Case Information
Case details
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Review Date
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Colleague Name
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Colleague Position
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Colleague Staff Number
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Case Reviewer Name
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Case Reviewer Position
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Case Reviewer Staff Number
Event Details
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Event eBASIS No.
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Event Location
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Event Date
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Summary of Event
Behavioural Classification
Behavioural Classification ( use SaMM Section 16.)
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Were rules intentionally broken? (Tap question to record rationale)
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Consider, did the individual knowingly or unreasonably contravene rules or not follow procedures in order to undertake the task?
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Was a correct plan of action selected? (Tap question to record rationale)
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Consider, would the plan of action selected by the individual have ever achieved its goal?
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Behavioural outcome is ERROR
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Rationale notes here
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Behavioural outcome is MISTAKE
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Rationale notes here
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Could the task have been done in accordance with the rules? (Tap question to record rationale)
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Consider, in the circumstances the individual found themselves in, was it possible to complete the task in line with rules or procedures?
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Was the situation outside normal practice? (Tap question to record rationale)
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Consider, did the individual find himself or herself in a situation that differed considerably from the usual operating environment?
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Behavioural outcome EXCEPTIONAL RULE BREAKING
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Rationale notes here
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Behavioural outcome SITUATIONAL RULE BREAKING
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Rationale notes here
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We're the consequences as intended? (Tap question to record rationale)
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Consider, did the individual set out to cause the event?
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Behavioural outcome is SABOTAGE
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Rationale notes here
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Was there a conscious, substantial and unjustifiable disregard for risk? (Tap question to record rationale)
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Consider, did the individual knowingly take a significant risk whist ignoring the potential for harm that could have been caused the themselves or others?
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Behavioural outcome is RECKLESSNESS
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Rationale notes here
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Were the actions to benefit the individual? (Tap question to record rationale)
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Consider, did the individual consider that their actions were for the good of the organisation (business) or were based upon blatant self-interest?
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Behavioural outcome RULE BREAKING FOR INDIVIDUAL GAIN
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Rationale notes here
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Behavioural outcome RULE BREAKING FOR ORGANISATIONAL GAIN
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Rationale notes here
Confirm Behavioural Classification
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Enter Identified Behaviour
- Error
- Mistake
- Situational Rule Breaking
- Exceptional Rule Breaking
- Rule Breaking for Organisational Gain
- Rule Breaking for Personal Gain
- Recklessness
- Sabotage
Intervention Test Questions
Accountability and Intervention Model - This section MUST be completed AFTER the Behavioural Classification. (SaMM Section 16. Must be used in conjunction with this form)
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Substitution test conducted?
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Routine test conducted?
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Proportionality test conducted?
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Determining the intervention?
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Outcome Accountability and Intervention model
Process Check
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The Reviewer has read and understood SaMM (Safety Management Manual) Section 16. - Just Culture
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The Behavioural Classification Flow Chart has been used from the SaMM (Safety Management Manual).
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The Accountability and Intervention model has been used from the SaMM (Safety Management Manual).
Outcome of Case Review
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Outcomes Action Colleague
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Outcomes Action Organisation
- SOP Change
- Colleague Training Requirement
- Colleague Communication
- Human Factors - Describe
- Other - Describe
- None - Describe
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Comments - Detail other salient / relevant comments here
Peer Review of Outcome
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Peer Reviewer Name/s
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Peer Reviewer Position/s
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Date and time of Peer Review
