Industri minyak dan gas bumi merupakan sektor dengan tingkat risiko keselamatan kerja yang tinggi akibat kompleksitas operasi, penggunaan teknologi bertekanan tinggi, serta paparan energi berbahaya. Meskipun indikator kinerja keselamatan seperti Total Recordable Injury Rate (TRIR) menunjukkan tren perbaikan, kecelakaan dengan konsekuensi tinggi seperti fatality masih tetap terjadi. Kejadian fatality tidak hanya menyebabkan kehilangan nyawa, tetapi juga berdampak terhadap aspek operasional, finansial, dan reputasi perusahaan. Penelitian ini bertujuan untuk menganalisis faktor-faktor penyebab kejadian fatality pada Perusahaan X selama periode tahun 2021–2025 menggunakan metode Human Factors Analysis and Classification System (HFACS). Penelitian ini merupakan penelitian deskriptif analitik dengan pendekatan kualitatif dan kuantitatif menggunakan data sekunder berupa laporan investigasi kejadian fatality. Unit analisis penelitian terdiri atas 12 kejadian fatality yang terjadi pada periode tahun 2021–2025. Analisis dilakukan dengan mengklasifikasikan faktor penyebab kecelakaan ke dalam empat level HFACS, yaitu Unsafe Acts, Preconditions for Unsafe Acts, Unsafe Supervision, dan Organizational Influences. Hasil penelitian menunjukkan bahwa faktor yang paling dominan pada level Unsafe Acts adalah Routine Violations dan Perceptual Errors (83%) dan Decision Errors (50%). Pada level Preconditions for Unsafe Acts, faktor dominan adalah Communication, Coordination and Planning (83%), Tools/Technology (75%), dan Mental States (75%). Pada level Unsafe Supervision, faktor Inadequate Supervision ditemukan pada seluruh kasus (100%), sedangkan Planned Inappropriate Operations dan Failure to Correct Known Problem masing-masing ditemukan pada 92% kasus. Pada level Organizational Influences, faktor Operational Process dan Resource Management ditemukan pada seluruh kasus (100%), sedangkan Organizational Culture ditemukan pada 92% kasus. Hasil penelitian juga menunjukkan bahwa sebagian besar korban fatality merupakan pekerja kontraktor. Penelitian ini menyimpulkan bahwa kejadian fatality pada industri migas merupakan hasil interaksi berbagai faktor yang saling berkaitan mulai dari level organisasi, pengawasan, kondisi kerja, hingga tindakan individu. Pendekatan HFACS mampu mengidentifikasi faktor-faktor laten yang berkontribusi terhadap terjadinya fatality sehingga dapat menjadi dasar dalam pengembangan strategi pencegahan kecelakaan berkonsekuensi tinggi pada industri migas.

The oil and gas industry is recognized as a high-risk sector due to operational complexity, high-pressure technologies, and exposure to hazardous energy sources. Although safety performance indicators such as the Total Recordable Injury Rate (TRIR) have shown improvement trends, high-consequence incidents such as fatalities continue to occur. Fatal accidents not only result in the loss of life but also have significant operational, financial, and reputational impacts on organizations. This study aimed to analyze the contributing factors of fatal occupational accidents in Company X during the period 2021–2025 using the Human Factors Analysis and Classification System (HFACS). This study employed a descriptive-analytic design using qualitative and quantitative approaches based on secondary data obtained from fatal accident investigation reports. The unit of analysis consisted of 12 fatal incidents that occurred between 2021 and 2025. Accident contributing factors were classified according to the four HFACS levels: Unsafe Acts, Preconditions for Unsafe Acts, Unsafe Supervision, and Organizational Influences. The results revealed that the most dominant factor within the Unsafe Acts level were Routine Violations and Perceptual Errors (83%), followed by Decision Errors (50%). At the Preconditions for Unsafe Acts level, the dominant factors were Communication, Coordination and Planning (83%), Tools/Technology (75%), and Mental States (75%). Within the Unsafe Supervision category, Inadequate Supervision was identified in all fatal cases (100%), while Planned Inappropriate Operations and Failure to Correct Known Problem were identified in 92% of the cases. At the Organizational Influences level, Operational Process and Resource Management were found in all cases (100%), whereas Organizational Culture was identified in 92% of the cases. The study also found that most fatality victims were contractor personnel. This study concludes that fatal occupational accidents in the oil and gas industry are the result of interactions among organizational, supervisory, workplace, and individual factors. HFACS proved effective in identifying latent conditions contributing to fatal accidents and can therefore serve as a basis for developing high-consequence risk prevention strategies in the oil and gas industry.