Investigation That Goes Beyond the Surface
Many organisations conduct investigations, and still face root causes not fully identified, findings that don't translate into action, and repeated incidents across sites. The focus here is not on producing reports, but on ensuring findings are understood, applied, and sustained.
Speak to UsIdentifying where incidents actually originate
This work focuses on identifying where incidents originate in real operations and ensuring root causes are fully understood, addressed, and prevented from recurring. It builds on a practical approach used in high-risk environments where failures must be understood and acted upon, not just documented.
The engagement extends beyond the immediate incident to examine the operational, technical, and organisational systems that allowed the failure to occur. Findings are translated into clear, actionable recommendations that can be implemented and sustained across the organisation.
- Investigating incidents to identify true root causes
- Identifying gaps between procedures and on-site execution
- Understanding how failures occur in real operations
- Supporting leadership teams in safety-related decision-making
- Strengthening accountability across teams and systems
- Ensuring findings are translated into action and sustained
A structured three-stage process
Understanding the incident
- Review of incident details, context, and contributing factors
- Identification of immediate and underlying causes
- Analysis of operational and system-level influences
Identifying system failures
- Gaps between policy and real-world execution
- Breakdowns in supervision, communication, or processes
- Weaknesses in existing safety systems and controls
Preventing recurrence
- Clear and practical recommendations aligned to operational realities
- Implementation support for corrective actions
- Ensuring findings are applied and sustained over time
Scope of investigation support
Incident investigation and forensic analysis
- Major accident and incident investigation
- Root cause analysis across complex environments
- Forensic analysis and reporting
- Recovery and analysis of critical evidence
- Support for legal, insurance, and formal investigations
Safety systems and risk evaluation
- Review of safety systems in real operational conditions
- Identification of gaps between policy and execution
- Evaluation of systemic and organisational risk factors
- Insurance company pre- and post-audit support
- Recommendations aligned with operational realities
Advisory and leadership support
- Guidance to leadership teams during and after incidents
- Support in interpreting investigation findings
- Strengthening decision-making and accountability
- Expert witness in a court of law
- Ensuring corrective actions are applied and sustained
Organisations typically engage when
- After a serious incident or near miss
- During insurance or claims-related reviews
- Following audit findings or compliance concerns
- When repeated incidents indicate deeper system failures
- When findings from previous investigations haven't been implemented
Outcomes
- Clear understanding of what caused the incident, not just the immediate trigger
- Identification of underlying system failures
- Corrective actions that are practical and implementation-ready
- Reduced likelihood of repeat incidents
- Stronger confidence during regulatory and insurance reviews
- Better alignment between safety systems and real operational practice
Peter McNair, CFIOSH
Supporting incident investigation and preventing repeat safety failures.
Peter McNair is a Chartered Fellow of the Institution of Occupational Safety and Health with extensive experience in incident investigation, forensic analysis, and safety system evaluation across high-risk industries including aviation, oil and gas, construction, and industrial environments.
His investigation experience includes major accidents involving fatalities, complex evidence retrieval from remote and submerged locations, helicopter and aircraft recovery operations, and analysis of flight recorder and remote-operated system data. He has provided expert witness input in formal legal proceedings and supported insurance-related investigations for major industry bodies.
Dealing with an incident or reviewing your safety systems?
Contact us to discuss your situation. We can advise on the appropriate level of investigation support and whether an independent review is the right next step.