PPRuNe Forums - View Single Post - Cougar S-92 Accident: A Case Study in Safety
Old 3rd Apr 2011, 22:07
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john_tullamarine
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Between 2007 and the date of the occurrence (March 2009), Cougar Helicopters had been subject to 16 external audits........

I have no comment on the mishap being discussed, nor the specific audits, but the above comment needs to be caveated in a more general sense.

In a past life I participated in a large number of audits such as those to which you refer. The number of hardware and procedural systems major errors I discovered suggested that many, if not all, such audits are a substantial waste of time. At the very least, if such errors had been detected, nothing had been done to fix them ...

For instance, in one FIFO audit which comes to mind, I discovered that the performance calculations for a mid size heavy turboprop operation had been predicated on the wrong critical cases - indeed the relevant critical case had been overlooked totally.

The particular operation had been running for some years and the operator had been subjected to the standard half dozen third party audits or so for this and that customer each year during the period. The error, which amounted to the aircraft's launching significantly overweight EVERY flight out of a particular mine strip was generic within the performance work.

Strangely, no-one amongst the various highly esteemed, experienced and qualified auditors had ever bothered to look at the performance calculations (or, perhaps, they just didn't understand much about what they did look at). Detection of the systemic error took me all of about two minutes (no, closer to a minute and a half) - and then half an hour of check calculations to convince myself that I was, indeed, seeing what I thought I was seeing ....

On this same audit, I also discovered that the aircraft trimsheet loading system was unworkable and that this error followed directly from an editorial error in the approved Flight Manual. Strangely, no-one had ever seen the confusion and variety of different ways to complete this trimsheet in favour with the fleet crew. Clearly a forgiving aircraft for loading or, perhaps, just good luck/skilled crews ?

This operator, otherwise, was basically OK. To their credit, when I raised the problems with them, they fixed them pretty quickly - indeed, our client directed me to make sure they were fixed that day.

I left with a very jaundiced view of a range of Industry audit teams - incompetent idiots at best.

Some years later, when I was running an endorsement program for their pilots in another country, some of the more senior chaps remembered me all too well from that audit .. made for some attentive students in the ground school and during the OEI work in the sim.
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