00:01:07Bayer CropScience
00:13:26The Incident
00:24:00The Investigation
00:24:43What Went Wrong?
00:26:54The Correct Start-up Procedure
00:28:31How The Operators Overrode So Much
00:30:13Organisational Change
00:34:21The DCS Upgrade Wasn't Finished
00:36:14Causality Explored: HMI Screen Design
00:36:20What Do We Learn?
00:42:49Aftermath
00:44:41Conclusion
00:48:37Outroduction