摘要：The Incident Report-Based Safety Knowledge Transfer (IRSKT) model found in this paper identifies the elements necessary for social systems in workplaces to extract, disseminate and use new safety knowledge emanating from incident reports. The purpose of this paper is twofold: to understand how recent developments in systems thinking and materiality of knowledge can influence understanding of safety knowledge transfer (SKT); and to propose a new systems-based safety knowledge transfer model founded on incident reports. The paper is a review of the literature on safety knowledge transfer, materiality of knowledge and systems thinking; leading to the proposal of a new SKT paradigm. This paper shows that the IRSKT model is well suited to analyzing safety knowledge transfer in both complex and small-scale systems. Empirical studies in various systems (of complexity) environments will help affirm and enrich the model. The paper sees that in organizations where safety of employees is important, the ability to extract knowledge from incidents reports – which is an accessible and ready estimate of safety situations in organizations - is vital for establishing safe workplaces. The capacity for effective exchange and utilization of safety information inherent in incident reports by employees, equipment manufacturers, professional bodies and government agencies as reflected in IRSKT will inform the decisions to build in safety in machinery, better safety rules, effective safety campaigns and enhance safety conscious behaviours in organizations. The paper offers a new safety knowledge transfer paradigm that views safety knowledge as a systemic, emergent, embedded and materially entangled representation of reality. The proposed knowledge transfer model is different from earlier attempts, concentrating movement of safety information in incident reports and the significance stakeholders must attach to them to minimize both human and machine error.
关键词：Incident reports; accidents; knowledge transfer; safety knowledge; systems analysis
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