Safety Culture Excellence®

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Peeling the Onion: Solving Safety Problems One Layer at a Time

April 29th, 2015

During a safety observation, workers were observed using the wrong tool for a job, which created a risk.  When a safety committee saw the report, they petitioned management to buy the proper tool for the work station.  The committee member who received the tool took it to the work station and presented it to the worker on shift with an explanation of what had happened and the action taken.  The worker admitted that he really had not been taught what the proper tool was for the job and had used the home-made tool since he began his job.

The next month’s observations reported that workers were still using the wrong tool for the job.  Follow-up revealed that workers on the other shifts had not received the communication and were not aware of the new tool.  The safety committee made sure that every worker was made aware of the proper tool in safety and tool box meetings and felt sure the next month’s data would show the problem solved.

The next month, the observations showed the workers were STILL not using the right tool. Follow-up revealed that workers had formed the habit of using the wrong tool and that the habit was not changed.  The safety committee developed a plan to remind workers and, within the next few months, the problem was truly solved.

Lessons learned: 

•             Safety problems can be multi-layered and require multiple fixes.

•             Solving problems requires follow-up.

•             Influences need to be addressed in order to change the behavior.


-Terry L. Mathis


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Terry L. Mathis is the founder and CEO of ProAct Safety, an international safety and performance excellence firm. He is known for his dynamic presentations in the fields of behavioral and cultural safety, leadership, and operational performance, and is a regular speaker at ASSE, NSC, and numerous company and industry conferences. EHS Today listed Terry as a Safety Guru in ‘The 50 People Who Most Influenced EHS three consecutive times. He has been a frequent contributor to industry magazines for over 15 years and is the coauthor of STEPS to Safety Culture Excellence (2013, WILEY).

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