The ATSB Annual Review 2003 documents ATSB's
achievements and safety activities from 1 July 2002 to 30 June 2003
and outlines its business planning for 2003-2004
Executive Director's message
During 2002-03, the ATSB assisted the Minister for Transport and
Regional Services with new legislation to enable the Bureau to
investigate rail accidents on the increasingly important interstate
system. The Transport Safety Investigation Act 2003 (TSI
Act) also updates and harmonises the Bureau's aviation and
marine investigative powers. The Transport Safety Investigation
Regulations 2003 were also finalised this year following industry
consultation and commenced together with the TSI Act on 1 July
2003.
In 2002-03 the ATSB further developed its website
www.atsb.gov.au which contains the new legislation and all ATSB
reports, recommendations, and key safety information and receives
more than five million hits' each year.
In August 2002, the Bureau received national tertiary
accreditation for five years for its internal competency-based
Diploma in Transport Safety Investigation. The Diploma will
validate that ATSB investigators have reached a minimum competency
standard linked to investigator work level standards.
The ATSB has worked closely with state and territory transport
agencies and other major stakeholders, through the National Road
Safety Strategy Panel, and coordinated the development of a
National Road Safety Action Plan for 2003 and 2004. The Action Plan
was endorsed by Australian Transport Council (ATC) Ministers in
November 2002 and covers priority areas including more effective
speed management, expansion of road-based treatments, enhanced
drink-driving deterrence, and measures to reduce fatigue-related
harm. The Action Plan seeks to accelerate progress towards reducing
the national road fatality rate by 40 per cent by 2010.
Senator Ron Boswell in his role as Parliamentary Secretary,
released a number of well-received ATSB research and statistical
reports and a number of other road safety publications throughout
the year. A special analysis of fatal crashes over the
Christmas/New Year holiday period was undertaken at the request of
the Minister. The ATSB also worked closely with the National Road
Transport Commission to develop a heavy vehicle safety strategy
which was approved by ATC Ministers in May 2003.
The ATSB continued to participate in rail safety investigations
at the invitation of state governments. Since 1999, the Bureau has
undertaken or taken part in 14 investigations. Most have been in
Victoria but others have involved WA, NSW, Queensland and SA.
Investigations have brought about important safety changes
including to operational practices, infrastructure and regulation.
The ATSB highlighted the potential inadequacies with deadman's
handle' braking devices in the event of driver incapacitation in
its Footscray and Epping reports.
In 2002-03, the 13 marine reports released included the October
2002 report of a ballast tank explosion on the Hong Kong registered
Nego Kim with eight fatalities. Its recommendations led to
both operator safety action and broader recommendations for
improved safety procedures for future painting and similar work in
enclosed spaces.
The ATSB released 78 final air safety investigation reports
during 2002-03. A major report on maintenance problems with the
Ansett Boeing 767 fleet has been especially well received in
Australia and internationally and has been nominated for an
international air safety award. The Bureau was pleased that in many
cases safety action was undertaken obviating a need for a
recommendation. Most recommendations made also led to positive
safety action.
At the invitation of the East Timor Government the ATSB is
leading an investigation into the fatal crash of an Ilyushin
IL-76TD aircraft near Baucau, East Timor in a joint investigation
with the Australian Defence Force and in cooperation with Russian
investigators.
The findings on 12 September 2002 of a WA Coronial inquest into
a charter accident involving Beech King Air VH-SKC included some
criticisms of the ATSB. While the Bureau accepted that in hindsight
there were areas it could improve upon in future investigations if
additional resources were applied, other criticisms were not
accepted, including criticism of the basis for independent ATSB
noblame investigations under Annex 13 to the Chicago
Convention.
A Coronial inquest into the accident involving Whyalla Airlines
Piper Chieftan VH-MZK commenced hearings on 22 July 2002 and the SA
State Coroner delivered his findings on 24 July 2003. The process
also involved civil damages litigation in the US and required
substantial Bureau resources to be diverted from other safety
priorities. The ATSB formally reopened its VH-MZK investigation
after the US engine manufacturer issued a service bulletin in
September 2002 which included MKZ's left crankshaft. The ATSB will
deliver a supplementary investigation report later in 2003.
During the year the Bureau continued to liaise with and seek to
improve cooperation and mutual understanding with coroners around
Australia and this remains a priority for 2003-04 based on the
ATSB's new legislative framework. The ATSB is reliant on coroners
to assist with forensic and pathology testing.
I am again grateful to the Deputy Prime Minister and Minister
for Transport and Regional Services, the Hon. John Anderson, to our
Parliamentary Secretary, Senator the Hon. Ron Boswell, and to the
Department Secretary Mr Ken Matthews, for their support throughout
the year. I also acknowledge the bipartisan support the ATSB has
received for its safety work and in the course of the passage of
the TSI Act.
Kym Bills