general aviation safety review working group. terms of reference review ga fatal & serious...

GENERAL AVIATION SAFETY REVIEW

WORKING GROUP

TERMS OF REFERENCE

• Review GA fatal & serious accidents & incidents, focussing on causal factors to identify trends and develop and action plan.

• Make recommendations for intervention to reduce potential fatal & serious accidents & incidents.

MEMBERSHIP

• CAA– GAI, AWD, SAFETY ANALYSIS, PLD

• INDUSTRY– AAIB, RAES, BMAA, ALAE, HAA,

GAPAN, AOPA, LAA, GASCO

METHODOLOGY

• Based on 2001 Safety Review of Large Transport Aeroplanes– Modified to meet GA situation.

• Causal Factors

• Contributory Factors

• Combine for Outcome

5 MAIN CAUSAL FACTORS

• Flight handling skills

• Poor judgement or airmanship

• Omission or inappropriate action

• Engine failure or malfunction

• Lack of training or inexperience

CONTRIBUTARY FACTORS

• Lack of Training or Experience

• Poor Judgement or Airmanship

• Design Shortcomings

• Inadequate Pre-Flight Preparation

• Distraction

COMBINED FACTORS

• Flight Handling Skills

• Poor Judgement or Airmanship

• Lack of Training or inexperience

• Omission or Inappropriate Action

AREAS FOR ACTION

• PPL & NPPL SYLLABII

• INSTRUCTPR QUALIFICATIONS

• GA AIRCRAFT MODIFICATION PROCESS

• USE OF SIMULATION

• OVERSIGHT OF FTOS.

• CARBURRETTOR ICING

RECOMMENDATIONS

• GROUP ESTABLISHED LONG TERM

• ACTION PLANUSED AS BASIS FOR DEVELOPMENT OF SAFETY MEASURES.

CURRENT SITUATION

• GROUP MEETS TWICE PER YEAR

• AAIB USE METHODOLOGY

• ONGOING REVIEW OF MORS

• FACTORS REMAIN UNCHANGED

ACTION PLANCOMPLETED ITEMS

• Carb Icing

• Safety Standards at Unlicensed Aerodromes

• Safety Info at Licence Issue

• Reintroduction of Hard Copy SSLs

• GPS SSL Include with New Garmin GPS

ACTION PLANONGOING OR NEW ITEMS

• AAIB Adoption of GASRWG Factors

• Instructor Standards

• GA Accident Rates

• Regulatory Impact on GA Safety

• Human Factors for GA Pilots

SUMMATION

• Reviewed Over 600 MORS

• Group Continuing to Meet Biannually

• Main Factors Remain Unchanging

• Instructor Standards/Standardisation Main Issue