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Personnel Error

Diagnostic Chart

High Stress

Low Alertness

Boredom

Illness

Fatigue

(Inadequate
Action)

(Mental and
Physical)

Mental or
physical
weakness
Distraction
due to illness
Excessive
work
schedule
without days
to rest and
recover

Inadequate
sleep
Poor shift
work rotation
Circadian
fatigue
Post meal/
midafternoon
Repeated
errors at
certain times

(NonStimulating
Work)
Poor work
planning
Poor
motivation
Goal
confusion

Low Morale
(High Stress)

High emotion
Job danger
Fear of
unemployment
Lack of
confidence
Poor teamwork
Perceived time
pressure

High
Complexity

Cognitive
Overload

(KB Perf. Error)

(Repeat Mistakes)

Inadequate
knowledge
Not familiar
with task
Perceived time
pressure
Poor
procedures
Poor
teamwork
Spatial
disorientation

Multi-tasking
KB
performance
Inadequate
training or
procedures
High rate of
interruptions
Too much info
Perceived time
pressure
Distractive
environment

Poor
Supervision
(Inadequate. Work
Assignment)
Job assignment
error
Staffing error
Poor
accountability
Poor command
Poor
communication

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High Confusion

Fear of Failure
(Fear Results of
Error)

Task confusion
Poor
accountability
Poor
supervision
Perceived time
pressure

Unawareness
(Information
Deficiency)

Lack of
teamwork
Information
not available
Not enough
information

Underestimated
Complexity
(Wrong Action)

Long time on
same job
Low
management
standards
Poor
procedures
Poor teamwork
Inadequate
motivation

Overconfidence

Low Compliance

Inadequate
Tracking

Inadequate
Motivation

Habit
Intrusion

(Place-Keeping
Failure)

(Inadequate
Attention to Detail)

(NonCompliance)

Inadequate
written
instructions
High rate of
distraction
Insufficient
information

Poor
accountability
Mindset
Perceived
time pressure
Low
consequence
Wrong
assumptions
Low
expectations

Reflex
Poor
supervision
Perceived
time pressure

Tunnel
Vision
(Inadequate Info
Checking)
Poor
supervision
Poor
accountability
Long time on
same job
Perceived time
pressure

Shortcuts

Mindset

(Information
Deficiency)

(Actions Based
on Reflex)

Tasks
outside of
procedure
Reflex
Poor
teamwork
Perceived
time pressure

Tasks
outside of
procedure
Assumptions
Tribal
knowledge
Perceived
time pressure

Embarrassed
(Fear of
Exposure)

Task too
complex
Lack of
procedures
Poor
supervision
Poor training

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