Implement Ation of Human Error Diagnosis (HED) System

人爲失誤診斷系統之建置

10.29977/JCIIE.200401.0009

劑鴻世(Hunszu Liu)；黃雪玲(Sheue-Ling Hwang)；劉祖華(Thu-Hua Liu)；陳光漢(Guang-Hann Chen)

人爲失誤 ； 工業安全與衛生 ； 人爲失誤鑑認 ； human error identification ； human error assessment ； human error

工業工程學刊

21卷1期（2004 / 01 / 01）

82 - 91

英文

人爲失誤被認爲是造成職業災害的主要原因，爲了降低職業災害所造成的損失，有必要針對人爲失誤發生原因進行診斷，以了解其狀況並擬定適當的因應對策。然而人爲失誤問題的發生原因相當廣泛，如果診斷工作只是仰賴少數專家學者的協助，勢必會造成緩不濟急或是涵蓋面不完整的問題。因此有必要發展一套能診斷工廠人爲失誤現況的系統，協助製造現場的管理者掌握其工作環境的現況。本研究發展出一套適合製造環境中的決策者使用的人爲失誤診斷系統。並利用案例研究及專家訪談的方式驗證此系統的有效性。研究結果能建立工廠人爲失誤診斷系統的初步運作模式，解決以往以專家學者協助診斷的資源不足問題。

Human error has been recognized as the major cause for industrial accidents. Because of the changing role of human in modern manufacturing environment and the lack of understanding of the human cost, the severity of human error problem is worsen by the increasing mental workload and the insufficient allocated company resources. To prevent the accidents from happening, it is necessary for managers to realize the potential human error threats and its likelihood of creating loss from daily operations. This study proposes the error data collected through observing the workers' operation status, instead of experts' judgments, can be used as the source information for analyzing human error and developing safety index. Safety index is used as a monitoring tool to control human errors. An industrial case is carried out to illustrate the implementation of this approach. It shows the operators' behaviors can be incorporated into the human errors assessment process and the factory managers can get closer understanding of their manufacturing risk. The problem of traditional Human Reliability Assessment Techniques, which can not provide the manager the daily operation risk information, is solved.

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