When Aaron Guilfoyle walked into the courtroom for the Dreamworld sentencing, he thought he was prepared. After two decades as a federal prosecutor and three years as Australia’s only independent Work Health and Safety Prosecutor, he had seen it all. But nothing had prepared him for what he would later describe as “absolutely the toughest day for me as a prosecutor.”
In our latest episode of “The Art of Safety Leadership,” Aaron provides an unprecedented insider’s view into industrial manslaughter prosecutions and the legal realities that every safety leader, CEO, and board director needs to understand in today’s high-stakes environment.
The Rapid Rise of Industrial Manslaughter
What started as a Queensland-only response to tragedies like Dreamworld has now spread across the entire country. “As we sit here now every jurisdiction in Australia including the Commonwealth now has a version of it,” Aaron explains. This isn’t just legislative posturing—it’s creating real legal risk for businesses and their leaders.
Aaron’s unique position as the person who initiated Australia’s first industrial manslaughter prosecution gives him a perspective no one else can offer: “I think the short history we’ve had shows it’s prosecutable… Are they going to prosecute it?”
The answer, based on his experience, is increasingly “yes.”
The 19 Seconds That Changed Everything
The Dreamworld tragedy remains one of Australia’s most significant workplace incidents, not just because of the four lives lost, but because of what it revealed about safety management in unexpected contexts. Aaron’s detailed breakdown of the incident is both technical and heartbreaking:
“The process that I described happened in 19 seconds. So from the point in time that the two rafts met until ultimately the conveyor stopped… happened in 19 seconds.”
What makes this case particularly relevant for other industries is Aaron’s assessment: “My view is this was a preventable tragedy.” This wasn’t a freak accident or an act of god—it was the result of systematic failures that could occur in any workplace.
The Prosecutor’s Uncomfortable Truth
Perhaps Aaron’s most confronting observation comes from his review of hundreds of serious incidents during his prosecutorial career: most workplace fatalities are preventable. This reality creates a fundamental challenge for the legal system and business leaders alike.
“It’s frustrating,” Aaron admits. “You can’t turn back the clock for them. And sometimes you can’t achieve the prosecution outcome for them that they want… because in that particular scenario, somebody didn’t do the thing that was that culpable thing.”
The False Security of “Doing Well”
One of Aaron’s most counterintuitive warnings concerns businesses that appear to be performing well in safety. “A couple of things that I’ve seen in recent years…one is we’re doing too well,” he explains, describing organizations that become complacent about continuous improvement.
His experience challenging board directors is particularly revealing: “If I ask most directors… do you think this is a safe business? Almost always the answer is yes, I do. And I don’t find it difficult to start to unwind that belief.”
This overconfidence often stems from not asking the hard questions or failing to dig beneath surface-level reporting.
The Power Imbalance You Don’t Know About
For many business leaders, Aaron reveals a shocking reality about regulatory investigations:
“Work health safety regulators and their inspectors have got investigation powers of a kind that not even police do. People understand that by and large police ask me questions, I don’t have to answer them. That’s not the way it works in safety world.”
This power imbalance becomes critical in post-incident scenarios, where the natural instinct to help and provide information can inadvertently increase legal risk.
When Paper Meets Reality
Aaron’s experience has shown him a persistent problem across industries: the gap between documented safety systems and actual workplace practices. “Post-incident that thing being done on the ground not matching the paper is so obvious,” he explains.
The problem isn’t just non-compliance—it’s the false security that comes from green ticks on audit sheets that don’t reflect reality. “Can that be right that every month, every tick was green? And then the incident happens… The inspector then comes and just starts asking… how long’s that been missing? Well, it’s two or three months.”
The Evolution of Safety Leadership
Aaron sees a fundamental shift needed in how safety professionals operate within businesses. The traditional model of presenting safety reports to the board and leaving is no longer sufficient.
“There are still safety leaders within the business who come into the boardroom. They present their safety report… And they step outside,” he observes. “Then there’s the category within a business which understands that the safety leader has to have input into a lot of what the business does.”
This evolution is particularly critical given emerging challenges like psychosocial hazards, where “never before has HR and the work health and safety side of the business had to work together.”
Practical Guidance for Leaders
Despite the sobering legal realities, Aaron’s advice is practical and actionable. For board directors, he emphasizes the importance of understanding critical risks: “What are the critical risks in our business? Do we know what they are? Have we done enough to educate ourselves about what they are?”
He also stresses the ongoing nature of due diligence: “Once you feel comfortable, come back in a little while and ask some more questions because the environment within the business is going to have changed by then.”
The Cultural Dimension
Aaron’s observations about safety culture are particularly insightful. He describes businesses that consistently make safer decisions in ambiguous situations: “What I see is business because of its culture… which is more accustomed to when it sits in the gray, making the safe decision over the not safe decision.”
This isn’t about having perfect policies—it’s about creating an environment where people default to safer choices when the rules don’t provide clear guidance.
Preparing for the Inevitable
Aaron’s advice to businesses is stark but necessary: “My advice to businesses, you’ll have a safety incident if you haven’t had one. You’ll have one. It’ll be a question of when it happens and what’s the gravity of it.”
This isn’t pessimism—it’s realism from someone who has seen the consequences when organizations aren’t prepared. His recommendation is clear: plan, practice, and ensure you have the right support ready when needed.
Aaron Gilfield’s unique journey from prosecutor to business advisor provides insights that no one else in the safety industry can offer. His perspective reveals the gap between how businesses think the legal system works and how it actually operates when incidents occur.
To hear Aaron’s complete analysis of the Dreamworld case, his practical advice for crisis management, and his predictions for where industrial manslaughter prosecutions are heading, listen to the full episode of “The Art of Safety Leadership” below.
For safety leaders, executives, and board directors operating in today’s legal environment, this conversation provides essential knowledge that could mean the difference between prevention and prosecution.
