Finding daily systemic interactions through accident analysis: the Safety Bowl Checklist applied in a rail company pilot study

This paper presents the application of the Safety Bowl Checklist in an Italian railway company. The Checklist is a structured set of guiding questions designed to support accident analysts in investigating everyday interactions within complex systems, including elements such as the organization, operators, tasks, and procedures. Its use allowed analysts to understand routine interactions from a Safety-II perspective, while also grounding the analysis in accident data, which remains a primary source of safety information consistent with the Safety-I approach. This method supported both a zoom-in approach - focusing on the specific dynamics of individual accidents - and a pan-out perspective - aimed at understanding how the system functions daily. As a result, analysts were able to identify patterns and propose organizational improvements to prevent future accidents that had not yet occurred.