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Safety issues and actions
Issue, description, who it affects Date, status, type
Issue, description, who it affects
Issue: AO-2020-010-SI-02 Cabin exit design criteria (Issue owner: United States Federal Aviation Administration)
Number: AO-2020-010-SI-02
Description: AO-2020-010-SI-02 :Cessna 206 aircraft that feature a rear double cargo door do not meet the aircraft certification basis for the design of cabin exits. Wing flap extensions beyond 10° will block the forward portion of the rear double cargo door, significantly hampering emergency egress. This has previously resulted in fatalities.
Issue owner: United States Federal Aviation Administration
Operation affected: Aviation: Air transport
Date, status, type
Date: 08 Jul 2021
Status: Open – Safety action pending
Type: Safety recommendation
Issue, description, who it affects
Issue: AO-2020-010-SI-01 Cessna 206 emergency procedures
Number: AO-2020-010-SI-01
Description: AO-2020-010-SI-01 :The Cessna 206 procedure for ditching and forced landing states that the flaps are to be extended to 40°. While that permits the aircraft to land at a slower speed, it also significantly restricts emergency egress via the cargo door. However, there is no warning about that aspect in the ...
Issue owner: Textron Aviation
Operation affected: Aviation: Air transport
Date, status, type
Date: 08 Jul 2021
Status: Open – Safety action pending
Type: Safety recommendation
Issue, description, who it affects
Issue: AO-2020-010-SI-02 Cabin exit design criteria (Issue owner: Civil Aviation Safety Authority)
Number: AO-2020-010-SI-02
Description: AO-2020-010-SI-02 :Cessna 206 aircraft that feature a rear double cargo door do not meet the aircraft certification basis for the design of cabin exits. Wing flap extensions beyond 10° will block the forward portion of the rear double cargo door, significantly hampering emergency egress. This has previously resulted in fatalities.
Issue owner: Civil Aviation Safety Authority
Operation affected: Aviation: Air transport
Date, status, type
Date: 08 Jul 2021
Status: Open – Safety action pending
Type: Safety recommendation
Issue, description, who it affects
Issue: AO-2020-036-SI-01 Maintenance manual supplement
Number: AO-2020-036-SI-01
Description: AO-2020-036-SI-01 :The inspection procedures in the West Star Aviation maintenance manual supplement for extended life program Cessna 441 aircraft were inadequate to detect the progressive disbonding of the emergency exit door.
Issue owner: West Star Aviation
Operation affected: Aviation: Maintenance
Date, status, type
Date: 30 Jun 2021
Status: Closed – Adequately addressed
Type: Proactive action
  Proactive action
  Proactive action
Issue, description, who it affects
Issue: AO-2018-026-SI-01Operator consolidation processes for flight crew
Number: AO-2018-026-SI-01
Description: AO-2018-026-SI-01:Although the operator complied with the regulatory requirements for training and experience of pilots, it had limited processes in place to ensure pilots with minimal time and experience on a new and technically different helicopter type had the opportunity to effectively consolidate their skills on the type required for conducting ...
Issue owner: Whitsunday Air Services
Operation affected: Aviation: Air transport
Date, status, type
Date: 16 Jun 2021
Status: Closed – Adequately addressed
Type: Proactive action
  Proactive action
Issue, description, who it affects
Issue: AO-2018-026-SI-07Pilots leaving the controls of the helicopter
Number: AO-2018-026-SI-07
Description: AO-2018-026-SI-07:It was common practice for the operator’s pilots to leave the controls of their helicopter, while the rotors were turning and the friction locks applied, to escort passengers to and from the helicopter.
Issue owner: Whitsunday Air Services
Operation affected: Aviation: Air transport
Date, status, type
Date: 16 Jun 2021
Status: Closed – Partially addressed
Type: Proactive action
Issue, description, who it affects
Issue: AO-2018-026-SI-06Operator management of birdstrikes
Number: AO-2018-026-SI-06
Description: AO-2018-026-SI-06:There was often a significant number of birds located on the pontoons at Hardy Reef used by the operator. However, the operator did not have a process to systematically manage the risk of birdstrike. For example: The operator had not conducted a formal risk assessment of the bird hazard at the ...
Issue owner: Whitsunday Air Services
Operation affected: Aviation: Air transport
Date, status, type
Date: 16 Jun 2021
Status: Closed – Partially addressed
Type: Proactive action
Issue, description, who it affects
Issue: AO-2018-026-SI-05Operator helicopter loading practices
Number: AO-2018-026-SI-05
Description: AO-2018-026-SI-05:Although the operator had calibrated scales available for use at two of their check-in locations, they were not routinely used to ascertain actual passenger and/or baggage weights. Instead, the operator's personnel relied on passengers’ volunteered weights (without an additional allowance) and only weighed passengers when the volunteered weights were perceived ...
Issue owner: Whitsunday Air Services
Operation affected: Aviation: Air transport
Date, status, type
Date: 16 Jun 2021
Status: Closed – Adequately addressed
Type: Proactive action
Issue, description, who it affects
Issue: AO-2018-026-SI-04Passengers with reduced mobility
Number: AO-2018-026-SI-04
Description: AO-2018-026-SI-04:The operator’s system used to identify passengers with reduced mobility and/or required additional safety briefing information relied on passengers self-reporting a problem.
Issue owner: Whitsunday Air Services
Operation affected: Aviation: Air transport
Date, status, type
Date: 16 Jun 2021
Status: Closed – Partially addressed
Type: Proactive action
  Proactive action
Issue, description, who it affects
Issue: AO-2018-026-SI-03Design of the EC120B rear left emergency exit
Number: AO-2018-026-SI-03
Description: AO-2018-026-SI-03:Due to multiple factors, the design of the rear left sliding door (emergency exit) on the EC120B helicopter was not simple and obvious to use unless the occupant was provided with specific instructions about how to operate the exit. In particular: the door required three actions to open (pull handle up, ...
Issue owner: Airbus Helicopters
Operation affected: Aviation: Air transport
Date, status, type
Date: 16 Jun 2021
Status: Open – Safety action pending
Type: Safety recommendation
Issue, description, who it affects
Issue: AO-2018-026-SI-02Requirements for verbally briefing passengers on emergency exits
Number: AO-2018-026-SI-02
Description: AO-2018-026-SI-02:There was no requirement for operators of passenger transport flights in aircraft with six or less seats to provide passengers with a verbal briefing, or written briefing material, on the method for operating the emergency exits.
Issue owner: Civil Aviation Safety Authority
Operation affected: Aviation: Air transport
Date, status, type
Date: 16 Jun 2021
Status: Closed – Adequately addressed
Type: Proactive action
  Proactive action
Issue, description, who it affects
Issue: AO-2018-019-SI-01Fuel quantity assessment methods
Number: AO-2018-019-SI-01
Description: AO-2018-019-SI-01:Although the operator had specified multiple methods of cross-checking fuel quantity gauge indications for its C441 fleet, there were limitations in the design, definition and/or application of these methods. These included: The primary method used (indicated versus calculated fuel) was self-referencing in nature, and not able to detect gradual changes in ...
Issue owner: Skippers Aviation
Operation affected: Aviation: Air transport
Date, status, type
Date: 27 May 2021
Status: Closed – Adequately addressed
Type: Proactive action
Issue, description, who it affects
Issue: AO-2019-045-SI-01 Maintenance processes for landing gear
Number: AO-2019-045-SI-01
Description: AO-2019-045-SI-01 :The operator did not place appropriate emphasis on ensuring the continuing airworthiness of the landing gear of its GA8 fleet, although being aware of: the increased loads on the landing gear when routinely operating from beach landing areas up to 20–30 times daily, and being subjected to a salt-laden and humid ...
Issue owner: Air Fraser Island
Operation affected: Aviation: General aviation
Date, status, type
Date: 29 Apr 2021
Status: Closed – Adequately addressed
Type: Proactive action
Issue, description, who it affects
Issue: AO-2019-015-SI-01 Aeropower post-training supervision
Number: AO-2019-015-SI-01
Description: AO-2019-015-SI-01 :There were no requirements in Aeropower procedures to provide any post-training supervision for powerline operations. What supervision was provided was ineffective in identifying that a modified stringing method was being used by the pilot.
Issue owner: Aeropower Pty. Ltd.
Operation affected: Aviation: General aviation
Date, status, type
Date: 09 Mar 2021
Status: Closed – Adequately addressed
Type: Proactive action
Issue, description, who it affects
Issue: AO-2019-025-SI-05Crew risk awareness
Number: AO-2019-025-SI-05
Description: AO-2019-025-SI-05:Although required by the harness instrument commonly issued by the Civil Aviation Safety Authority, the operator did not appraise shooting crews of the risks of using only a harness for restraint during low-level flight.
Issue owner: Jayrow Helicopters
Operation affected: Aviation: General aviation
Date, status, type
Date: 26 Feb 2021
Status: Closed – Adequately addressed
Type: Proactive action
Issue, description, who it affects
Issue: AO-2019-025-SI-04Harness instrument clarity
Number: AO-2019-025-SI-04
Description: AO-2019-025-SI-04:A harness instrument, commonly issued by the Civil Aviation Safety Authority (CASA), stated that a harness could be used instead of a seatbelt for take-off and landing. Although not intended by CASA, this instrument was easily able to be misinterpreted as indicating that a seatbelt was not required to be ...
Issue owner: Civil Aviation Safety Authority
Operation affected: Aviation: General aviation
Date, status, type
Date: 26 Feb 2021
Status: Open – Safety action pending
Type: Proactive action
Issue, description, who it affects
Issue: AO-2019-025-SI-03Aerial platform shooter emergency training
Number: AO-2019-025-SI-03
Description: AO-2019-025-SI-03:Recurrency training and drills in aircraft emergencies were not required for reissue of an aerial platform shooting permission. Some shooters last conducted training about 20 years prior, during initial issue of their permissions.
Issue owner: Civil Aviation Safety Authority
Operation affected: Aviation: General aviation
Date, status, type
Date: 26 Feb 2021
Status: Open – Safety action pending
Type: Proactive action
Issue, description, who it affects
Issue: AO-2019-025-SI-02 The Director of National Parks' risk management
Number: AO-2019-025-SI-02
Description: AO-2019-025-SI-02 :The Director of National Parks did not actively manage the risk of the aerial culling task being conducted in the Kakadu National Park, or effectively supervise the operation. As a result, an increase in the number of crew, a change in helicopter type and change of helicopter operator all progressed ...
Issue owner: Director of National Parks
Operation affected: Aviation: General aviation
Date, status, type
Date: 26 Feb 2021
Status: Open – Safety action pending
Type: Proactive action
Issue, description, who it affects
Issue: AO-2019-025-SI-01Helmet provision and use
Number: AO-2019-025-SI-01
Description: AO-2019-025-SI-01:Although the Director of National Parks’ safe operating procedures required shooters and spotters to wear helmets during aerial culling tasks, helmets were not provided or used on a routine basis.
Issue owner: Aviation: General aviation
Operation affected: Aviation: General aviation
Date, status, type
Date: 26 Feb 2021
Status: Open – Safety action pending
Type: Proactive action
Issue, description, who it affects
Issue: AO-2017-118-SI-04Fitment of recording devices in light aircraft - International Civil Aviation Organization
Number: AO-2017-118-SI-04
Description: AO-2017-118-SI-04:Annex 6 to the Convention of International Civil Aviation did not mandate the fitment of flight recorders for passenger-carrying aircraft under 5,700 kg. Consequently, the determination of factors that influenced this accident, and numerous other accidents have been hampered by a lack of recorded data pertaining to the flight. This ...
Issue owner: International Civil Aviation Organization
Operation affected: Aviation: Air transport
Date, status, type
Date: 29 Jan 2021
Status: Open – Safety action pending
Type: Safety recommendation
  Safety advisory notice
  Safety recommendation
First page Page 1 of 48 Last page Total records: 957