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Work accidents in construction are serious problems at public health due to the large number of occupational risks that their workers are exposed. These accidents involve high costs, and are generally analyzed by unicausal theories, which limit the prevention of similar accidents. It is important a broader study based on organizational and systemic theories. Aim Contribute at improving the accident analysis methodologies, integrating organizational approach to the theory of expansive learning enhancing the agency inside the organizations. Method – Ethnographic data collection such as interviews, observations and analysis of documents related to the airport construction. Workers of different functions and departments of the company were interviewed, as well two sessions of Collective Worker Analysis was applied. Application of Model of Analysis and Prevention of Work Accident (MAPA) along with the Model of Event Organizational Analysis (AOE), which propose a systemic approach to the case. These analysis were used to support the sessions of the Changes Laboratory (CL) which were based on theory of expansive learning and the concept of double stimulation. Results The analysis of habitual work, the analysis of changes and barriers and analysis of historical, vertical and transverse dimension allowed to understand the accident underlying causes, which was originated in the network of multiple failures in interaction (management of projects and changes; management of materials and logistics; management of outsourcing companies; management of emergencies; safety management). The historical analysis showed that these factors had emerged over time at organization as a result of management decisions at different levels. The airport was planned to be built in time determined politically, and insufficient and inconsistent with its complexity. The choice of the type of contract, which the joint venture was responsible for all phases of the construction site, was another critical historical event because it allowed the airport construction initiated without the definitive executive project. Moreover, there were different cultures of companies working for the first time together in time pressure context, with the outsourcing strategy without the necessary coordination. These changes have led to manifestations of secondary contradictions, which eventually led to the emergence of anomalies, such as rework, accidents, delays, waste of resources. Many problems concerning the construction of the airport appeared during CL sessions. The method of double stimulation led to the engagement of actors with the creation of artifacts and models, such as timeline of the construction site, vicious circle and activity system, which contributed to an expansive view of contradictions that were leading to anomalies in this site and creation of possible solutions. Conclusion The CL and concepts of expansive learning associated with the concepts used at MAPA and AOE provided an understanding of the manifestations of contradictions and systemic origins of the accident and other anomalies at airport construction site; creation of agency and engagement of actors; and also at visualizing preventive solutions in future construction sites. Descriptors: Work Accidents; Airport; Accident analysis; Organizational and Systemic approach; Change Laboratory.

Abordagem formativa para prevenção de acidentes na edificação de um aeroporto: uma análise histórica e organizacional