There have been numerous accidents worldwide that were the result of simple human errors in data calculation or entry.
Data errors—such as the wrong figure being used as well as data being entered incorrectly, not being updated, or being excluded—happen for many different reasons.
The consequences of these sort of errors can range from aborted take-offs through to collisions with the ground. Errors can occur irrespective of pilot experience, operator, aircraft type, location and take-off performance calculation method.
What the ATSB is doing
As part of its investigation into an Airbus A340 tailstrike and runway overrun at Melbourne Airport in March 2009, the ATSB acknowledged the European Aviation Safety Agency (EASA) action in assisting setting up a working group with the European Organisation for Civil Aviation Equipment (EUROCAE) to study the feasibility of take-off performance monitoring systems and developing an equipment standard. The ATSB also made a recommendation to the US Federal Aviation Administration (FAA) to address the existing standard that did not provide flight crews with a means to detect degraded take-off acceleration. The FAA has subsequently joined EASA as a member of the working group and, given this safety action, the ATSB has closed that recommendation.
In 2016, the EASA released Safety Information Bulletin (SIB) No.: 2016-02. The SIB was directed to competent authorities, operators, and approved training organisation to raise awareness of the hazard, and provide recommendations for safety risk analyses, training and flight data monitoring. EASA are also conducting a survey to obtain feedback from operators on actions that were taken.
The ATSB will continue to monitor the output from the EUROCAE take-off performance monitoring working group and any associated developments that may assist in mitigating this risk.
What can you do?
While no one is immune from data input errors, risk can be significantly reduced through effective management and systems. Good communication and independent cross-checks between pilots, effective operating procedures, improved aircraft automation systems and software design, and clear and complete flight documentation will all help prevent or uncover data entry errors.
The ATSB advises operators to consider all the possible errors that could be introduced and then determine if the procedures in place will prevent these errors from occurring, or will provide an opportunity to detect them.
The following investigation reports also provide useful lessons on the potential dangers of data input errors:
- Incorrect configuration involving Boeing 717, Canberra Airport, ACT on 20 June 2016
- Airbus A340-541 tailstrike and runway overrun that occurred at Melbourne Airport, Vic. on 20 March 2009
The ATSB has also released a safety research report, Take-off performance calculation and entry errors: A global perspective, which examines Australian and international occurrences between 1 January 1989 and 30 June 2009 that involved the calculation and entry of erroneous take-off data.
- A study by the US Navy/NASA Ames Research Center, Cockpit interruptions and distractions: A line observation study, presents preliminary findings about the scope and nature of concurrent task demands on the flight deck.
- The NASA research publication, Performance Data Errors in Air Carrier Operations: Causes and Countermeasures, provides a broad set of countermeasures that can reduce vulnerability to accidents caused by performance data errors.
- European Operators Flight Data Monitoring Working Group B’s Study for Runway Excursion Precursors addresses previously identified hazards and potential precursors associated with runway excursions and these have been documented.