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First page Previous page Page 1 of 30 Next page Last page Total records: 596
Issue, description, who it affects Date, status, type
Issue: External lighting in the operator’s AW139 helicopters
Number: AO-2011-166-04
Description: The helicopter’s lighting set-up did not allow independent control of the searchlights by the pilot using the switches on the flight controls, as required by the operations manual and Civil Aviation Order 29.11, and increased the risk of loss of hover reference and distraction in the case of a single ...
Who it affects: The helicopter operator
Issue owner: The helicopter operator
Operator type: Aviation - Aircraft operator
Date: 16 May 2013
Type: Proactive Action
Issue: Role of the Ambulance Service of NSW specialty casualty access team
Number: AO-2011-166-02
Description: The increased capability of helicopters and rescue winches enabled the conduct of complex winch rescues beyond the current level of winch training and procedural support associated with the traditional special casualty access team clinical access role, leading to an increased risk that hazards associated with complex rescues were not identified.
Who it affects: Ambulance Service of NSW specialty casualty access team
Issue owner: Ambulance Service of NSW
Operator type: Aviation - Other organisation type
Date: 16 May 2013
Type: Proactive Action
Issue: Night winching recency training
Number: AO-2011-166-03
Description: Ambulance rescue crewmen did not conduct any night winching recency training, resulting in an increased risk of unfamiliarity with night winching procedures and their associated hazards.
Who it affects: Special casualty access training
Issue owner: Ambulance Service of NSW
Operator type: Aviation - Other organisation type
Date: 16 May 2013
Type: Proactive Action
Issue: Ambulance Service of NSW specialty casualty access team operating procedures
Number: AO-2011-166-01
Description: The accepted use of procedural adaptation by special casualty access team paramedics, and the past success of rescues that involved adapted techniques, probably led to the retrieval procedure that was used on the night.
Who it affects: Ambulance Service of NSW specialty casualty access teams
Issue owner: Ambulance Service of NSW
Operator type: Aviation - Other organisation type
Date: 16 May 2013
Type: Proactive Action
Issue: Fitment of rubber, bladder-type fuel tanks to R44 helicopters
Number: AO-2012-021-SI-01
Description: A significant number of R44 helicopters, including VH-COK, were not fitted with bladder-type fuel tanks and the other modifications detailed in the manufacturer's Service Bulletin, SB-78 to improve resistance to post‑impact fuel leaks and fire.
Who it affects: All owners and operators of R44 helicopters
Issue owner: Robinson Helicopter Company
Operator type: Aviation - Aircraft manufacturer
Date: 03 May 2013
Original risk: Significant
Status: Adequately addressed
Type: Proactive Action
Issue: Aircraft hopper markings or other level indicators not updated when hopper is modified
Number: AI-2011-150-SI-004
Description: Aircraft operations with an enlarged hopper but no associated recalibration of the hopper level sight gauge increased the potential for operations at an uncertain aircraft operating weight, and therefore risk of operations in excess of the published aircraft limitations.
Who it affects: Aerial work industry
Operator type: Aviation - General Industry Groups
Date: 09 Apr 2013
Issue: Required modifications for M18 aircraft under Supplemental Type Certificate SVA521
Number: AI-2011-150-SI-003
Description: There was limited assurance that M18 and M18A Dromader aircraft incorporating Supplemental Type Certificate SVA521 would exhibit acceptable handling and performance characteristics if not fitted with vortex generators and M18B standard elevators, in particular that the risk of longitudinal instability had been reliably addressed.
Who it affects: Aerial work industry
Issue owner: Rebel Ag
Operator type: Aviation - Other organisation type
Date: 09 Apr 2013
Status: Adequately addressed
Type: Proactive Action
Issue: Information for M18 agricultural operations at weights between 4,200 kg and 5,300 kg
Number: AI-2011-150-SI-002
Description: There was a potential, depending on the supplements that were incorporated in an aircraft’s flight manual, for pilots and/or operators to apply incorrect operational limitations to agricultural operations in M18 and M18A Dromader aircraft at weights between 4,200 kg and 5,300 kg. This increased the risk of their inconsistent application ...
Who it affects: Aerial work industry
Issue owner: Rebel Ag
Operator type: Aviation - Other organisation type
Date: 09 Apr 2013
Status: Adequately addressed
Type: Proactive Action
Issue: Adherence to M18 flight limitations under Supplemental Type Certificate SVA521
Number: AI-2011-150-SI-001
Description: M18 Dromader aircraft were being operated in the agricultural role at weights for which a 15° bank angle limitation had effect, whereas the nature of agricultural operations increased the risk of pilots exceeding that limitation.
Who it affects: Aerial work industry
Issue owner: Rebel Ag
Operator type: Aviation - Other organisation type
Date: 09 Apr 2013
Status: Adequately addressed
Type: Proactive Action
Issue: Fitment of rubber, bladder-type fuel tanks to R44 helicopters
Number: AO-2013-055-SI-001
Description: Robinson R44 helicopter accidents result in a significantly higher proportion of post-impact fires than for other similar helicopter types. In addition, a significant number of R44 helicopters have not been fitted with bladder-type fuel tanks as specified in the manufacturer's Service Bulletin SB-78 to improve resistance to post-impact fuel leaks ...
Who it affects: All owners and operators of R44 helicopters
Issue owner: Civil Aviation Safety Authority (CASA)
Operator type: Aviation - Aircraft operator
Date: 27 Mar 2013
Original risk: Significant
Type: Proactive Action
Issue: R44 helicopter all-aluminium fuel tanks
Number: AO-2012-021-SAN-001
Description: The Australian Transport Safety Bureau encourages all operators and owners of R44 helicopters that are fitted with all-aluminium fuel tanks to note the circumstances of this accident as detailed in this preliminary report. It is suggested that those operators and owners actively consider replacing these tanks with bladder-type fuel tanks ...
Who it affects: Owners and operators of R44 helicopters
Issue owner: Robinson Helicopter Company
Operator type: Aviation - Aircraft manufacturer
Date: 09 Mar 2012
Original risk: Significant
Residual risk: Minor
Status: Partially addressed
Type: Safety Advisory Notice
Issue: Cross-Crew Qualification and Mixed Fleet Flying
Number: AO-2009-012-SI-002
Description: The available Cross Crew Qualification and Mixed Fleet Flying guidance did not address how flight crew might form an expectation, or conduct a ‘reasonableness' check, of the speed/weight relationship for their aircraft during takeoff.
Who it affects: Flight crews
Issue owner: Airbus Industrie, Flight Safety Foundation, International Air Transport Association
Operator type: Aviation - Regulator / Standards provider
Date: 19 Dec 2011
Original risk: Significant
Residual risk: Minor
Status: Not addressed
Type: Safety Advisory Notice
Issue: Take-off decision making philosophy
Number: AO-2009-012-SI-001
Description: The existing take-off certification standards, which were based on the attainment of the take-off reference speeds, and flight crew training that was based on monitoring of and responding to those speeds, did not provide crews a means to detect degraded take-off acceleration.
Who it affects: Flight crews
Issue owner: US Federal Aviation Administration
Operator type: Aviation - Regulator / Standards provider
Date: 16 Dec 2011
Original risk: Significant
Residual risk: Minor
Status: Partially addressed
Type: Recommendation
Number: AO-2009-044-SAN-068
Description: The Australian Transport Safety Bureau encourages all operators of single-pilot, turbine-powered, pressurised aircraft to consider the installation of an aural cabin altitude pressure warning system that operates separately to their aircraft's visual warning system.
Who it affects: All operators of single-pilot, turbine-powered, pressurised aircraft
Date: 21 Sep 2011
Status: Closed
Type: Safety Advisory Notice
Number: AO-2011-060-SAN-001
Description: The Australian Transport Safety Bureau encourages all operators of R22 helicopters, and organisations performing installation, inspection, and maintenance activities on the drive belts of R22 helicopters to note the circumstances detailed in this preliminary report. The ATSB reinforces the need for continued vigilance by operators and maintenance organisations during the ...
Who it affects: Operators of R22 helicopters
Date: 06 Jul 2011
Status: Closed
Type: Safety Advisory Notice
Number: AO-2009-073-SAN-048
Description: The Australian Transport Safety Bureau advises that all operators of Eurocopter AS350 aircraft should consider the implications of this safety issue and take action where considered appropriate. In particular, operators are encouraged to review the appropriate sections of the aircraft maintenance manual with regard to cargo door flushness and give ...
Who it affects: Operators of Eurocopter AS350 aircraft
Date: 11 Apr 2011
Status: Closed
Type: Safety Advisory Notice
Issue: Robinson R44 helicopter hydraulic-boost systems
Description: The Australian Transport Safety Bureau encourages all operators of hydraulic system‑equipped R44 helicopters, and organisations performing inspection, testing, maintenance and repair activities on the flight control systems of those helicopters, to note the circumstances detailed in this preliminary report. It is suggested that those operators and maintenance organisations consider inspecting ...
Who it affects: Robinson R44 operators and maintenance organisations
Date: 18 Mar 2011
Status: Closed
Type: Safety Advisory Notice
Number: AO-2008-003-SR-108
Description: The flight crew quick reference handbook did not include sufficient information for the flight crew to appropriately manage operations on standby power. Action taken by the aircraft operator As a result of this occurrence, the aircraft operator: evaluated the provision of additional formal guidance to 747‑400 flight crew for operations on standby power, ...
Who it affects: Boeing Company
Date: 13 Dec 2010
Original risk: Significant
Status: Closed - Action Taken
Type: Recommendation
Number: AO-2008-003-SAN-107
Description: Significant safety issue The priority level of the battery discharge messages that were provided by the engine indicating and crew alerting system did not accurately reflect the risk presented by the battery discharge status. Action taken by the ATSB During the investigation, the ATSB discussed the background for this safety issue and the associated safety risk with the ...
Who it affects: Operators and flight crews of transport category aircraft
Date: 13 Dec 2010
Status: Closed
Type: Safety Advisory Notice
Number: AO-2008-003-SR-109
Description: Significant safety issue The United States Federal Aviation Administration regulations and associated guidance material did not fully address the potential harm to flight safety posed by liquid contamination of electrical system units in transport category aircraft. Action taken by the ATSB During the investigation, the ATSB discussed the background for this safety issue and the associated safety ...
Who it affects: US Federal Aviation Administration
Date: 13 Dec 2010
Status: Closed - Partial Action
Type: Recommendation
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