Aviation stalwart donates historic propeller

On 26 April 2017, Australian aviation stalwart Peter Lloyd AC OBE MiD donated the propeller from a Supermarine Walrus aircraft to the ATSB.

Figure 16: Mr Peter Lloyd and ATSB Chief Commissioner Greg Hood

Mr Peter Lloyd and ATSB Chief Commissioner Greg Hood

The Supermarine Walrus was a British single-engine amphibious biplane reconnaissance aircraft first flown in 1933. It was operated by the Fleet Air Arm and also served with the Royal Air Force, Royal Australian Air Force, Royal New Zealand Navy and Royal New Zealand Air Force.

Designed for use as a fleet spotter to be catapult launched from cruisers or battleships, the Walrus was later employed in a variety of other roles, most notably as a rescue aircraft for downed aircrew. It continued in service throughout the Second World War.

ATSB Chief Commissioner, Greg Hood, accepted the propeller on behalf of the ATSB, stating the donation was even more significant coming from Mr Lloyd.

‘Peter has made an indelible contribution to aviation safety nationally and internationally for more than half a century’, Mr Hood said. ‘The ATSB is honoured by his donation of this significant piece of Australian aviation history’.

Mr Lloyd was assigned to the 2/6th Field Regiment during the Second World War and saw action in the Middle East and New Guinea. On 8 March 1945, he was Mentioned in Dispatches for gallant and distinguished service in the South-West Pacific.

On his return to Australia, Mr Lloyd worked as a grazier and in 1951 was elected treasurer of the Royal Aero Club of New South Wales. In 1957, he became president of the club—a position he held for ten years—and then again from 1972 to 1974. He built up the club from poor condition to the largest aviation school in the British Commonwealth.

In 1958, Mr Lloyd became president of the Federation of Australian Aero Clubs, and set about greatly increasing the federation’s membership and promoting aviation sports throughout Australia.

Figure 17: Mr Peter Lloyd and the propeller from a Submarine Walrus donated to the ATSB


Mr Lloyd has been bestowed numerous prestigious awards for his services to aviation, including an Order of the British Empire in 1964, and the FAI Gold Air Medal in 1989. He has been awarded the Oswald Watt Gold Medal twice, the only person other than Sir Charles Kingsford Smith to achieve the honour. He received the award in 1969 and 2017. He was also made an Officer of the Order of Australia in 1990 for service to aviation and international relations. In 1992, he was inducted into the Sport Australia Hall of Fame.

In the 2016 Queen’s Birthday Honors, Mr Lloyd was upgraded to a Companion of the Order of Australia for eminent service to the aviation industry, particularly to the advancement of air safety in Australia, through leading roles with national and international aeronautical organisations, and airport associations.

Mr Lloyd still devotes extraordinary time and energy to the industry as President Emeritus and Life Member of Safeskies, Australia’s international air safety conference.

He is Patron of the Australian and International Parachute Federation and conducted parachute jumps over Canberra on his 80th, 85th, 90th and 95th birthdays.

The donated 1937 Supermarine Walrus propeller now takes pride of place in the foyer of the ATSB’s Canberra office.

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The ATSB’s contribution to charitable causes

The ATSB made a significant contribution to many charitable causes during 2016–17, with staff participating in dragon boat racing, marathon bike rides and a sleepout on a cold Canberra winter’s night to raise awareness and funds for a number of worthwhile charities.

In October 2016, the ATSB’s ‘Dragon Ninja’s’ participated in the Dragon Boat Regatta on Lake Burley Griffin. This fundraising event was in support of Dragons Abreast Australia, Palliative Care ACT and the Cancer Council. Dragons Abreast is an organisation that provides a ‘face’ for breast cancer statistics whilst spreading the message of breast cancer awareness through participation in the strenuous sport of dragon boat racing.

The ATSB continued its contribution to breast cancer awareness in May 2017 with staff donating to a Love Your Sister fundraising event, which secured the Guinness World Record for the longest line of five cent coins, in the shape of a love heart.

In June 2017, the ATSB offices were filled with staff wearing pink as part of the Real Men Wear Pink campaign in support of the National Breast Cancer Foundation. This included a fundraising morning tea which saw the ATSB raise over $2,500. Upon hitting this target, the ATSB Chief Commissioner kept his promise to dye his hair pink, which brought another level of colour to the ATSB.

On 5 March 2017, the ATSB’s ‘Propeller Heads’ geared up to take on the Big Canberra Bike Ride. The rides ranged from 35 km to 120 km and raised funds for the Amy Gillette Foundation—a national organisation with a mission to reduce the incidence of serious injury and death of bike riders in Australia. One of its key messages to motor vehicle drivers is ‘a metre matters’. This message, along with a couple of close encounter stories from colleagues, propelled the team to top fundraiser status for the event, raising over $1,400 for this worthy cause.

The temperature dropped into the minuses on 22 June 2017 when Chief Commissioner Greg Hood slept in the grounds of Old Parliament House to participate in the Vinnie’s CEO sleepout. The sleepout is the largest source of funding for the St Vincent De Paul Society’s homeless services. With the support of the ATSB and some extremely generous donors, more than $68,000 was raised for the appeal. These donations placed the Chief Commissioner as the ACT’s highest fundraiser and positioned him third nationally. An incredible effort for a very important cause.

Figure 18: ATSB Chief Commissioner Greg Hood at the St Vincent De Paul Society’s CEO Sleepout

ATSB Chief Commissioner Greg Hood at the St Vincent De Paul Society’s CEO Sleepout

Source: ATSB

Other ATSB activities have included the annual blood drive for the Red Cross, a 35 km walk in support of the Australian Mitochondrial Disease Foundation and awareness campaigns for White Ribbon Day, Legacy Week and DonateLife Week.

The personal time and dedication that ATSB staff have given to charities has been a true testament to the character of the ATSB and its altruism, which is not unexpected for an organisation dedicated to improving the safety of the travelling public.

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ATSB use of RPAS in investigations

During 2016–17, the ATSB acquired a DJI Phantom 4, very small remotely piloted aircraft (VSRPA), to use in its investigations on site. The ATSB had been monitoring the potential benefits of remotely piloted aircraft systems (RPAS) for a number of years, however, it was only recently that advances in technology made this a viable option. In particular, RPAS are now software-equipped and capable of high-fidelity resolution photography. These capabilities enable accident site safety assessment, and site and debris mapping that has significant advantages to traditional on-site survey techniques.

Before adopting the technology, the ATSB was aware that, in Australia, the Australian Federal Police and New South Wales and Queensland law enforcement agencies were already using VSRPA. These agencies hold operating certificates from CASA, even though they are not required because of their size.

With the ATSB being a safety agency and seeking to ensure that it is operating under the safest possible framework, the ATSB set out to acquire its own operating certificate. The ATSB was officially presented with the RPA Operator’s Certificate (ReOC) on Friday 21 July 2017.

Figure 19: ATSB investigators training to use a Remotely Piloted Aircraft System

ATSB investigators training to use a Remotely Piloted Aircraft System

Source: ATSB

On receiving the ReOC, the ATSB’s Chief Pilot for RPAS operations, Mr Derek Hoffmeister said, ‘The RPAS brings significant capability to our investigations. Investigators are now able to undertake an initial site survey to check for safety hazards before entering the site, and we can perform site mapping more quickly and with more accurate measurements. Also, comprehensive photos of an entire accident site can help investigations enormously. We can capture that imagery ourselves using RPAS–imagery that could previously only be obtained with a helicopter’.

Several ATSB investigators are now qualified to fly the DJI Phantom 4 and other RPAS up to seven kilograms. However, with the DJI Phantom 4 under the threshold for requiring an ReOC, the ATSB wants to send the message that:

  • people who are flying RPAS commercially should follow the lead of the ATSB and gain their ReOC, regardless of the size of the RPAS they’re using.

In addition to building its RPAS capability, the ATSB is conducting research and data analysis into this emerging technology to assess the safety risk to aircraft. There have been a number of ‘encounters’ between RPAS and fixed and rotary winged aircraft, which is a focus of the ATSB.

Everyone who is flying an RPAS, whether for recreational or commercial purposes, needs to make themselves aware of the regulatory requirements to perform their safety role in managing hazards and risks. Gaining an ReOC demonstrates the highest level of commitment and affords a commercial operator the flexibility and preparedness to fly any kind of drone or deal with any changes to rules or regulations.

For more information about gaining your remote pilot licence (RePL) and RPA operator’s certificate (ReOC) go to CASA website at

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ATSB presentation at the International Society of Air Safety Investigators

The annual International Society of Air Safety Investigators (ISASI) conference was held from 17 to 20 October 2016 in Reykjavik, Iceland. The ATSB was represented by Senior Transport Safety Investigator Heather Fitzpatrick, presenting a paper titled Investigating linkages between an occurrence and an organisation’s safety system performance.

The paper detailed how the ATSB has used the ‘fatigue and fatigue risk management system framework’ in linking the performance of an organisation’s systems to the events leading up to an occurrence itself. This included discussing how an organisation’s safety management system performance is considered in the course of an investigation, with examples from recent ATSB investigations (AO-2014-189) and (AO-2014-192).

Approximately 320 people attended the conference, which hosted representatives from 43 countries. Overall, the presentations given throughout the conference included a number that were of interest to the ATSB’s methods and approach to investigation, including presentations from the UK’s Air Accidents Investigation Branch on the use of a drone and photogrammetry software to create 3D models of accident sites; the Dutch Safety Board’s presentation on the MH17 investigation from the perspective of the personal challenges faced by the investigators during their on-site work; and the deputy investigator in charge of the Germanwings accident presenting on the various considerations in managing pilot mental health.

The ATSB seeks to be an active participant in forums where there is an opportunity to share knowledge and experiences. Accident investigators are best positioned to identify safety issues when they are working from the wealth of knowledge from occurrence investigations that has come before them.

Figure 20: Heather Fitzpatrick presenting at the International Society of Air Safety Investigators


Source: ATSB


The ATSB hosts marine investigators forum

In October 2016, the ATSB hosted the 19th meeting of the Marine Accident Investigators Forum in Asia (MAIFA).

The meeting brought together experts from across the Asia–Pacific region to discuss and exchange views, ideas and information on marine safety investigations.

A number of presentations were provided by participating countries and discussions also took place on a wide range of topics, including an interesting debate on hydrographic services, chart corrections and collision avoidance stemming from a Singaporean case study.

Attendees were also provided with an insight into Australia’s investigative capabilities with a tour of the ATSB’s laboratories, and into the work of the Australian Maritime Safety Authority through a visit to its Joint Rescue Coordination Centre.

Figure 21: Participants at the October 2016 MAIFA Conference in Canberra

Participants at the October 2016 MAIFA Conference in Canberra

Source: ATSB

ATSB Chief Commissioner, Greg Hood, said Australia’s reputation for high-quality, rigorous investigations makes us uniquely placed to assist with transport safety in the Asia–Pacific region.

‘The ATSB has an active program of regional engagement with other transport safety agencies, over and above that required by our international obligations’, Mr Hood said.

‘In addition to investigating marine accidents and incidents in Australia, we provide technical assistance to a number of countries in our region’, he continued.

Countries participating in the 19th MAIFA were Cambodia, the People’s Republic of China, Hong Kong, Japan, the Republic of Korea, Malaysia, New Zealand, Singapore, Thailand, Vietnam and Australia.

A key outcome was a motion for establishing a permanent secretariat for MAIFA— a non-profit organisation dedicated to the advancement of marine safety and the prevention of marine pollution. MAIFA’s purpose is to promote and improve marine accident investigation, and to foster cooperation and communication between marine accident investigators.


The ATSB proactively engaging with industry on transport safety

The ATSB’s independent investigations and world-class research and analysis produce important safety messages intended to help prevent accidents and incidents from recurring. To get safety messages to the people and organisations who can make the best use of them, the ATSB undertakes a wide variety of industry engagement activities. These include participation in consultative forums with industry and other safety agencies; representation at conferences and events; bilateral engagement with operators, associations and other stakeholders; the creation and distribution of educational materials; and active involvement in safety education forums.

In addition to its participation in a number of public forums, the ATSB works to familiarise members of industry with its operations, hosting meetings on its premises and acquainting visitors with the organisation’s capabilities. This includes meeting with investigators, and providing guided tours of our technical facilities: the engineering lab, the recorder download lab, and the audio lab. These last two, where investigators access and analyse Cockpit Voice Recorder and Flight Data Recorder readouts for occurrences in Australia and overseas, are unique to the Asia–Pacific region. Australia is one of the few countries in the Asia–Pacific region to possess these types of laboratories.

In February 2017, stakeholder engagement included hosting a meeting of chief pilots from all of Australia’s high-capacity carriers. The forum was established to enhance aviation safety by encouraging the ongoing, effective relationship with industry stakeholders.

Facilitated by Virgin Australia Regional Airlines, the group met at the ATSB to discuss transport safety notifications and occurrence reporting, as well as aviation regulatory matters. This provided an opportunity for Chief Commissioner Greg Hood to explain how the national transport safety investigator is evolving to meet a host of new challenges within the aviation industry. The chief pilots were also able to tour the ATSB’s technical facilities.

The ATSB Chief Commissioner, Greg Hood, said that connecting with industry was vital to making a real difference to transport safety. ‘We make recommendations to industry and government on an ongoing basis as part of our investigations. By establishing a relationship of mutual respect and ensuring that industry understands the importance and quality of our investigations, we’re working to ensure that our safety messages lead to real action’.

Figure 22: ATSB Chief Commissioner Greg Hood with members of the Chief Pilots’ Forum

ATSB Chief Commissioner Greg Hood with members of the Chief Pilots’ Forum

Source: ATSB

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ATSB safety message goes viral

Figure 23: Image showing aftermath of the battery explosion

Image showing aftermath of the battery explosion

Source: Supplied

A cautionary news article written by the ATSB on lithium ion batteries exploding inside a set of headphones mid-flight went viral in March, after being shared on the ATSB’s social media channels.

On 14 March 2017, the ATSB authored an article highlighting the potential risk of explosion and fire from battery-powered devices on flights after a woman was injured by malfunctioning headphones.

The article was viewed more than 50,000 times and reached over 79,000 people through Facebook, while also receiving almost 30,000 impressions on Twitter. The story was picked up by a large number of media outlets nationally and internationally, further spreading the safety message to the travelling public and industry. An internet search for the story at the time brought up over a million search results on Google.

ATSB Chief Commissioner, Greg Hood, said the level of interest in the article, and its rapid spread across the world, highlights the importance of online engagement by the ATSB. He said, ‘A key function of the ATSB is to improve safety and public confidence in the aviation, marine and rail modes of transport, and one of the ways we do this is through fostering safety awareness, knowledge and action. Our online channels, including our website, allow us to communicate our messages immediately with our stakeholders.

‘In this instance, we were able to use the article to direct readers to further information on travelling safely with batteries and portable powerpacks, as well as provide details of other similar incidents for context’.

Continuing to build the ATSB’s social media presence is one of the ATSB’s Key Deliverables in 2017–18.

You can visit the ATSB online through our website, Twitter, Facebook, or YouTube accounts.


The ATSB Evolution Program

The 2016–17 financial year has been a year of positive and exciting change for the ATSB.

Under the direction of its Chief Commissioner, the ATSB implemented a significant transformation initiative known as the ‘Evolution Program’. This program, in essence, was designed to enable better resource allocation and utilisation across the agency. It was underpinned by a number of change imperatives including:

  • shifting our strategic focus towards becoming a fully capable and mature data-driven organisation—moving from being reactive to proactive to eventually, predictive
  • recognising the importance/imperative of improving safety by raising industry and community safety awareness, knowledge and action through safety education and promotion
  • moving from output or report focused, to outcome focused
  • improving our cumbersome procedural framework
  • re-establishing accredited learning and development pathways
  • strengthening our recruitment, performance and talent management frameworks
  • developing a culture of empowerment, performance and continuous improvement
  • re-energising our workforce
  • establishing greater financial assuredness and sustainability.

Ultimately, the overarching objective of the program is to create an environment where all ATSB employees work collaboratively as ‘one team’. Implicitly, our staff will be empowered and given every opportunity to bring to bear their collective core skills, shared values, passion and drive to improve transport safety.

Figure 24: ATSB staff meeting

ATSB staff meeting

The Evolution Program has certainly lived up to its connotation. While there have been changes within our organisational structure–most notably, a streamlined senior management group and the introduction of multi-disciplined investigator teams—the program has also provided the impetus to refine our business practices and expand our deliverables.

A key success factor for the program has been the Government’s recent budget measure which will enable the ATSB to increase its capabilities beyond primarily conducting independent ‘no-blame’ accident and incident investigations. The ATSB will have a renewed focus on data collection, analysis and research, and will raise industry and community safety awareness through increased safety education and communications. Consequently, the ATSB will be able to more selectively allocate resources to investigate accidents and incidents that have the greatest potential for improving safety for the travelling public. It will also allow the ATSB to make advances in the timeliness of completed reports.

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ICAO audit the ATSB

In April 2017 the International Civil Aviation Organization (ICAO) conducted an on-site audit of the ATSB’s compliance with ICAO’s standards, recomme nded practices and guidance material for aircraft accident investigation. Australia sought the audit from ICAO with ATSB Chief Commissioner Greg Hood stating, ‘This is an important opportunity for the ATSB to demonstrate its accident investigation capabilities against the benchmark set by ICAO. We know that we are doing well in a number of areas but the results of an audit can give us new insights into how we conduct investigations, with a view to enhancing our capacity to deliver outcomes for aviation safety’.

The audit covered core areas including:

  • promulgation of aircraft accident investigation legislation
  • establishment of an independent accident investigation authority
  • allocation of sufficient financial resources
  • qualifications and training of personnel
  • availability of facilities and equipment
  • establishment and implementation of investigation procedures
  • the conduct of timely investigations and publication of findings.

Figure 25: ICAO Auditor Thor Thormodsson

ICAO Auditor Thor Thormodsson

Source: ATSB

The ICAO auditor sent to Australia was Mr Thor Thormodsson. He has a background as a commercial and instrument-rated pilot and as an accident investigator. He has conducted ICAO audits for the past eight years.

Mr Thormodsson said the following in relation to his work as an ICAO auditor, ‘On the whole, my job is highly rewarding. It keeps me in touch with the outside world. I perform an audit, then go back to the country and see significant differences due to the audit findings and safety recommendations’.

Australia is fortunate that it has a relatively mature safety oversight system and expects that the audit will reflect well on Australia’s conformance with ICAO’s requirements for accident investigation. Where there are identified opportunities to improve, the ATSB will be working to ensure positive change.

The results of the audit will be made available through ICAO’s online portal.

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Search for MH370—mapping the seafloor in the search area

Consistent with the principles of open government, the ATSB seeks to transparently disclose information in the public domain that it acquires during the course of carrying out its functions. The search for MH370 was an extension of the ATSB’s normal investigative work in which large volumes of data was acquired from surveying the seafloor. This information is now being released to the public.

The underwater search for MH370 required a phased approach, given the unknown composition and topography of the seafloor in the search area. Before the high resolution sonar search commenced, a bathymetric survey was conducted to ensure that the underwater vehicles to be used in the search could be navigated safely and efficiently close to the seafloor.

The majority of the bathymetric survey was conducted using hull-mounted multibeam sonar systems on numerous vessels from May to December 2014. Supplementary bathymetry data was intermittently acquired to expand the search area from December 2014 to February 2017.

Figure 26: The differences in resolution between multibeam and satellite‑derived bathymetry data

The differences in resolution between multibeam and satellite‑derived bathymetry data

The search for MH370 collected 278,000 square kilometres of bathymetry data within the search area and 710,000 square kilometres of data in total, which includes the data acquired in transit between port and the search area.

The data gathered during the underwater search was analysed and mapped by Geoscience Australia. Previous maps of the seafloor in the search area were from satellite-derived gravity data and only indicated the depth of the ocean at a coarse resolution of approximately 5 square kilometres per pixel. The MH370 bathymetric survey collected data at 40 square metres per pixel, allowing for safe navigation for underwater vehicles.

The underwater mapping revealed details about the seafloor that were not visible in the previous satellite-derived bathymetry, including vast seamounts 1,500 m high and kilometres wide, deep canyons and underwater landslides of sediment that travel for kilometres along the seafloor.

Figure 27: Geelvinck Fracture Zone 4,500 m below sea level, fault depth 900 m.

Geelvinck Fracture Zone 4,500 m below sea level, fault depth 900 m.

Source: ATSB/Geoscience Australia

Note: Vertical exaggeration is 3 times.

From the beginning of the underwater search for MH370, it was always intended that all seafloor data gathered would be released to the Australian and international public.

While the data was collected for the sole purpose of locating MH370, it will also be of particular interest to the scientific community, as it represents the results of the largest continuous deep-sea survey undertaken, and is some of the first high-resolution data of this area of the southern Indian Ocean.

The data collected through the first phase of the search for MH370 is now publically available from Geoscience Australia.