Executive Director's message The 2005-06 financial year continued to have a substantial building element for the ATSB as rail investigation further matured and aviation investigators were trained and prepared for 2006-07 implementation of a new aviation safety database with associated project and risk management. The Bureau is continuing its commitment to training its investigators through the Diploma of Transport Safety Investigation. In 2005-06, ten staff completed the Transport Safety Investigation (TSI) Diploma and a further 25 were progressing through the coursework and mentoring. In…

This report was tabled in the Australian Parliament on 23 November 1999 Class G airspace (or uncontrolled airspace) has the lowest level of service and the fewest restrictions on aircraft operations. In Australian Class G airspace, third-party directed traffic information is provided to pilots of aircraft operating under the instrument flight rules. There have been a number of attempts to change the operation of Class G airspace since its introduction in 1995. As part of the Airspace 2000 program, the Civil Aviation Safety Authority (CASA) decided to conduct a 'Class G demonstration'…

Reciprocating-engine powered low-capacity transport aircraft (8 to 10 passengers) provide an important public transport connection throughout regional Australia. In the period January 2000 to December 2005, twenty powertrain structural failures of high-power (300 to 375 brake horsepower) horizontally-opposed, reciprocating engines were associated with air safety occurrences reported to the ATSB. These occurrences ranged in severity from; in-flight engine shutdown; engine failure and forced landing; engine failure combined with in-flight fire and fracture of both upper engine mounts; to the…

The purpose of this publication is to provide a national overview of serious non-fatal injury in Australia due to transport accidents involving a railway train in the period 1999-00 to 2003-04, including level crossing accidents. The definition of transport injury used in this report excludes injuries given an external cause of intentional self harm, assault or undetermined intent (terms that are defined in the report). This report includes all injuries that were serious enough to require hospitalisation but did not result in death. Publication available from the Australian Institute of…

The reporting of aviation safety occurrences enables the Australian Transport Safety Bureau (ATSB) to investigate accidents and serious incidents and monitor safety through the analysis of any trends. On 1 July 2003 the Transport Safety Investigation Act 2003 came into effect, introducing the terms immediately reportable and routine reportable matters (IRMs and RRMs, respectively). This report examines trends in IRMs that involved regular public transport operations and provides a context for interpreting any changes over time. The aim is to inform the aviation community of any important…

Executive Summary The partial wreckage of a Cessna 206 aircraft was recovered from an area in the Gulf of Carpentaria, near where an aircraft of this type disappeared on 24-November 1999 (ATSB Occurrence number 199905562). Photographs and video footage of the wreckage were supplied to the ATSB and reviewed with a view to gathering further detail regarding the accident. The ATSB bsubsequently requested that the propeller and attitude indicator instrument from the aircraft be shipped to the bureau's Canberra laboratories for further study and analysis. On the basis of damage to several aircraft…

The ATSB carried out a safety deficiency investigation in accordance with powers under section 19CB (1) (d) of the Air Navigation Act 1920. SAFETY DEFICIENCY An allegation was made to the ATSB that Australian registered Boeing 747-300 aircraft operating from Bangkok airport in Thailand were failing to meet take-off performance requirements. A 'specified' flight was cited as demonstrating that the aircraft had not complied. Comprehensive analysis of data from the 'specified' flight, as well as data from other flights departing Bangkok under similar conditions, was undertaken. Documentation…

Communication within the air traffic system relies heavily on the verbal interaction between pilots and air traffic controllers (controllers) to ensure the safe and efficient operation of air traffic. The use of standard phraseology and radio telephony procedures, such as readbacks, minimises the opportunity for misinterpretation between pilot and controller. Some sectors of the industry have raised concerns regarding the use of excess or non-standard phraseology in readbacks on the surface movement control (SMC) frequency, resulting in radio congestion. The purpose of this report was to…

The 1995 House of Representatives Standing Committee on Transport, Communications and Infrastructure Plane Safe Report (Morris, 1995), found that 'a paucity of information' and 'an absence of safety indicators' were features of the low-capacity RPT sector of the Australian aviation industry. A Preliminary Information Paper published by BASI in 1996 concluded that a range of safety issues warranting further research existed within the regional airline industry. BASI then appointed a research team to comprehensively investigate the level of safety in the regional airline industry. After a study…

Spatial disorientation (SD) is among the most common factors contributing to aviation accidents and incidents, but its true prevalence is difficult to establish. This is because many accidents where SD is cited as a likely factor are fatal, and therefore its role cannot be known with any certainty, but also because in the many instances of SD where an accident doesn't result, it goes unreported. This study provides a comprehensive explanation of the various types of SD in the aviation environment, and suggest strategies for managing the risk associated with SD events. This report provides an…