ABSTRACT
Various accident investigations have been conducted to identify the causes of the Fukushima nuclear accident and to propose countermeasures to prevent future severe accidents. This chapter describes an attempt to review the investigations from the perspective of Resilience Engineering. Most investigations are based on a fundamental approach of listing up adverse events experienced during an accident to find out the causes of each adverse event, and to propose countermeasures to eliminate the identified causes. An implicit belief underlying the fundamental approach is that safety can be achieved by eliminating the causes that contributed to the accident. As a natural consequence, the causal descriptions and proposed recommendations are large in number and complicated in structure. It would obviously be desirable if the proposed recommendations were better organized and simplified. The present study took an alternate approach where safety of a system is believed to be achievable by properly maintaining the four essential capabilities proposed in Resilience Engineering: responding, monitoring, anticipating and learning. Also, efforts have been made to find so-called “second stories” (Woods and Cook, 2002) latently existing behind the multiple causal relationships described in the investigation reports.
