what the single greatest factor in safety and health programs' failure to completely keep us free of workplace accidents is, why, and what can we do about it.

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The answer to this is probably something like the human factor or a human error. That is because no matter how great the conditions are, you can't prevent people from making a mistake eventually and this can include even simple things like falling down stairs. What you can do is make sure you get good employees, but even those banal injuries still count as a workplace accident and the worker needs to be paid and covered to mend it.