The purpose of this study was to analyze the underlying causal factor and root causes which contribute to the accident occurrence using several tools from Root Cause Analysis (RCA). The two major accidents analyzed in this study were Kaohsiung gas explosion, which happened on 31st August 2014; and blackout accident which happened on 15th August 2017. The data collected through the accident report, news, and several papers; then analyzed using seven RCA tools that consist of STEP analysis, task analysis, change analysis, control barrier analysis, event and causal factor chart, Accimap analysis, and onion model. The tools were applied into three different stages, which are data collection, analysis, verification and recommendation
The result shows that there were five root causes from the Kaohsiung accident which were no regulation regarding property development near gas pipelines; lack of pipelines data integration; no resource allocation for gas pipelines maintenance; work not coordinated carefully; and emergency procedure not followed correctly. Subsequently, there were four root causes from the blackout accident, lack of supervision in risk management; lack of DCS control training; poor design DCS controller; and emergency procedure not followed correctly. In addition, several strengths and weaknesses of each tool were pointed out. The importance of the risk assessment; regulation and data integration of gas pipelines; clear and strict maintenance procedure; and emergency response training were suggested as recommendation.

The purpose of this study was to analyze the underlying causal factor and root causes which contribute to the accident occurrence using several tools from Root Cause Analysis (RCA). The two major accidents analyzed in this study were Kaohsiung gas explosion, which happened on 31st August 2014; and blackout accident which happened on 15th August 2017. The data collected through the accident report, news, and several papers; then analyzed using seven RCA tools that consist of STEP analysis, task analysis, change analysis, control barrier analysis, event and causal factor chart, Accimap analysis, and onion model. The tools were applied into three different stages, which are data collection, analysis, verification and recommendation
The result shows that there were five root causes from the Kaohsiung accident which were no regulation regarding property development near gas pipelines; lack of pipelines data integration; no resource allocation for gas pipelines maintenance; work not coordinated carefully; and emergency procedure not followed correctly. Subsequently, there were four root causes from the blackout accident, lack of supervision in risk management; lack of DCS control training; poor design DCS controller; and emergency procedure not followed correctly. In addition, several strengths and weaknesses of each tool were pointed out. The importance of the risk assessment; regulation and data integration of gas pipelines; clear and strict maintenance procedure; and emergency response training were suggested as recommendation.

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