We employed an instrumental case study of a multisystem hydroelectric power producer, a high-reliability organization (HRO), to explore how new knowledge is created in a context in which errors may result in destruction, catastrophic consequences, and even loss of human life. The findings indicate that knowledge creation is multilevel, nested within three levels of paradox: paradox of knowing, paradox of practice, and paradox of organizing. The combination of the lack of opportunity for errors with the dynamism of the HRO context necessitates that individuals work through multiple paradoxes to generate and formalize new knowledge. The findings contribute to the literature on knowledge creation in context by explicating the work practices associated with issue recognition, resolution, and refinement, and the formalization of knowledge in failure-intolerant organizations.