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Safety Action

Summary

Several safety deficiencies were identified during the initial phase of the investigation. Local safety action was agreed to and addressed by the operator prior to publication of the final report. Those safety actions were as follows:

Issue of company Maintenance Alert MA/C400/2, which required a detailed inspection and functional check of the fuel selector system of all the operator's Cessna 402C aircraft.

A second Alert MA/C400/2 amendment 1, was issued a short time later after the initial fleet inspection found that the fuel selector valves for a second aircraft were out of synchronisation with the selector indicator. This alert detailed further inspection and rectification instructions.

The operator has undertaken to re-examine the company operations manual with a view to improving the guidance information on fuel planning and reserves.

The operator has agreed to re-examine the need for the cross-feed and shut-off checks. If they are considered necessary, then a procedure to ensure that the desired outcome is achieved will be devised and introduced.

The operator's maintenance controller has introduced procedures to ensure that all trip records are now vetted daily. Any endorsement item considered to have the potential to affect the safety of flight will now be subject to immediate maintenance rectification.

The operator has amended and amplified the incident and accident reporting section of the company Policy and Procedures Manual to better reflect the correct reporting procedures.

The Operator has introduced the Daniel System Australia, Integrated Aviation Software (IAS) in the company's electronic maintenance control system. This software has the ability to monitor and identify repetitive defects. The company Maintenance Control manual Vol 1, section 9 has been changed to reflect the changed procedures.

 
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