Recommendation R19990052

Recommendation issued to: Civil Aviation Safety Authority

Recommendation details
Output No: R19990052
Date issued: 06 September 1999
Safety action status:
Background: Why this Recommendation was developed

Output text

The Bureau of Air Safety Investigation recommends that the Civil Aviation Safety Authority, in conjunction with the aircraft manufacturer, British Aerospace Plc, address deficiencies that permit the entry of fumes into the cockpit and cabin areas of BAe146 aircraft. These deficiencies should be examined by the regulatory authority as part of its' responsibilities for initial certification and continued airworthiness of the BAe 146 Aircraft.

As a result of the investigation into this occurrence, the Bureau simultaneously issues recommendation R990053 to British Aerospace Plc:

"The Bureau of Air Safety Investigation recommends that British Aerospace Plc liaise with the engine manufacturer, AlliedSignal, to investigate failures within the engine that result in fumes entering the cockpit and cabin areas of BAe146 aircraft".

Initial response
Date issued: 21 January 2000
Response from: Civil Aviation Safety Authority
Action status: Monitor
Response text:

In the lengthy period between the incident and the release of your report,CASA has investigated this issue in considerable detail, in conjunction with the aircraft manufacturer and the major Australian operators. As a result of this work, and discussions with the certifying authority (the UK Civil Aviation Authority), CASA is satisfied that the BAel46 aircraft in service in Australia are safe for public transport. CASA technical specialists are available to brief your investigators on the scope and findings of this work.

As your recommendation does not specify the nature of any additional deficiencies that the Bureau believes need to be addressed by CASA and the aircraft manufacturers, I am seeking details of any deficiencies that you believe have not been appropriately dealt with. It would also assist us in providing a meaningful and constructive response to your recommendations if you were to provide us with details of any incidents that have occurred since the original incident in 1997.

In the meantime, we will continue to monitor the situation and review any information that comes to hand.

ATSB response:

The following letter was sent to the Civil Aviation Safety Authority on 24 January 2000:

Thank you for your response to Occurrence Brief 199702276 and Recommendation R19990052 dated 5 November 1999.

In regard to the detailed investigation CASA has carried out in conjunction with the manufacturer and UK CAA, your conclusion that the BAe 146 aircraft type is safe for public transport in Australia has been noted.

This has been a very complex issue and to ensure that the ATSB is fully conversant with the reasons behind your conclusions, I would be most pleased to accept your offer of a CASA technical specialist briefing of our investigators. To facilitate planning, your early advice as to when this could take place is sought


ATSB Note:

In early May 2000, Bureau staff met twice with CASA staff to discuss fumes occurrences and actions available to mitigate fumes events. The actions available included modifications for BAe 146 aircraft and one operator had commenced modifying its 146 fleet.

The ATSB reclassifies the recommendation as Closed - Partially Accepted.

Further correspondence
Date issued: 12 May 2000
Response from: Civil Aviation Safety Authority
Response status: Closed - Partially Accepted
Response text:
Last update 01 April 2011