Wot no safety case
DV, I too was taken aback reading that there was no safety case report. there must have been something. I read the term e-Cassandra (I think, or did I imagine it?)
I would like to ask what happened to the Cassandra Hazard log I helped the EA in the then S&AD IPT to put together. It was back in the early naughties. It may not have been for that particular seat. I had no knowledge of the seat mechanics but did have experience of Cassandra from a previous life.
Would it have made any difference to the SI? I'm not that sure. What I do know is that had the hazardous condition of the shackle been on it then someone would have had to have made an ALARP statement.
You mention George and others in relation to Haddon Cave. I wonder if those responsible in the AES will suffer a similar fate.
Tuc mentioned the HEART report of the 90s in an earlier post. I was still wrestling with some of those recommendations up to the day I retired.