New CASA regulations do not impact on existing obligations to report safety occurrences to the ATSB

The Australian Transport Safety Bureau is stressing that the introduction of new Civil Aviation Safety Authority flight operations regulations do not impact on existing obligations to report safety occurrences to it.

The new CASA regulations took effect from 2 December 2021, and are relevant to all pilots and operators.

But they do not affect obligations to notify the ATSB of aviation accidents and incidents, as these are defined under the Transport Safety Investigation Regulations, and so are separate to CASA’s Civil Aviation Safety Regulations.

“Pilots’ and operators’ obligations to report accident and incidents to the ATSB remain unaffected by the introduction of the new CASA regulations,” ATSB Director Transport Safety Dr Stuart Godley said.

“When reporting occurrences to the ATSB we do ask that reporters be aware of the flight operations Civil Aviation Safety Regulation (CASR) Part relevant to your operation and include this in your reports to the ATSB.

“But your obligations to report occurrences are based on the type of operation defined in the Transport Safety Investigation Regulations which remain unchanged by CASA’s new regulation changes.”

Accidents and incidents which affect the safety of an aircraft must be immediately reported to the ATSB by telephone by calling 1800 011 034 (or if calling from outside Australia, +61 2 6230 4470). Less serious aviation occurrences – matters that have not had a serious outcome but transport safety was affected or could have been affected – can be reported to the ATSB online via our webform.

Obligations to report accidents and incidents are legislated under the Transport Safety Investigation Act 2003, which enable the Transport Safety Investigation Regulations.

Dr Godley noted that the ATSB anticipates undertaking consultation on updates to the reporting requirements in the Transport Safety Investigation Regulations during 2022, with a planned commencement date of revised regulations of 1 January 2023.

Pilot encountered pitch-up controllability issues after ground handlers estimated weight of relocated freight by feel

A Metro freighter aircraft’s pilot had to use forward pressure on the control column to maintain level flight after ground handlers estimated the weight of freight that was relocated into the aircraft’s nose by feel. This resulted in the aircraft’s centre of gravity falling outside of the rear limit, an Australian Transport Safety Bureau investigation into the occurrence details.

On 11 May 2020, the twin turboprop Fairchild Metro 23 aircraft, operated by Toll Aviation, was being loaded for a scheduled freight service from Townsville to Brisbane via Rockhampton, in Queensland.

Prior to take-off from Townsville, the pilot completed a load and trim sheet based on a load plan provided by the ground handling team.

A load and trim sheet is used to calculate the total weight on board, and to ensure the distribution of that weight does not shift the aircraft’s centre of gravity beyond lateral and longituidinal limits, which is critical to ensure stable, controllable flight.

The pilot’s calculation indicated the distribution of freight throughout the aircraft’s six main zones was too heavily weighted to the rear.

To address this, the pilot and ground handlers agreed 126 kg of freight would be moved out of the aircraft’s third zone compartment, and into the nose storage compartment.

“During this last-minute change, the ground handlers did not accurately weigh the freight being relocated, as there were no scales at the aircraft,” ATSB Director Transport Safety Dr Michael Walker explained.

“Instead, they estimated the mass of the freight by feel, and only actually moved around 65 kg of cargo.”

The resulting discrepency between the pilot’s planned load and trim sheet, and the actual load distribution on the aircraft, was not initially enough to put the aircraft’s centre of gravity outside the allowable limits.

However, when the aircraft landed in Rockhampton, more freight was loaded into the rear half of the aircraft, and the centre of gravity shifted further aft, beyond the allowable limit.

“On the second leg of the journey, the pilot reported the aircraft had a strong pitch-up tendency, and that strong forward pressure on the flight controls was required to maintain the correct pitch attitude,” Dr Walker said.

“During the cruise, the autopilot would not consistently maintain level flight. The pilot disconnected the autopilot and, with full nose-down trim applied, the pilot had to maintain forward pressure to control the pitch attitude of the aircraft.”

After landing safely in Brisbane, the pilot discussed the incident with ground maintenance engineers, and the freight from each compartment was reweighed as it was unloaded.

“The pilot subsequently completed a new load and trim sheet using the actual weights and the centre of gravity was found to be aft of the rear limit,” Dr Walker said.

Additionally, when accounting for the weight added in Rockhampton, the new data showed the aircraft was actually about 6 kg above its maximum take-off weight when it initially took off from Townsville, on the first leg of its journey.

Due to fuel burn during the first leg of the flight, the aircraft had come under its weight limit by the time it landed and took off in Rockhampton.

“This incident demonstrates the critical nature of load control,” Dr Walker said.

“It also emphasises the importance of providing ground handlers with sufficient and detailed procedures to allow them to accurately conduct load control duties and minimise the potential for error.”

The ATSB’s investigation found the operator’s ground handling manual did not contain detailed procedural guidance for facilitating accurate redistribution of freight and ensuring that an aircraft would be correctly loaded.

Following the incident, Toll amended its ground handling processes, and included increased direction to ensure that freight would be accurately redistributed in the event of a last-minute change.

Notably, the operator has since divested its flying operations to another operator, and relinquished its Air Operator’s Certificate.

The ATSB, in consultation with Toll, contacted the new aircraft operator to discuss the potential risk of a lack in procedural guidance for ground handling.

“Although the safety issue was not directly related to them, the new operator has reviewed their ground handling manual and incorporated amendments to address the safety issue,” Dr Walker concluded.

Read the final report: Aircraft loading and in-flight controllability issue involving Fairchild SA227, VH-HPE, Rockhampton Airport, Queensland, on 11 May 2020

Supporting World Maritime Day 2021 to help keep the world's seafarers safe

The United Nation’s World Maritime Day is an opportunity to highlight the professionalism and dedication of the 2 million seafarers who serve on the world’s merchant fleet.

Throughout the pandemic shipping has continued to transport vital medical supplies, food and other basic goods that are critical for the global COVID-19 response and recovery and highlighted the contribution of all seafarers as key and essential workers on the front line of delivering vital goods through a pandemic and in ordinary times.

This year World Maritime Day(Opens in a new tab/window) aims to raise awareness of seafarer’s crucial role in world trade and focus attention on their place at the core of the global shipping industry including their role in maritime safety.

The ATSB is deeply committed to improving maritime safety for seafarers through its ‘no-blame’ maritime accident investigations and safety messaging to industry and individuals to prevent future accidents. The ATSB also recognises and celebrates its transport safety investigators who began their careers at sea.  Ahoy!

To learn more about some of our more recent maritime investigations and their related safety messaging read the reports below. 

MO-2018-008: Loss of containers overboard involving YM Efficiency, 16 NM east-south-east of Newcastle, New South Wales, on 1 June 2018

MO-2018-009: Fatality in the elevator trunk on board OOCL Kuala Lumpur, 8.5 nautical miles south-east of Port Botany, New South Wales, on 3 June 2018

MO-2018-011: Fire on board Iron Chieftain, Port Kembla, New South Wales, on 18 June 2018 

New transport safety reporting requirements reflect growing importance of remotely piloted aircraft

The Australian Transport Safety Bureau will be better able to assess safety issues and monitor trends in the operation of remotely piloted aircraft (or drones), thanks to new reporting requirements.

On 30 September 2021, the Transport Safety Investigation Regulations 2003 will be repealed and replaced by the new Transport Safety Investigation Regulations 2021(Opens in a new tab/window). These new regulations will continue to require the reporting of certain transport safety occurrences to the ATSB as immediately or routine reportable matters.  The main changes to these regulations will be the introduction of updated requirements for operators of certain types of remotely piloted aircraft (RPA) to make reports to the ATSB.

“RPAs are an emerging form of commercial aviation that will benefit from investigation into systemic safety issues to help prevent future accidents,” said ATSB Chief Commissioner Angus Mitchell.

“The recognition of transport safety issues associated with the operation of RPAs, will be a welcome development, and provide greater certainty for commercial operators and enthusiasts alike.

“For the ATSB, it’s an exciting opportunity to apply our world-leading aviation safety investigation capabilities, and improve safety outcomes in a growing field.”

Recognising the range of different types of RPA and their uses, the regulations will categorise relevant RPA as type 1 or type 2 RPA.  RPAs that have been certified against relevant airworthiness standards (type certification), large (greater than 150kg) and medium RPAs (more than 25kg but not more than 150kg) are defined as type 1 and are an emerging form of commercial aviation that will benefit from investigation into systemic safety issues to help prevent future accidents.

In contrast, type 2 RPA are defined as those RPA that are not type 1, excluded or micro RPA (gross weight of not more than 250 grams) and will have fewer reporting requirements. This distinction is made on the basis that ATSB investigations are unlikely for these operations unless there is serious risk of harm to people or significant third-party property.

RPAs that are not type 1 or type 2 including excluded or micro RPA will have no reporting requirements under these regulations.

Mandatory reporting for certain occurrences involving type 1 and type 2 RPA (see below) will allow the ATSB to properly measure, investigate and report on safety trends in the RPA sector.

Making a report to the ATSB is not a time-consuming process, and the ATSB investigates incidents from a ‘no-blame’ perspective, prioritising improved safety outcomes.

Who is affected?

In order to provide an efficient and effective safety framework, the new regulations define two types of RPAs which will be subject to specific reporting requirements.

Type 1 RPAs are those which are type certified, large (over 150 kg) or medium (25 kg to 150 kg) RPA.

Type 2 RPAs are those that are not Type 1, and are not an excluded or micro (under 250 g) RPA.

Under the revised requirements, Type 1 operators will be required to immediately report to the ATSB RPA occurrences involving:

• death or serious injury;
• accidents;
• loss of a separation standard with aircraft; and,
• serious damage to property.

Less serious incidents and occurrences are required to be reported to the ATSB within 72 hours

Occurrences involving Type 2 RPAs will generally only need to be immediately report to the ATSB if they involve death or serious injury, while less serious incidents and damage to the RPA will need to be reported within 72 hours.

Reports can be made on the ATSB website, or by calling 1800 011 034.

About the ATSB

The ATSB contributes to transport safety by independently investigating, analysing and openly reporting on transport safety matters.

Each year the ATSB receives more than 17,000 notifications of transport incidents and accidents.

To prevent future transport safety occurrences, especially those with the potential for loss of life or serious injury, the ATSB directs its investigation resources to those incidents and accidents with the greatest potential of identifying systemic issues in aviation, marine and rail transport operations.

Read more: /about_atsb/overview/

Changes bring ATSB marine regulations up to date

Amendments to investigation regulations have revised the descriptions for the types of vessels that are required to report transport safety occurrences to the Australian Transport Safety Bureau.

On 30 September 2021, the Transport Safety Investigation Regulations 2003 will be repealed and replaced by the new Transport Safety Investigation Regulations 2021(Opens in a new tab/window). These regulations will update the descriptions for vessel types and reportable matters to align with terminology in the Navigation Act 2012.

The commencement of the new regulations will require the following vessel types to report certain occurrences to the ATSB:

• regulated Australian vessels (within the meaning of the Navigation Act) in the course of relevant marine navigation
• foreign vessels (within the meaning of the Navigation Act) in certain Australian waters and in the course of relevant marine navigation
• domestic commercial vessels, as defined in the Marine Safety (Domestic Commercial Vessel) National Law, that are on an interstate voyage.

The regulations will also align the types of occurrences that must be reported to the ATSB (as a reportable matter) under the TSI Regulations, with ‘marine incidents’ that must be reported to AMSA under the Navigation Act

“In practice, these amendments won’t change the process for reporting transport safety occurrences to the ATSB, and operators may continue to report occurrences directly to the Australian Maritime Safety Authority, who will forward the report,” ATSB Chief Commissioner Angus Mitchell said.

“These amendments will ensure that the Transport Safety Investigations Regulations are aligned with the terminology in the Navigation Act. The Regulations will continue to exclude domestic commercial vessels from these requirements, unless they are on an interstate voyage.”

Underwater helicopter escape highlights importance of emergency breathing systems 

A pilot’s difficulty experienced while escaping an aerial firebombing helicopter after it had impacted and sank in a reservoir following an engine failure highlights the potential value of emergency breathing systems, an ATSB investigation highlights. 

Using a 1,400 litre water bucket on a 100 foot long-line, the UH-1H helicopter was collecting water from the Ben Boyd Reservoir to assist bush-fire clean-up operations near Eden on the NSW south coast on 9 January 2020. 

As the helicopter arrived in a 100 ft hover over the water, the pilot heard a grinding noise. In response they jettisoned the long-line and bucket and applied forward cyclic to fly towards land. 

However, the helicopter experienced a complete loss of engine power and immediately descended into the water. On impact, the helicopter’s chin-bubbles fragmented, and the helicopter rolled inverted, filled with water, and sank. 

Unable to open the pilot, co-pilot, or sliding cabin doors, the pilot punched out the right sliding door rear window and escaped the helicopter. The pilot inflated their lifejacket and swam to shore, surviving the accident with minor injuries. 

While the pilot was not carrying, and was not required to carry, an emergency breathing system (EBS), during the escape they found a pocket of air in the cabin, allowing them to take ‘a couple of breaths’. 

“Research into helicopter overwater accident survival consistently reports drowning as the leading cause of fatalities, due to the inability of the occupant to hold their breath long enough to escape,” said ATSB Chief Commissioner Angus Mitchell. 

“In this accident, the pilot found an air pocket in the cabin, which enabled the escape time to extend beyond the initial breath-hold time. While it could not be determined if the pilot would have drowned without the air pocket, it would have increased that likelihood. 

“Although the pilot was able to successfully escape from underwater after finding the air pocket, an emergency breathing system would have reduced the risk of drowning.” 

The pilot had conducted a number of helicopter underwater escape training (HUET) courses, a condition of the operator’s contract with the NSW Rural Fire Service. At interview, the pilot told ATSB investigators he ‘would have been dead without HUET’. 

However, the pilot had not completed the EBS portions of the HUET courses as EBS equipment had not been introduced into their operation.  

A range of EBS options are available on the market, including rebreather, compressed air, and hybrid options. 

“Helicopter underwater escape training – or HUET – provides a learning environment for the essential skills of maintaining orientation, location, and operation of exits,” said Mr Mitchell.  

“However, extended breath-hold may be necessary for problem-solving and physical effort during an underwater escape, such as dealing with snagging hazards, obstructions, or inoperative exits that require an alternative escape route, as in this accident.  

“In these scenarios an EBS can afford the pilot sufficient time to perform the escape actions without an air pocket and therefore reduce the risk of drowning.” 

Following the accident, the pilot acquired a compressed air EBS and intends to conduct the EBS elements of future HUET courses. 

“The operator reported they have started investigating how to implement EBS company-wide, and how to attach the units to their pilots without limiting their movement when conducting long-line operations,” Mr Mitchell said. 

Following a teardown inspection by the manufacturer, the engine failure was determined to have resulted from inadequate lubrication to two main bearings in the front section of the engine, leading to their failure. 

This resulted in contact between the power and compressor shafts, disconnection of rotational drive to the fuel pump and fuel control, and subsequent fuel starvation. 

However, the exact cause of the restriction of oil flow to the main bearings in the front section of the engine was not able to be established. 

Read the report: Engine failure and collision with water involving Garlick Helicopters UH-1H, VH-ONZ, Ben Boyd Reservoir, New South Wales, on 9 January 2020

Guidance updated after airliner overruns wet Newman runway

Key points:

• Aircraft was conducting a higher than normal speed approach due to winds and turbulence;
• Runway was wet with active rain, reducing braking effectiveness;
• Aircraft came to a stop beyond the runway threshold, but inside the runway end safety area.

Operator and regulator guidance has been updated after a Fokker 100 airliner overran a wet runway at Newman Airport last year, an Australian Transport Safety Bureau investigation notes.

The ATSB investigation into the 9 January 2020 incident found the combination of the higher than normal approach speed required due to the prevailing winds and poor braking effectiveness on a wet runway resulted in the aircraft overrunning runway 05 at Newman Airport, in Western Australia’s Pilbara region.

The aircraft, with five crew and 88 passengers on board, was conducting a regular public transport service from Perth. It was operated by Network Aviation, a subsidiary of the Qantas Group.

The weather forecast for Newman Airport on the morning of the incident included heavy rain, moderate to severe turbulence below 5,000 feet, and a 25 knot crosswind. The airport had received about 88 mm of rainfall since 0900 the previous day.

“Despite assessing the weather as a threat, during their approach briefing the flight crew did not identify the potential effect of the rainfall on the stopping distance,” ATSB Director Transport Safety Stuart Macleod said.

Instead, their discussions were focussed on the cloud base and the visibility required to conduct the approach, the expectation of windshear, turbulence and the strong crosswind.

The flight crew followed guidance for the expected turbulence, selecting a flaps 25 approach, and maintained a faster than normal approach speed.

The aircraft touched down at or before the touchdown zone at an airspeed of 154 knots.

“The aircraft did not slow after crossing the runway threshold, or during the flare, and a higher groundspeed than airspeed was recorded, indicating a possible unforecast tailwind component,” Mr Macleod noted.

During the landing roll, the aircraft then did not decelerate as expected. Recorded flight data showed this low deceleration, along with directional oscillations, was consistent with aquaplaning.

The captain, sensing the aircraft aquaplane, applied the aquaplaning response technique to maintain directional control and subsequently commanded maximum reverse thrust. The aircraft came to a stop 70 metres beyond the runway threshold, but inside the runway end safety area.

There were no injuries to crew or passengers, while an inspection of the aircraft found that some components of the landing gear sustained minor damage from loose gravel.

“Given the magnitude of this overrun it is highly likely that had the landing speed been reduced, or the braking effectiveness had been normal, or there had been less crosswind, the overrun would not have occurred,” Mr Macleod said.

The ATSB found at the time of the incident neither the operator nor the regulator had guidance to allow flight crews to recognise the conditions at the time as a hazard to the operation.

“While Network Aviation policy did not approve operations on contaminated runways, there was limited documented guidance on how to determine if the runway was contaminated, and moderate or heavy rain were not identified as possible runway contaminants,” Mr Macleod explained.

The ATSB also found that prior to the occurrence, the runway had been examined and found to be requiring maintenance to ensure an adequate level of surface friction, however no maintenance was performed.

Following the overrun, the operator circulated additional guidance and procedures to flight crew for identifying runway water contamination and to ensure appropriate speed control on approach and landing.

The Civil Aviation Safety Authority has also since published guidance, reflecting research from the US Federal Aviation Authority, that found landing on ungrooved runways in moderate rain has the potential to significantly affect braking performance.

“Moderate to heavy rainfall is one of many factors that can influence the stopping distance of an aircraft,” Mr Macleod said.

“Water on an ungrooved runway can significantly reduce the ability of an aircraft to slow down.”

Operators and pilots are encouraged to review the latest guidance and tools available in relation to maintaining safety on runways and the factors that cause runway overruns, Mr Macleod continued.

“In wet weather, additional conservatism is encouraged when calculating the required landing distances.”

​Read the final report: Runway overrun involving Fokker F100, VH-NHY, Newman Airport, Western Australia, on 9 January 2020

ATSB preliminary report from on-going investigation into fatal accident involving a Cessna 150 light aircraft during aerobatic flight training released.

The ATSB has released a preliminary report from its on-going investigation into a fatal accident involving a Cessna 150 light aircraft during aerobatic flight training near Peachester, South East Queensland, on 23 June 2021.

The report, which details factual information from the investigation’s early evidence collection phase, notes the Cessna A150M Aerobat had departed Sunshine Coast Airport with an instructor and student aerobatic pilot on board with the intention of conducting spin recovery training. The aircraft arrived overhead the locality of Peachester, the area intended to conduct aerobatics, about 20 minutes later.

Air traffic control radar data from the last 90 seconds of the aircraft’s flight shows the aircraft turned left and decelerated while maintaining an altitude of 6,000 feet, before beginning to descend rapidly. Shortly after it impacted a dense stand of trees.

The aircraft was destroyed, and the two occupants were fatally injured.

ATSB transport safety investigators’ examination of the wreckage and accident site determined the aircraft was intact prior to the collision.

Calculations of tree impact points along a 50 metre wreckage trail indicated the final flight path was a descent of about 13°. The throttle setting was at idle, and propeller rotational damage signatures were minimal, indicating a low power setting.

“The disruption to the aircraft and foliage, coupled with the length of the wreckage trail, indicated that the aircraft had significant forward speed at impact,” ATSB Director Transport Safety Dr Mike Walker said.

No evidence was found of pre-impact defects with the flight controls or aircraft structure, and external examination revealed no obvious defects with the engine.

Dr Walker noted the preliminary report does not include any safety findings or analysis, which will be detailed in the investigation’s final report.

“As the investigation continues, the ATSB will interview parties involved with the aircraft’s operation, further analyse the radar data, examine the pilots’ qualifications, experience and medical histories, and review aircraft records,” he said.

“Spin training requirements and practices will also be assessed.”

A final report will be published at the conclusion of the investigation.

“However, should a critical safety issue be identified at any time during the course of the investigation, the ATSB will immediately notify relevant parties so appropriate and timely safety action can be taken,” Dr Walker concluded.

Read the preliminary report: Collision with terrain involving Cessna A150M, VH-CYO, 5 km west-south-west of Peachester, Queensland, on 23 June 2021

ATSB seeks information from Robinson Helicopter owners and operators on ground handling incidents

The Australian Transport Safety Bureau (ATSB) is asking for pilots, operators, and engineers with knowledge of aft tail cone bulkhead or tail rotor gearbox input cartridge damage involving Robinson R22, R44 and R66 helicopters to make contact.

The call for information comes as the ATSB releases an investigation update from its ongoing investigation of a fatal Robinson R44 helicopter accident in Broome, Western Australia on 4 July 2020.

During the accident flight, the R44’s tail rotor gearbox, tail rotor and tail assembly separated from the helicopter soon after take-off. The helicopter subsequently collided with the ground, fatally injuring the pilot and rear-right passenger, while the other two passengers sustained serious injuries.

The ATSB has since undertaken extensive and ongoing metallurgical examination and analysis of the airframe and tail rotor components, including examining other R44 helicopter tail rotor gearboxes, components and bulkhead castings.

“Due to the disruptive nature of the accident, this examination and analysis may not reveal a specific point of failure in the helicopter,” said ATSB Director Transport Safety Dr Mike Walker.

“Indeed, in similar accidents overseas, despite extensive materials analysis, contributing factors have not been identified.”

Dr Walker said the ATSB has to date worked closely with the manufacturer, the US National Transportation Safety Board and the UK Air Accidents Investigations Branch to better understand this and similar accidents involving the R44 helicopter, and was now seeking the assistance of industry.

“To help us better understand the nature of this accident, we are seeking Robinson R22, R44 and R66 helicopter pilots, operators and maintenance engineers who may have knowledge of aft tail cone bulkhead or tail rotor gearbox input cartridge damage to make contact with us as soon as practical,” he said.

Regulations under the Transport Safety Investigation Act 2003 require the ATSB to be notified of damage sustained from when an aircraft is being prepared for flight until it has landed and passengers and crew have disembarked, but not for damage sustained during ground handling.

“There may have been events during ground handling resulting in damage to Robinson helicopters that were not required to be reported to the ATSB,” said Dr Walker.

“As a result, industry may be aware of information that could significantly aid the ATSB’s investigation.”

Any information provided to the ATSB that could assist the investigation would be protected as evidence under the Transport Safety Investigation Act 2003, Dr Walker noted.

“If damaged components are available, we may seek to recover these for examination,” he said.

The context of the occurrence and the results of ATSB’s analysis will be published in the final report at the conclusion of the investigation.

"At this point in the investigation it is important to stress that the ATSB has not determined that this helicopter sustained ground handling damage, nor that damage while ground handling contributed to this accident," Dr Walker stated.

Read the update here: In-flight break-up, Robinson R44 Raven I, VH-NBY, 3 km north of Broome Airport, Western Australia, on 4 July 2020

Rail Safety Week: Stand Back. Look Up. Stay Rail Safe

The Australian Transport Safety Bureau is joining the rail industry in recognising the key messages of the 16th annual Rail Safety Week, from 9-15 August.

An initiative of the TrackSAFE Foundation, this year Rail Safety Week seeks to remind community members, workers and operators that a single moment of distraction can change your life forever – so Stand Back, Look Up, and Stay Rail Safe.

The face of this year’s Rail Safety Week is Paralympian, and rail accident survivor, Vanessa Low. 

When Ms Low was 15, she fell from a busy platform into the path of an oncoming train. She lost both her legs in the accident, and was in a coma for two weeks. It took two years for her to walk again, with the aid of prosthetics.

“Ms Low’s story is a powerful reminder for everyone to stand back, look up and stay rail safe,” said ATSB Head of Engagement and Influence Paul Sadler.

A member of the public is killed or injured on the Australian rail network every two and half days, and there are around 2,000 near misses at level crossings or because of trespassing on the rail network.

“The majority of these incidents can be avoided by acting responsibly when near or on the rail network,” said Mr Sadler.

“As part of the ATSB’s promotion of Rail Safety Week, we will be highlighting the safety messages of some of our investigations that tie directly to this year’s theme.”

The ATSB is the nation’s independent ‘no-blame’ rail safety investigator.

ATSB investigations aim to determine what and why an accident happened, identify ongoing safety risks, and to influence safety actions to address those safety issues.

For more information on how you can Stay Rail Safe, visit the Rail Safety Week 2021 website(Opens in a new tab/window).