126: Procedure Use Discouraged
Definition/Typical Issues
Was the procedure classified for "training" or "reference"? Based upon the significance or difficulty of the job, should the procedure have been classified as a "use every time" or "must be in hand" procedure?
Examples
Example 1
- An operator made a valving error, resulting in a tank overflow. He did not take a copy of the procedure with him because it was for reference only, and he thought he knew how to perform the valving operation.
Example 2
- A mechanic incorrectly performed a repair job on a key pump without using the procedure. Mechanics were not required to use the procedure in the field because it was for training purposes only. Mechanics were discouraged from using procedures in the field. However, using the procedure in the field would probably have prevented the error made by the mechanic.
Typical Recommendations
- Procedures classified as "reference" procedures should contain very few steps. If the number of steps is too overwhelming for short-term memory, it should be classified as a "use every time" procedure.
- Training and reference materials may need to be supplemented by:
- Easy-to-carry checklists that parallel the procedure
- More detailed step-by-step procedures for "use every time" if the training and reference manuals are too cumbersome
- Have supervisors enforce appropriate use of procedures in the field.
Cross-References
| Version 10 Element(s) | |
|---|---|
| Node ID | Node Name |
| 115 | Use Not Required But Should Be |