Reflection Aerospace Engineering

Course subject(s) 6. Debriefing per case

Reflection by Michiel Schuurman

I feel compelled to give you a warning, because in my experience the most obvious accident cause is sometimes the correct one. Using the Ring of Trustworthiness and being diligent will help you in an investigation to determine the failure (root) cause.

Before going to an accident scene, an investigator once said to me; “It is one of those accidents again”. Further into the field investigation, the investigative mindset was lost. He skipped the analysis phase, because he already assumed that he knew what happened. The conclusions were already set and written down in a report.  The movie which didn’t show the actual accident aircraft was included in the report as evidence. The work that was necessary to complete the investigation was enormous and valuable time was lost to find the real cause. So, be mindful and keep this experience in mind.

It is nice to be the one to “solve the accident,” but it is just as rewarding when you can contribute a small part to the investigation. The steps, methods and mindset of the Forensic Engineering approach are valuable, and I hope you use it in the future to learn from failure.

I hope you enjoyed the course and the information provided. Now you are able to use it in your own practice!

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Forensic Engineering: Learning from failures by TU Delft OpenCourseWare is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Based on a work at https://ocw.tudelft.nl/courses/forensic-enginee…earning-failures/.
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