Annual Safety Report 2013
U.K. Air Accidents Investigation Branch (AAIB). 77 pp. Figures, indexes, tables. October 2013. Available from the AAIB at <www.aaib.gov.uk>.
This report is the AAIB’s ninth annual review of aviation accident data from the previous year, along with a description of progress made involving agency safety recommendations published the previous year.
The document includes a brief presentation of accident data from 2012, 2011 and 2010, followed by the AAIB’s progress report on the results of recommendations; this progress report is divided into eight sections — one each for three weight categories of airplanes and three weight categories of rotorcraft, one for microlights and one for “others” — and two indexes — one arranged by section and the other, by recommendation number.
The report’s data show a total of 744 aviation accidents and serious incidents in 2012, including 13 fatal accidents involving 16 fatalities; all fatal accidents involved privately operated aircraft. In comparison, the 2011 data showed 788 accidents, including 14 fatal accidents and 16 deaths.
The AAIB made 35 safety recommendations in 2012. Of that number, 22 were accepted and considered closed, one was rejected “for acceptable reasons” with no further AAIB action planned, two were rejected and considered open with further action required, and four were partially accepted and still considered open. The AAIB was awaiting a response to six others, which were classified as open.
More AAIB safety recommendations were directed to the European Aviation Safety Agency than to any other entity, with a total of 32; followed by the U.S. Federal Aviation Administration, the recipient of 19 recommendations; and the U.K. Civil Aviation Authority, which received 11, the report said. (A number of recommendations were made to more than one addressee.)
In an introductory section of the report, AAIB Chief Inspector Keith Conradi wrote that, because of the recent introduction of the European Union (EU) Safety Recommendation Information System, which provides a central repository for recommendations from all EU member states, the AAIB will review the format of its annual safety report before publication of the 2014 document.
Human Factors Considerations in the Design and Evaluation of Flight Deck Displays and Controls
DOT/FAA/TC-13/44. Yeh, Michelle; Jo, Young Jin; Donovan, Colleen; Gabree, Scott. U.S. Department of Transportation John A. Volpe National Transportation Systems Center. 361 pp. Appendixes, figures, index, tables. Available from the Volpe Center at <www.volpe.dot.gov/our-work/safety-management-and-human-factors/human-factors-publications-and-papers>.
This report, designed as a “single-source reference document for human factors regulatory and guidance material for flight deck displays and controls,” is intended to help in the early identification of a number of human factors issues on the flight deck.
“The flight deck is an information-intensive environment,” the report said. “The number of flight deck displays and controls has proliferated as new technology offers new capabilities and formats for presenting information and new methods for control and interaction. Understanding how a display system or control will be used by pilots and flight crews and how it will interact with other flight deck displays and controls is essential. Consideration of human factors issues early on and throughout the design process will help to ensure that the displays and controls will support all flight crew functions, tasks and decisions.”
Human factors requirements for using flight deck displays and controls are discussed in a number of regulatory and guidance documents, the report said, and in many cases, generic human factors material is scattered throughout a document that is several hundred pages long.
Therefore, this report was designed to consolidate human factors material that applies to “all types of flight deck displays and controls used for all types of aircraft,” the report said. “The guidance addresses the human factors/pilot interface aspects of the display system hardware, software (e.g., the depiction and organization of information display elements and features), and the design of control devices. A discussion of the importance of establishing a design philosophy and considerations for assessing workload, managing errors, implementing automation, and protecting against and managing system failures [is] also provided.”
In its introduction, the report said that it should not replace the FAA’s aircraft-specific regulatory and guidance information but instead help “raise the level of awareness regarding human factors to facilitate the identification and resolution of human factors issues as well as to support consistency and compatibility in designs within and across flight decks.”
The report’s 10 chapters discuss issues including display hardware and how hardware resolution, size and other characteristics affect the readability of cockpit displays; the design, layout and operation of controls and related usability issues; flight deck design philosophy; error management and mitigation, as well as the potential for human error; workload and workload evaluation techniques; and automation.
A series of appendixes provide additional information on the best use of the report; a list of related research reports and other helpful documents; sample checklists, evaluation procedures and “scenarios for identifying human factors considerations as part of flight deck display and control evaluations”; and a list of regulations related to human factors.
Further Actions Are Needed to Improve FAA’s Oversight of the Voluntary Disclosure Reporting Program
AV-2014-036. U.S. Department of Transportation Office of Inspector General (OIG). April 10, 2014. 20 pp. Exhibits, figures. Available from OIG at <www.oig.dot.gov/oversight-areas/aviation>.
This OIG report on the agency’s review of the U.S. Federal Aviation Administration’s (FAA’s) handling of its voluntary safety reporting programs describes the programs as crucial in improving air carrier safety and suggests that the FAA ensure that it takes advantage of all opportunities to use the associated safety data.
The report focused on the FAA Voluntary Disclosure Reporting Program (VDRP), which allows air carriers to voluntarily report areas of noncompliance with FAA regulations and to make corrections without being subject to civil penalties. The voluntary reporting process also provides the FAA with valuable safety oversight information.
“While VDRP provides an important opportunity to identify and mitigate safety issues, it requires close monitoring by FAA to ensure the program is not misused,” the report said. “For example, in 2008, we reported a serious abuse of the program in which FAA allowed a major airline to repeatedly self-disclose violations of mandatory safety directives without ensuring the carrier had developed and implemented solutions to prevent recurrence of the problems.”
A 2012 law required an OIG review of the FAA’s oversight of VDRP, and this report describes the findings of that review, which found that the FAA has strengthened controls designed to prevent misuse of the program and has improved its analysis of safety data.
The report said that OIG auditors visited 10 air carriers operating under U.S. Federal Aviation Regulations Part 121, as well as the FAA offices responsible for oversight of the air carriers’ VDRPs. The review found that instances of noncompliance reported through VDRP usually are identified “through the air carrier’s internal quality control processes, analysis of safety data and employee reporting through the aviation safety action program [another voluntary program that enables individual pilots, dispatchers, flight attendants, maintenance technicians and members of other specified employee groups to disclose possible safety violations without fear of penalty],” the report said.
The review found that the FAA has made progress since the 2008 incident in “ensuring that air carrier disclosure reports meet VDRP requirements.”
Nevertheless, the report detailed several persistent problems, including an insufficient emphasis on underlying causes of VDRP-covered violations and the ineffective collection and analysis of VDRP data to “identify trends and target safety risks.”
To address those concerns, the report recommended that the FAA “add dedicated data fields in the VDRP electronic system for air carriers to describe the root cause(s) associated with the noncompliance and identify whether the violation occurred due to the actions of an individual or a systemic problem” and “require inspectors to evaluate the root cause(s) determination to ensure repeat self-disclosures do not go undetected and potential systemic issues are identified.”
Other recommendations included calls to “ensure that inspectors’ ability to obtain safety data is not further restricted through efforts to streamline voluntary safety programs” and to “analyze VDRP data from a national perspective to aid in the identification of system-wide trends and patterns that represent risks.”