Aviation safety issues and actions
Risk controls associated with pilots identifying fatigue risks associated with insufficient sleep and extended wakefulness
| Issue number: | AO-2018-022-SI-01 |
|---|---|
| Issue owner: | Heli-Aust Whitsundays Pty Limited |
| Transport function: | Aviation: Air transport |
| Background: | Investigation Report AO-2018-022 |
| Issue release date: | 16 June 2022 |
| Current issue status: | Closed – Adequately addressed |
|---|---|
| Issue status justification: | The ATSB is satisfied that the proactive safety action taken by the operator and the appropriately addresses this issue. |
Safety issue description
The sleep log tool used by the operator contained a coding error and it also pre-loaded sleep periods of future nights by default. This combination of factors reduced the likelihood pilots would identify fatigue risks associated with insufficient sleep and extended wakefulness.
Proactive action
| Action number: | AO-2018-022-PSA-03 |
|---|---|
| Action organisation: | Heli-Aust Whitsundays Pty Limited |
| Action status: | Closed |
The ATSB advised the operator in April 2020 of the coding error with the sleep reporting spreadsheet and this element was promptly addressed by the developer of the spreadsheet.
The operator’s new FRMS was approved by CASA for a trial period that commenced on 23 February 2022. The trial requires regular safety assurance oversight and reporting to CASA, which includes assessment of FRMS information as part of the monthly FSAG meetings. The operator’s new FRMS does not include the sleep reporting spreadsheet utilised at the time of the occurrence.