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, VH-OLM, operating as a regular public transport service from Sydney to…

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 ATSB investigation found that a 737…

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 at Darwin, overran the runway and…

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 conference, from where they will be escorted…

A media conference discussing the fatal helicopter accident on 22 November 2004 near Dubbo in New South Wales will be held today, Tuesday 23 November 2004. When: 14:30 local time (NSW)Where: 12 kms south-west of Dunedoo, New South Wales (accident site) The ATSB's Investigator at the site will only discuss factual events known to the investigation team at the time. Any person/witness with information about the accident is encouraged to contact the ATSB on 1800 020 616 and will be put in touch with an investigator. With the exception of this media conference all media contact will continue to…

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 phenomenon and the benefit of their education and prevention programs, which are…

[slide 1] Note: Presentation slide references. Thank you, Mr Chairman and good morning ladies and gentlemen. As most of you know, the Australian Transport Safety Bureau was established on the 1st of July 1999 and you will see in your delegate's information folders that the ATSB's mission [slide 2] is to maintain and improve transport safety and public confidence through independent 'no blame' investigations which seek to uncover the causal factors that led…

Speech delivered to Asia-Pacific Coroners' Conference, Hobart, Tasmania on ATSB fatality investigations in Australia and the Asia Pacific by Mr Kym Bills, Executive Director, Australian Transport Safety Bureau.

Presentation given to Waypoint 2007 on Investigation and data issues.

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 report, released in November 2002, highlighted that a robust system for…