Identification and Evaluation of Human Errors in Locomotive Maneuvers Using the SHERPA Technique: A Case Study in a Rail Operation Repair and Development Project

Background and Aims: despite complex technologies in many work environments, human errors are of great importance due to leading to severe and catastrophic accidents. Therefore, in order to prevent and limit the consequences of human error, it seems necessary to identify and find the causes of them. The aim of this study was to identify and evaluate the human errors of locomotive maneuvers in the railway repair and development project, 2019. Methods: In this cross-sectional study, the identification and evaluation of human errors in locomotive maneuvers in the Mapna railway repair and development project using SHERPA technique has been done. First, using the hierarchical task analysis method, the activities of the maneuvers are divided into their tasks and sub-tasks, and in the next step, the types of human errors in each of the tasks are identified and then human errors are evaluated according to SHERPA instruction. Results: 206 errors were identified in the present study. errors were included 48.5% action error, 39.8% checking error, 10.2% Information communication error and 1.5% selection error. The lowest and highest errors related to locomotive displacement error were related to hot single diesel (14.0%) and locomotive displacement error on service pit (29.6%). 23.8% of the identified errors had an unacceptable risk level, 51.1% had an ALARP risk level and 25.2% had an acceptable risk level. Conclusion: The findings of the study indicated that the most unacceptable risks and ALARP were related to checking and action error, respectively. So it is suggested that the design and implementation of control measures related to these two types of errors should be prioritized.