ASHINGTON, Nov. 19 — The largest blackout in North American history was set off by a series of human and computer failures at an Ohio power company, where workers could not act to halt an escalating crisis because they did not even know it existed, a panel of government and industry officials reported on Wednesday.

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The report says that, even some 20 minutes before the lights went out from Detroit to New York City on Aug. 14, the blackout could have been safely contained if not for the utility's malfunctioning computers and inadequately trained control room workers.

The report found that the utility, FirstEnergy, and the regional agency that was supposed to be overseeing it, the Midwest Independent Transmission System Operator, also failed to contact neighboring power companies as the system unraveled, a violation of one of the essential rules governing the operation of the nation's power grid. And the government officials who released the report charged that the worsening series of transmission line failures that drove the wider collapse of power were the result in part of a failure by FirstEnergy to do the most basic maintenance of the company's transmission lines — namely the trimming of trees underneath and alongside the lines.

At each turn on Aug. 14, the 124-page document says, human inaction made matters worse, until a system collapse struck with such force and speed that it surged from Ohio into Michigan, Ontario and New York in a matter of seconds.

"This blackout was largely preventable," said Energy Secretary Spencer Abraham, who headed the inquiry, along with Herbert Dhaliwal, the Canadian minister of natural resources. "A number of relatively small problems combined to create a very big one."

The blackout spread through eight states and vast parts of Ontario, disrupting the lives of millions of people and inflicting billions of dollars in economic losses.

Mr. Abraham and Mr. Dhaliwal, in releasing the most definitive official account of the calamity to date, repeatedly emphasized the need for an enforceable set of operating standards for the electrical grid, with violations punishable by monetary penalties, for power companies and the entities that supervise them, independent system operators.

"If the voluntary reliability standards had been complied with, we wouldn't have had a problem," Mr. Dhaliwal said. Describing the grid as a chain of connected systems, he said, "We have to make sure we don't have weak links in the chain that affect others."

The energy bill passed by the House on Monday would allow for an enforceable set of rules, to be drafted by an industry group, the North American Electric Reliability Council. (Mr. Abraham and Mr. Dhaliwal said they favored enforceable standards but their report today had no recommendations. Those will come later this year at the earliest, they said.) It would also give the council the power to audit the practices of power companies and system operators, which Michehl R. Gent, the group's president, said was more important than penalties. "I'm into performance, not fines," he said.

Mr. Gent said the blackout also showed that his group's rules needed to be more explicit about requiring that power companies and I.S.O.'s have sophisticated, comprehensive computer systems for monitoring their power lines and detecting problems. The Midwest I.S.O., a relatively new agency, has less effective systems than its counterparts in the Northeast.

Mr. Abraham repeatedly declined to answer questions about what penalty, if any, FirstEnergy might or should face, adding that it might be up to state regulators. But with the report putting the blame so squarely on FirstEnergy, others jumped in. Saying that "FirstEnergy needs to be held accountable," Representative Eliot L. Engel of New York said the company should pay reparations to power companies, so that they can, in turn, reimburse customers for their losses.

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