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information in the course of the investigation and consider multiple causes?
Indications of investigator bias as a result of preconceived ideas about what the investigation
results should be.
The event history. Was a complete and accurate event history constructed as part of the
investigation?
By reviewing the items listed above, an accurate picture of the capability of one investigator can
be drawn. This, however, may or may not be representative of the site. To get a better picture of
the program as a whole, a second report done by a different investigator should be reviewed to
determine if there is consistency in the overall site or activity program. This type of review can be
time consuming, therefore, assessors may want to pursue only a few aspects of this review in
detail.
6.7 Assessing Notifications.
6.7.1 Discussion. Notifying DOE personnel following certain events or conditions helps
ensure the safety and efficiency of DOE facilities. Timely notification of appropriate DOE
personnel and other agencies, when required, is employed to ensure that the facility is responsive
to public health and safety concerns.
For events that require notification of DOE personnel (and when appropriate, state and local
officials), it is essential that information be gathered and transferred in a systematic, controlled
method. Procedures that define responsibilities and provide for adequate documentation are used
to control the process and ensure that the notification procedure is effective.
Following notification, the DOE can trend and analyze the reported conditions in an effort to
focus needed resources or direction. Additionally, central analysis allows for the dissemination
of lessons learned to other facilities where similar potential exists for occurrence of such events.
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