh, Saudi Arabia
(View photos here and here.)
Special 2-Day Courses!  Summit Discounts!  Wow!
Many of these exclusive courses are only offered once this year!

October 25 and 26, 2010 mark the dates for our special 2-Day Courses!  This year these exclusive courses taught by our global instructors will be held in San Antonio, Texas.  Schedule for the TapRooTŪ Summit immediately following a special 2-day course, and save $200 on your registration (Multi-attendee discounts:  3 or more people who register for a special 2-Day Course together save $100 each.  3 or more people who register for the Summit and Special 2-Day Course together save $400 each)!

Choose from this list of Special 2-day Pre-Summit Courses:

A Police Enquiry into a Death in the Work Place - Corporate Responsibility

Improving Your Organization's Safety Culture

2-Day TapRooTŪ Incident Investigation & Root Cause Analysis Course

(Spanish) 2-Day TapRooTŪ Incident Investigation & Root Cause Analysis Course 

Special 2-Day Equifactor Equipment Troubleshooting and Root Cause Analysis Course

Advanced Trending Techniques

Advanced TapRooTŪ Techniques

How to Interview & Gather Evidence

Stopping Human Error

Risk Analysis and Management Best Practices

Hazard Recognition Best Practices

Getting the Most from Your TapRooTŪ Software

LEARN MORE on our course page:  http://www.taproot.com/courses.php

Limited space is available! 

REGISTER TODAY!
Register for a TapRooTŪ Course

PUBLIC 2-DAY TAPROOTŪ INCIDENT INVESTIGATION
AND ROOT CAUSE ANALYSIS COURSE SCHEDULE (Outside of North America)
(View Course Description
)

AUSTRALIA, Adelaide:  July 26-27

AUSTRALIA, Brisbane:  September 22-23

AUSTRALIA, Karratha:  October 4-5

AUSTRALIA, Mackay:  August 16-17

AUSTRALIA, Melbourne:  September 20-21

AUSTRALIA, Perth: August 9-10 and September 6-7 and September 9-10 and October 7-8

AUSTRALIA, Singleton:  July 28-29 and October 7-8

AUSTRALIA, Sydney:  August 5-6 and September 20-21

BRAZIL, Sao Paulo:  August 4-5

ENGLAND, Birmingham:  October 13-14

INDONESIA, Balikpapan:  October 13-14

INDONESIA, Batam: September 2-3

MALAYSIA, Kuala Lumpur:  August 9-10 and September 29-30

NEW ZEALAND, Christchurch:  August 19-20

SINGAPORE, Singapore:  August 4-5 and August 12-13


PUBLIC 5-DAY TAPROOTŪ ADVANCED ROOT CAUSE ANALYSIS TEAM LEADER TRAINING SCHEDULE (Outside of North America)
(View Course Description)


SOUTH AFRICA, Johannesburg:  August 23-27

AUSTRALIA,
Brisbane:  August 16-20 and October 18-22

AUSTRALIA, Perth:  August 23-27

AUSTRALIA, Singleton:  August 23-27

CHINA, Hong Kong:  September 6-10

MEXICO, Monterrey:  September 27-October 1

NEW ZEALAND, New Plymouth:  July 29-August 2

SCOTLAND, Aberdeen:  September 20-24


View our worldwide calendar of courses at:

http://www.taproot.com/courses.php


J.O.K.E. of the Week
laugh
Editor's Note:  Win an iPod Touch!
Dear Readers,

Starting today, we are having a TapRooTŪ Best Practice Contest!  Submit your TapRooTŪ
Success Stories to me at the e-mail address below (please type "Best Practice Submission" in the subject line) for a chance to win an iPad.

iPad

The contest will run six months (deadline:  January 27, 2011, 6:00 p.m.).  All entries will be shared on the Root Cause Analysis blog as they are received along with the name of the submitter.  Readers can vote for the Best Practices Success Stories that are most useful to them by simply clicking the "Like" button.  In the event of a tie at deadline, the in house instructors at System Improvements will select the winner by vote.

Please submit your Best Practice in a Challenge/Actions/Results format.  Here are some examples:

Ciba Vision

Canyon Fuel Company

Rohm & Hass

Intel

Enter as many Best Practice Success Stories as you like.  Don't forget -- the upcoming TapRooTŪ Summit is all about best practices, so be sure to enter the ideas you learn at the Summit and implement at your facility!

Best regards,

Barb Phillips

Barbara Phillips
Editor
System Improvements, Inc.
editor@taproot.com
865.539.2139
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The opinions and information contained in this newsletter are provided in the spirit of cooperation
and continued learning. They do not represent any corporation's views. Use the information to help you form your opinions but all risk based on your use of this information is assumed by you and your company.Please feel free to pass this e-Newsletter along to other individuals interested in TapRooTŪ by clicking on the "Forward email" link at the end of this newsletter.
email: info@taproot.com
phone: 865-539-2139
web: http://www.taproot.com