4.1.5. MxFACS

The MxFACS taxonomy aids in identifying three out of four of the basic elements of error identified by Reason [30]; the action, the outcome, and the context. However, it is not always possible to determine from investigative reports the intention of those who produced the errors.

As such, interview (perhaps in the MEDA format) with the maintenance personnel involved with particular events, shortly after the event, would complement a more representative coding of the accident or serious incident. This is not without its challenges, particularly for lower level occurrences where investigation may be undertaken sometime after the fact, therefore making it difficult for the personnel to accurately recall the intentions which lead to the error.
