Always one root cause?

[Kronos147]

Yep, I was standing about 1/4 mile away from it when the thing blew and I knew many of the people involved.

Did you ever get the stains out of your drawers?

I hope I have a chance to hear that one over a cocktail someday.

 

[Randy]

Did you ever get the stains out of your drawers?

I hope I have a chance to hear that one over a cocktail someday.

Naa, wasn't that bad, at least not as bad as an Arc Light hitting a klick or so in front of ya. The event was pretty much the death of the Titan II era and the liquid fueled missile system we had here in the US. Everyone for 100 miles around took a deep and cautious breath realizing how close things came. Some of the declassified information give indication that a couple of the triggers were compromised but not in the correct sequence and locations for a more catastrophic event. The Good Lord was with us that night

 

[Matt's Quality Handle]

They are capable ( have the competence, knowledge, know the criteria to accept o reject product) the
problems happend because inspector was tired (working two shifts for three continuous weeks) and when outside is cloudy,
the light into the inspection room is not adequate (light affects directly at inspections).
Have to detect deltas of tones in colors in labels.
Hope my explanation is clear.

It's like the 12 steppers say, "Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference"

Here's a simple example. Can you change the cloudy weather? No. Then you need to find a way to succeed in spite of it, such as installing better artificial light.

The same concept applies to the double shift issue. Can you change the need, or the ability to double shift? It would be awesome if you could, but I've never been in an environment where as a QE, I could demand those changes. I would have to work on qualifying more inspectors, or rotating them out to a task where less attention is required for a part of their double shift.

 

[Marc]

A quick addition: It must be remembered that visual inspection can not only be tedious work, most people, by their 40's, start having at least minor vision problems which aren't always recognized at the time. Many people don't realize their vision is deteriorating until the have headaches and seek a cause.

 

[mattador78]

A long, long time ago when my Attack Helicopter Troop was putting on a live fire demonstration for our Governor (some guy named Clinton if I remember correctly) and other dignitaries, one of our #1 gun pilots, clear of mind, so far beyond basic competence it was off the scale and probably 10,000 plus hours of stick time touched the wrong button and instead of firing 18 2.75 inch rockets, each containing 17 pounds of very high explosive were jettisoned and rolled across the ground about 75 feet below us going every way but the one intended, relieved of out load we went up like a runaway elevator nearly out of control....The outcome of this adventure resulted in an investigation by the Army Aviation Safety Office and you know what the outcome was....Oops! George said that he had just touched the wrong button, I saw him touch the wrong button, and our unit commander in the other seat told George at the time "You hit the wrong button" All the cause analysis, all of the investigation with charts, graphs and everything else resulted in what we knew from the start ...Oops you touched the wrong button. That's what I was getting at, the defects can be nothing more than....Oops and not a slam at people or anything else.

Many years ago I was on an exercise at Pirbright in the UK as series of night attacks and bug outs under fire, this was all blank rounds and thunderflashes etc the usual training equipment. I was on stag(watch) at about 1-2am when i saw someone something approaching our lines when they rose up to throw a thunderflash i challenged them and opened fire. This caused them to look at me and slightly change their angle of throw so instead of it landing harmlessly in the centre of our LUP it bounced of a tree and landed clear in our CO's sleeping area. Setting fire to his bivvy, sleeping bag, poncho and webbing, which also contained his loaded (blank) magazines and a couple of thunderflashes. All hell broke loose flames bursting everywhere and a British officer losing all sense of decorum as he stripped off his burning uniform swearing and cursing like a trooper. The corporal who had thrown it was hauled in to determine if it was on purpose or an accident, with him not being able to identify who fired on him i kept silent as to my involvement and an accident was determined. As you say oops moments just happen for the slightest reasons and nothing can be done about them.

 

[Randy]

Yep, sometimes "S" happens and nothing can stop it. Accept it, learn from it, try to minimize it and move on or you'll go nowhere but back or down