btw /me lurves Root Cause Analysis ... it may be the shortest TLA with the LARGEST importance, as it encapsulates the Aim--> of every after-accident program. Or that 'investigation' is pure unfumigated shit. (Being a 'technologist' never DID mean that: you must turn-off your lifetime of experience) ..nor eschew re-Framing [hate that word] of what it is you {increasingly suspect} is approaching Root, as you burrow down your own check-list.

aka Seiberling discovered the vulcanizing-effect upon (natural) rubber, when he accidentally spilled some on a stove. Archimedes-in-bathtub etc. Winners both.



Eureka!!