A media conference presenting the ATSB's investigation findings and recommendations on the 26 September 2002 accident of Piper Cherokee Six registration VH-MAR in which the pilot and five passengers were fatally injured will be held at 11.00 am, Thursday 18 March 2004. Who: Mr Kym Bills (Executive Director)When: 18 March 2004 (1100 ESuT)Where: ATSB Headquarters (15 Mort Street, Canberra City) The report will then be available on the website www.atsb.gov.au. Note: Media are requested to assemble in the foyer at 15 Mort Street 15 minutes prior to the…

In releasing our final investigation report the ATSB's hope is that this tragic accident should be a reminder for all pilots of the dangers of controlled flight into terrain (CFIT) especially during approach and landing in dark night conditions and at times of inclement weather with reduced visibility and into unfamiliar aerodromes. The Bureau is a member of the International Flight Safety Foundation and the Bureau's report highlights the extensive research undertaken by the Flight Safety Foundation into the CFIT…

The ATSB investigation has classified the airspace incident near Launceston on 24 December as a 'serious incident' and has recommended a review of certain aspects of NAS airspace implementation in Class E airspace including education, training and chart frequency material. Unlike previous reports made to the Australian Transport Safety Bureau since the NAS 2b changes from 27 November, of which two warranted investigation, the ATSB has determined that the occurrence near Launceston on 24 December was a type of serious incident known as an 'airprox'. The…

The ATSB's final investigation report has found that a Boeing 737 passenger aircraft that overran the runway in Darwin in June 2002 did so because of a high approach speed, an inaccurate and unstabilised approach, and poor crew resource management. Significant safety action has been taken by the operator to address the problems found and to improve training and safety systems to seek to ensure it doesn't happen again. At about 1135pm on 11 June 2002, Boeing 737-800 registered VH-VOE touched down an estimated 1016 metres from the departure end of Runway 29…

A final ATSB investigation report into a serious incident involving a Saab passenger flight in June 2002 has found that pilots lost control because of low airspeed, airframe icing and the operation of the aircraft autopilot system, and that they did not receive a prior stall warning. As a result of this serious incident and an ATSB report released in May 2001 into a similar serious incident, the ATSB has made further safety recommendations to operators, to Saab, and to CASA. On the evening of 28 June 2002, a Saab 340B…

The ATSB supports safety recommendations the SA Coroner has made today that reinforce those by the ATSB, but disagrees with some of the Coroner's key conclusions. The ATSB formally re-opened its investigation in November last year after possible significant new evidence about a potential manufacturing defect in the left engine crankshaft became available from the US engine manufacturer (Textron Lycoming) - the ATSB has since re-tested the crankshaft, including using destructive testing open to non-Bureau witnesses and the input of external laboratories, and found no problems with the steel…

The ATSB's report into the Epping rail accident reinforces the limitations of reliance on automatic train stops and 'deadman's handle' devices in the event of driver incapacitation and highlights the importance of improving these defences as well as medical standards and processes for train crew. The sole purpose of ATSB investigations is to improve future safety and the Bureau acknowledges the safety actions taken through the Victorian Department of Infrastructure as a result of ATSB's investigation such as reviewing signalling systems and defences,…

The supplementary ATSB investigation Report into the Whyalla Airlines fatal accident tabled in the Senate today confirms the likelihood of the ATSB's accident scenario in its December 2001 Report in contrast to the findings of the SA State Coroner in July 2003. In November last year the ATSB formally re-opened its investigation into the VH-MZK accident after possible significant new evidence about a potential manufacturing defect in the left…

The Australian Transport Safety Bureau (ATSB) has received international recognition for outstanding work in its Investigation into Ansett Australia maintenance safety deficiencies and the control of continuing airworthiness of Class A aircraft report. In Washington earlier this week, the prestigious Flight Safety Foundation 2003 Cecil A Brownlow Publication Award went to the ATSB for extraordinary efforts in identifying, investigating and reporting on a systemic problem affecting aviation safety worldwide. The ATSB's…

Overview Australia has a very safe transport system in international terms across all modes However, major accidents are low probability, high consequence events and we can never afford to be complacent Human factors associated with well-known human performance continue to dominate Systemic investigations remain crucial but pro-active reporting and data analysis also provide for evidence-based risk reduction.