Merged: Senate Inquiry

[Lookleft]

You don't need the aircraft you just need the recorders. If the ATSB are not going to be required to reopen the investigation then yes, there is very little point in even bringing the recorders to the surface.

[Ziggychick]

After all these years...

Five years next week.
Still the same bull****e from the "Trusted Authorities"

What a crock!
Go Abbott, raise your fists for justice for the Australians that perished in the two air disasters.

Survivors of Oz first Int'l Aviation Incident. Nah. We lived. No justice for us.
Seems like it will just be words, that's all. Thanks PM and co.

This is a living hell. Every day. Knowing the truth and watching the clowns perform their deceitful acts.

I lost so much that night. Have fought for the truth and justice.

Not a day goes by lately when I sit in pain, knowing the pain and disability is permanent.

Some days I honestly do wish I perished. This living hell that my own country has put me and others on board through is not acceptable.

How about justice for the living?

I am so disgusted with my "leaders" that I will leave this country when all is done. If I survive that long.

Bunch of pathetic asses. How can they do this to their own citizens?

Mr Skidmore. I beg you to be honest and finish this disgraceful and embarrassing, torturous battle. Please. No-one else has yet shown the balls to do so.

[Kharon]

Strength and patience Ziggy; hang in there and look after yourself first. The foul messenger boy got his marching orders, maybe Clive has seen some of the dreadful emails regarding your plight he wrote; probably not, but Karma is alive, well and always on duty. Skidmore has many ghosts at his feast and much to deal with from real life, perhaps you may prove to be a spur to prick conscience, or an incentive to do better.

[Kharon]

A matter of conscience – methinks.

LL - You don't need the aircraft you just need the recorders.

Semantics, whatever, perhaps it's become more a matter of principal rather than a pressing need, a holy hand grenade sort of thing, to knock down a brick wall of deceit and malice aforethought. The Senate, CASA and the ATSB all know full well that the report must be withdrawn and the entire case honestly re examined. The attempt to diffuse, dilute and dust off the issue failed; and failed miserably. It was amateur hour, handled at the coal face by totally misguided, inept, unqualified, overweening egos.

Leave the bloody CVR/FDR to rot; just publicly fire the two CASA twerps who mismanaged and manipulated the 'evidence' to suit and in doing so, compromised the entire CASA. Get rid of those who aided and abetted them. Restore a sense of purpose and pride in both ATSB and CASA. Cut out the rot, to save the tree. No one can operate a government service where none can look their clients in the eye, without knowing that we know to what depths some will sink to. There are only two camps, the willing accomplices, or those who are unafraid to speak out against the iniquity. Two choices, no options; except resignation and scampering off to live quietly on the super and attempt to assuage a guilty conscience.

Better to openly and honestly seek forgiveness from an offended industry; for permission to act as they did was surely never granted.

Selah..

I do repent. But heaven hath pleased it so,
To punish me with this and this with me,
That I must be their scourge and minister.
I will bestow him and will answer well
The death I gave him. So, again, good night.
I must be cruel only to be kind.
Thus bad begins and worse remains behind.
One word more, good lady—

[Soteria]

More frequent flyer points for Terry

Sleepy Terry is off to Hong Kong at the moment. Perhaps to do a course on 'investigation techniques' or 'deep sea diving'? Or just earning a few more points on the frequent flyer card before he flies off into the permanent sunset in January? You never know what these sneaky buggers are up to! Besides, maybe while he is out of the country (hope Sky Sentinel engaged Tezza's out of office email message) DAS Skidmore makes a robust move and bones one or two of Tezza's cohorts? I've seen that little trick rolled out before! Now that would be fun to watch wouldn't it?

P.S Rumour has it that he went to Honkers on an A380. Anybody know if Terry was part of the operating crew?

[Dangly Bits]

If Tezza is O/S, who is running the show? Please don't tell me it is PB?

[halfmanhalfbiscuit]

Isn't Mr Skidmore in position now.

Soteria indicated an EM had already departed?

[Soteria]

If Tezza is O/S, who is running the show? Please don't tell me it is PB?

Richard Dreyfuss is keeping Terry's seat warm while he is in Honkers.
Perhaps there is a CX reunion going on? Tezza, Skull, all the big hitters!

[Kharon]

Memory lane – it's quite a journey.

While we all languish in an information vacuum, trapped in the tension of glutinous silence emanating from those who will not, or dare not speak; we are akin to those trapped in a time warp by the cold, uncaring space time continuum. Doomed to endlessly watch the same events, time after time – bit like MKR, same old ****, different day. Like this little episode, eloquently and succinctly 'nutshelled' by Creampuff.

[The] report of the $20 million Commission of Inquiry into the Relations between the Civil Aviation Authority and Seaview Air followed 2 years and later. The Minister for Transport at the time the report was handed down noted in Parliament:

[That] recommendation was made eighteen years ago. Today, all of the problems identified by the Commissioner in Regulation 206 remain. The definition of the operation specifically mentioned at recommendation five - regular public transport - is in exactly the same terms.

You'll notice Lockhart River had a brief return to the front page, that event had similar treatment, to Seaview: and Pel Air; well, it's only a pup, just five years old, but with all the attendant required trimmings for it to fall into the chasm of 'legend' and enter the great void. Maybe in ten years, it too will be dragged out, dusted off and discussed on Pprune; only to be shut down again for lack of intelligent discussion.

One of the truly amazing things to emerge from research is how other countries in the aviation 'first world' and even some of the emerging nations have dealt with 'their' Seaview, Lockhart and Norfolk versions of fatal accidents, how 'their' political masters have responded and how the associated government agencies have acted in response to Coronial and Parliamentary inquiry and recommendations. It may have escaped your notice, but other counties do have accidents, people get killed and injured; aircraft get burnt, broken and drowned. The glaring difference in response, even from those countries without Australia's resources and talent pool is they actually get off their collective rumps and do something when the 'grown ups' demand changes which affect the safety of the travelling public.

What a sad, sorry, expensive testament to Australian government has been the response to fatal air accidents – the same path taken so often – with same result; every single time. It's not my say so, the facts are there all neatly documented, from the wailing and rending of flesh, to the steely eyed determination to 'fix it', the same money spent, the same time wasted: the same result, every heartbreaking time.

Wasted lives, futures, careers, all sacrifices on the altar dedicated to perpetuating the myth of 'Safety'. Oh, it's 'safe' enough if you are a politician or 'servant of the people' that is, but for the rest of you, those without a cushion, it's the devil take the hindmost and book early to cross the Styx.

Perhaps we could just openly dismiss the recent Senate committee report and Forsyth review; that would at least be honest. The ship of state has set course, once again the destination is known and we will at least avoid the huge impost of the pointless, empty 'inquiry' pantomime. Just bury the dead, scrape the airframe remains off the runway and get back to being the proud, aviation superstar we claim to be; strutting our proud heritage on the world stage. Bugger the incredible number of ignored recommendations, edicts, policies and bollocks uttered by neutered politicians, coroners and independent report writers. "Sleepy Hollow rules: OK, you got it. Good, now STFU, give us your money and do as you're told"..(instant compliance).. "There now, there's a good little industry".

Outstanding – GOLD!, gold for Australia.

Words and music.

[Sunfish]

Kharon, the only logical conclusion is that CASA is corrupt and rotten to the core. That includes anyone who works there because by definition they are required to leave their ethics at the door when they join.

I was once asked to do that (at my first job with Exxon) and I immediately walked. To stay would have meant becoming one of them. You saw the depths of Exxon/Esso unethical behaviour following the Longford gas explosion and subsequent Royal Commission.

CASA's bad behaviour is on display daily, all you have to do is follow the AAT and the aviation press.

[Sarcs]

Closing the loop - Part 1

Perhaps we could just openly dismiss the recent Senate committee report and Forsyth review; that would at least be honest. The ship of state has set course, once again the destination is known and we will at least avoid the huge impost of the pointless, empty 'inquiry' pantomime. Just bury the dead, scrape the airframe remains off the runway and get back to being the proud, aviation superstar we claim to be; strutting our proud heritage on the world stage. Bugger the incredible number of ignored recommendations, edicts, policies and bollocks uttered by neutered politicians, coroners and independent report writers. "Sleepy Hollow rules: OK, you got it. Good, now STFU, give us your money and do as you're told"..(instant compliance).. "There now, there's a good little industry".

85 recommendations from Senate/Govt inquiry/review in last five years...

Pilot training and airline safety; and Consideration of the Transport Safety Investigation Amendment (Incident Reports) Bill 2010

Recommendation 1 - The committee is of the view that an ATPL should also be required for first officers in high capacity regular public transport (RPT) jet aircraft such as Boeing 737, A320 and other aircraft of similar or greater capacity, and that consideration be given to implementing this as a standard.

Recommendation 2 - The committee recommends that for non-jet operations which employ low-experience first officers, operators be required to provide enhanced supervision and mentoring schemes to offset such lack of experience.

Recommendation 3 - The committee recommends that Air Operators Certificate (AOC) holders be required to develop and implement 'green on green' policy positions relating to the use of low experience pilots in RPT operations, to maximise, wherever possible, the collective experience level of flight crew.

Recommendation 4 - The committee recommends that Civil Aviation Safety Regulation (CASR) Part 61 ensure that all prospective regular public transport (RPT) pilots be required to complete substantial course-based training in multi-crew operations and resource management (non-technical skills) and human factors training prior to, or in reasonable proximity to, initial endorsement training; the committee recommends that the Civil Aviation Safety Authority (CASA) expedite, and assign the highest priority to, the implementation of CASR Part 61.

Recommendation 5 - The committee recommends that the Civil Aviation Safety Authority (CASA) ensure that Part 61 of the Civil Aviation Safety Regulations currently being reviewed place sufficient weight on multi-engine aeroplane experience as opposed to the current recognition of glider and ultra-light experience.

Recommendation 6 - The committee recommends that the Civil Aviation Safety Authority (CASA) be required to undertake a risk assessment of current simulator training to assess whether the extent, aims and scope of such training is being utilised to achieve optimum safety outcomes rather than minimum compliance objectives.

Recommendation 7 - The committee recommends that the Civil Aviation Authority (CASA) expedite, and assign the highest priority to, the implementation of Civil Aviation Safety Regulations (CASR) Part 141 'Flight Training Operators' and Part 142 'Training and Checking Operators'.

Recommendation 8 - The committee recommends that the Government require the Productivity Commission or another suitable body to undertake a review of the current and future supply of pilots in Australia, with particular reference to the general aviation and cadet training pathways, and HECS HELP and VET FEE-HELP arrangements.

Recommendation 9 - The committee recommends that the Civil Aviation Safety Authority (CASA), the Australian Transport Safety Bureau (ATSB) and Australian aviation operators review the final findings of France's Bureau of Investigation and Analysis into Air France 447, including consideration of how it may apply in the Australian context. Subject to those findings, the committee may seek the approval of the Senate to conduct a further hearing in relation to the matter.

Recommendation 10 - The committee recommends that the Minister for Infrastructure and Transport provide a report to Parliament every six months outlining the progress of the Civil Aviation Safety Authority's (CASA) regulatory reforms and specifying reform priorities, consultative processes and implementation targets for the following 12-month period.

Recommendation 11 - The committee recommends that the Government undertake a review of the funding to the Civil Aviation Safety Authority (CASA) to ensure that there is sufficient specific funding to support an expedited regulatory reform process.

Recommendation 12 - The committee recommends that, as an ongoing measure, the Government provide the Civil Aviation Safety Authority (CASA) with specific funding to enable it to offer salaries that are competitive with industry; in addition, or as an alternative, the Government should consider implementing formal mechanisms for the sharing of expertise between industry and CASA.

Recommendation 13 - The committee recommends that the Transport Safety Investigation Amendment (Incident Reports) Bill 2010 not be passed.

Recommendation 14 - The committee recommends that the current prescriptive approach needs to be supplemented with a general obligation to report whenever the 'responsible person' believes that there is an urgent safety risk that must be addressed.

Recommendation 15 - The committee recommends that the Australian Transport and Safety Bureau (ATSB) review its approach to the investigation and publication of human factors with a view to achieving a more robust and useful learning tool for the industry.

Recommendation 16 - The committee recommends that the Australian Transport and Safety Bureau (ATSB) review existing processes for the categorisation of aviation events to ensure that miscategorisation is minimised and opportunities for system improvement are not lost.

Recommendation 17 - The committee recommends that the Civil Aviation Safety Authority (CASA), in concern with Australian Transport and Safety Bureau (ATSB), consider developing and publishing guidance on model reporting to minimise understatement of the actual or potential significance of aviation events.

Recommendation 18 - The committee recommends that Civil Aviation Safety Authority (CASA) require operators to observe the highest standards of incident reporting from their personnel and provide appropriate training as part of the safety promotion function of their SMS.

Recommendation 19 -The committee recommends that, in order to enhance 'just culture' and open reporting of incidents, aviation operators should ensure that their relevant managers are adequately trained in procedural fairness.

Recommendation 20 - The committee recommends that, following the release of the International Civil Aviation Organization (ICAO) fatigue guidelines, the Civil Aviation Safety Authority (CASA) should expedite necessary changes and/or additions to the regulations governing flght and cabin crew fatigue risk management as a priority

Recommendation 21 - The committee recommends that, in the event that the International Civil Aviation Organization (ICAO) fatigue guidelines do not extend to cabin crew duty limits and fatigue risk management more broadly, the Government should amend the Civil Aviation Act 1998 to include cabin crew fatigue risk management under the Civil Aviation Safety Authority's (CASA) regulatory oversight.

Recommendation 22 - The committee recommends that the Civil Aviation Safety Authority (CASA) specify the type of training and amount of training required for cabin crew, including mandatory English language standards.

Aviation accident investigations

Recommendation 1 - The committee recommends that the ATSB retrieve VH-NGA flight data recorders without further delay.

Recommendation 2 - The committee recommends that the minister, in issuing a new Statement of Expectations to the ATSB, valid from 1 July 2013, make it clear that safety in aviation operations involving passengers (fare paying or those with no control over the flight they are on, e.g. air ambulance) is to be accorded equal priority irrespective of flight classification.

Recommendation 3 - The committee recommends that the ATSB move away from its current approach of forecasting the probability of future events and focus on the analysis of factors which allowed the accident under investigation to occur. This would enable the industry to identify, assess and implement lessons relevant to their own operations.

Recommendation 4 - The committee recommends that the ATSB be required to document investigative avenues that were explored and then discarded, providing detailed explanations as to why.

Recommendation 5 - The committee recommends that the training offered by the ATSB across all investigator skills sets be benchmarked against other agencies by an independent body by, for example, inviting the NTSB or commissioning an industry body to conduct such a benchmarking exercise.

Recommendation 6 - The committee recommends that, as far as available resources allow, ATSB investigators be given access to training provided by the agency's international counterparts. Where this does not occur, resultant gaps in training/competence must be advised to the minister and the Parliament.

Recommendation 7 - The committee recommends that the Transport Safety Investigation Act 2003 be amended to require that the Chief Commissioner of the ATSB be able to demonstrate extensive aviation safety expertise and experience as a prerequisite for the selection process.

Recommendation 8 - The committee recommends that an expert aviation safety panel be established to ensure quality control of ATSB investigation and reporting processes along the lines set out by the committee.

Recommendation 9 - The committee recommends that the government develop a process by which the ATSB can request access to supplementary funding via the minister.

Recommendation 10 - The committee recommends that the investigation be re-opened by the ATSB with a focus on organisational, oversight and broader systemic issues.

Recommendation 11 - The committee recommends that CASA processes in relation to matters highlighted by this investigation be reviewed. This could involve an evaluation benchmarked against a credible peer (such as FAA or CAA) of regulation and audits with respect to: non-RPT passenger carrying operations; approach to audits; and training and standardisation of FOI across regional offices.

Recommendation 12 - The committee recommends that CASA, in consultation with an Emergency Medical Services industry representative group (eg. Royal Flying Doctor Service, air ambulance operators, rotary wing rescue providers) consider the merit, form and standards of a new category of operations for Emergency Medical Services. The minister should require CASA to approve the industry plan unless there is a clear safety case not to. Scope for industry to assist as part of an audit team should also be investigated where standardisation is an issue. This should be completed within 12 months and the outcome reported publicly.

Recommendation 13 - The committee recommends that a short inquiry be conducted by the Senate Standing Committee on Rural and Regional Affairs and Transport into the current status of aviation regulatory reform to assess the direction, progress and resources expended to date to ensure greater visibility of the processes.




Recommendation 14 - The committee recommends that the ATSB-CASA Memorandum of Understanding be re-drafted to remove any ambiguity in relation to information that should be shared between the agencies in relation to aviation accident investigations, to require CASA to:

• advise the ATSB of the initiation of any action, audit or review as a result of an accident which the ATSB is investigating.
• provide the ATSB with the relevant review report as soon as it is available.

Recommendation 15 - The committee recommends that all meetings between the ATSB and CASA, whether formal or informal, where particulars of a given investigation are being discussed be appropriately minuted.

Recommendation 16 - The committee recommends that, where relevant, the ATSB include thorough human factors analysis and discussion in future investigation reports. Where human factors are not considered relevant, the ATSB should include a statement explaining why.

Recommendation 17 - The committee recommends that the ATSB prepare and release publicly a list of all its identified safety issues and the actions which are being taken or have been taken to address them. The ATSB should indicate its progress in monitoring the actions every 6 months and report every 12 months to Parliament.

Recommendation 18 - The committee recommends that where a safety action has not been completed before a report being issued that a recommendation should be made. If it has been completed the report should include details of the action, who was involved and how it was resolved.

Recommendation 19 - The committee recommends that the ATSB review its process to track the implementation of recommendations or safety actions to ensure it is an effective closed loop system. This should be made public, and provided to the Senate Regional and Rural Affairs and Transport Committee prior to each Budget Estimates.

Recommendation 20 - The committee recommends that where the consideration and implementation of an ATSB recommendation may be protracted, the requirement for regular updates (for example 6 monthly) should be included in the TSI Act.

Recommendation 21 - The committee recommends that the government consider setting a time limit for agencies to implement or reject recommendations, beyond which ministerial oversight is required where the agencies concerned must report to the minister why the recommendation has not been implemented or that, with ministerial approval, it has been formally rejected.

Recommendation 22 - The committee recommends that Airservices Australia discuss the safety case for providing a hazard alert service with Fijian and New Zealand ATC (and any other relevant jurisdictions) and encourage them to adopt this practice.

Recommendation 23 - The committee recommends that the relevant agencies review whether any equipment or other changes can be made to improve the weather forecasting at Norfolk Island. The review would include whether the Unicom operator should be an approved meteorological observer.

Recommendation 24 - The committee recommends that the relevant agencies investigate appropriate methods to ensure that information about the incidence of, and variable weather conditions at, Norfolk Island is available to assist flight crews and operators managing risk that may result from unforseen weather events.

Recommendation 25 - The committee recommends that the Aeronautical Information Package (AIP) En Route Supplement Australia (ERSA) is updated to reflect the need for caution with regard to Norfolk Island forecasts where the actual conditions can change rapidly and vary from forecasts.

Recommendation 26 - The committee recommends that in relation to mandatory and confidential reporting, the default position should be that no identifying details should be provided or disclosed. However, if there is a clear risk to safety then the ATSB, CASA and industry representatives should develop a process that contains appropriate checks and balances.

1. The Civil Aviation Safety Authority delegates responsibility for the day-to-day operational management of airspace to Airservices Australia, including the designation of air routes, short-term designations of temporary Restricted Areas, and temporary changes to the classification of airspace for operational reasons.

2. The Department of Infrastructure and Regional Development and Department of Defence (and appropriate agencies) establish an agreed policy position on safety oversight of civil operations into joint user and military airports.

3. The Civil Aviation Safety Authority changes its regulatory philosophy and, together with industry, builds an effective collaborative relationship on a foundation of mutual understanding and respect.

4. The Civil Aviation Safety Authority continues to provide appropriate indemnity to all industry personnel with delegations of authority.

5. The Civil Aviation Safety Authority finalises its Capability Framework and overhauls its training program to ensure identified areas of need are addressed, including:
a. communication in a regulatory context
b. decision making and good regulatory practice
c. auditing.

9. The Civil Aviation Safety Authority publishes and demonstrates the philosophy of ‘just culture’ whereby individuals involved in a reportable event are not punished for actions, omissions or decisions taken by them that are commensurate with their experience and training. However, actions of gross negligence, wilful violations and destructive acts should not be tolerated.

10. The Civil Aviation Safety Authority reintroduces a ‘use of discretion’ procedure that gives operators or individuals the opportunity to discuss and, if necessary, remedy a perceived breach prior to CASA taking any formal action. This procedure is to be followed in all cases, except where CASA identifies a Serious and Imminent Risk to Air Safety.

11. The Australian Transport Safety Bureau transfers information from Mandatory Occurrence Reports to the Civil Aviation Safety Authority, without redaction or de-identification.

12. The Australian Transport Safety Bureau transfers its safety education function to the Civil Aviation Safety Authority.

13. The Civil Aviation Safety Authority changes its organisational structure to a client-oriented output model.

14. The Civil Aviation Safety Authority establishes small offices at specific industry centres to improve monitoring, service quality, communications and collaborative relationships.

15. The Civil Aviation Safety Authority shares the risk assessment outputs of Sky Sentinel, its computerised risk assessment system, with the applicable authorisation holder.

16. The Civil Aviation Safety Authority provides full disclosure of audit findings at audit exit briefings in accordance with international best practice.

17. The Civil Aviation Safety Authority introduces grading of Non-Compliance Notices on a scale of seriousness.

18. The Civil Aviation Safety Authority assures consistency of audits across all regions, and delivers audit reports within an agreed timeframe.

19. The Civil Aviation Safety Authority implements a system of using third-party commercial audits as a supplementary tool to its surveillance system.

20. The Australian Transport Safety Bureau transfers its safety education function to the Civil Aviation Safety Authority.

21. The Civil Aviation Safety Authority changes its organisational structure to a client-oriented output model.

22. The Civil Aviation Safety Authority establishes small offices at specific industry centres to improve monitoring, service quality, communications and collaborative relationships.

23. The Civil Aviation Safety Authority shares the risk assessment outputs of Sky Sentinel, its computerised risk assessment system, with the applicable authorisation holder.

24. The Civil Aviation Safety Authority provides full disclosure of audit findings at audit exit briefings in accordance with international best practice.

25. The Civil Aviation Safety Authority introduces grading of Non-Compliance Notices on a scale of seriousness.

26. The Civil Aviation Safety Authority assures consistency of audits across all regions, and delivers audit reports within an agreed timeframe.

27. The Civil Aviation Safety Authority implements a system of using third-party commercial audits as a supplementary tool to its surveillance system.

28. The Civil Aviation Safety Authority establishes a safety oversight risk management hierarchy based on a categorisation of operations. Rule making and surveillance priorities should be proportionate to the safety risk.

29. Recreational Aviation Administration Organisations, in coordination with the Civil Aviation Safety Authority, develop mechanisms to ensure all aircraft to be regulated under CASR Part 149 are registered.

30. The Civil Aviation Safety Authority changes the current two-tier regulatory framework (act and regulations) to a three-tier structure (act, regulations and standards), with:
a. regulations drafted in a high-level, succinct style, containing provisions for enabling standards and necessary legislative provisions, including offences
b. the third-tier standards drafted in plain, easy to understand language.

31. The Civil Aviation Safety Authority structures all regulations not yet made with the three-tier approach, and subsequently reviews all other Civil Aviation Safety Regulation Parts (in consultation with industry) to determine if they should be remade using the three-tier structure.

32. The Civil Aviation Safety Authority reassesses the penalties in the Civil Aviation Safety Regulations.

33. The Civil Aviation Safety Authority applies a project management approach to the completion of all Civil Aviation Safety Regulation Parts not yet in force, with drafting to be completed within one year and consultation completed one year later, with:
a. a Steering Committee and a Project Team with both CASA and industry representatives
b. implementation dates established through formal industry consultation.

34. The Civil Aviation Safety Authority’s Director of Aviation Safety meet with industry sector leaders to jointly develop a plan for renewing a collaborative and effective Standards Consultative Committee.

35. The Civil Aviation Safety Authority devolve to Designated Aviation Medical Examiners the ability to renew aviation medical certificates (for Classes 1, 2, and 3) where the applicant meets the required standard at the time of the medical examination.

36. The Australian Government amends regulations so that background checks and the requirement to hold an Aviation Security Identification Card are only required for unescorted access to Security Restricted Areas, not for general airside access. This approach would align with international practice.

37. The Civil Aviation Safety Authority amends the current Terms of Reference of the Industry Complaints Commissioner so that:
a. the ICC reports directly to the CASA Board
b. no CASA staff are excluded from the ICC’s jurisdiction
c. the ICC will receive complaints that relate to both the merits and the process of matters
d. on merits matters, including aviation medical matters, the ICC is empowered to convene an appropriately constituted review panel, chaired by a CASA non-executive director, to review the decision
e. while all ICC findings are non-binding recommendations, the original decision-maker is required to give reasons to the CASA Board if a recommendation is not followed.

TBC...

[Sarcs]

CTL Part 2: A parallel anniversary - Seaview v PelAir

On the anniversaries - (20th) Seaview crash & (5th) Norfolk Is ditching - we are left with some very disturbing parallels that reflect very poorly on our government department & agencies responsible for administering & regulating aviation safety in this country - the question is have we progressed or digressed since Seaview??

IMHO we have very much digressed for - unlike in Seaview - we now no longer can trust the veracity, integrity & independence of our (once proud & fully independent) aviation safety watchdog i.e. the ATsB/BASI...

Welcome and thank you for flying with us. Your aircraft today is an Aero Commander 690 conducting an overwater flight to Lord Howe Island.

Your aircraft is probably overloaded by about 300kg. Your pilot is 25 years old and has 60 hours flying this type. He has an infection and is taking unregulated antibiotics and analgesics. His annual medical certificate elapsed last month and has not been renewed.

The latest weather report may or may not have been obtained and indicates the aircraft will be flying in significant icing conditions. There is a placard restricting flight into icing because of equipment deficiencies.

The maintenance control officer lives 500km away, in Wagga Wagga, and has acted as a clerk rather than directing and controlling maintenance. In the last 12 months numerous defects have not been recorded.

Airworthiness directives have been actioned tardily, or not at all, and the right engine of your aircraft has exceeded a 5400-hour manufacturer’s limit.

The chief pilot of your airline was employed six months ago after the previous chief pilot was sacked. The sacked chief pilot reported directly to the Civil Aviation Authority (CAA) citing serious safety concerns. In recent years your ‘airline’ (in reality a charter operator) has been involved in 11 air safety reports and two of these allege unauthorised RPT operations in overloaded states with unsecured cargo and inaccessible life rafts.

In May your ‘airline’ was mentioned negatively in Parliament and numerous inspectors and managers within the CAA have failed to address these issues.

Please ensure your seatbelt is buckled and enjoy your flight …

Somewhat ironically the above quote/parody on what the safety cards (in hindsight) could/should have said (pre-Seaview tragedy) is taken from the CAsA Flight Safety Australia online article - The Seaview disaster: conscience, culture and complicity...

This paradox was not missed by Planetalking on these inauspicious anniversaries:

Pel-Air and Seaview anniversaries highlight safety failures

At a time when the Minister responsible for aviation safety, Warren Truss, appears to be invisible in relation to the shameful Pel-Air crash and its aftermath, it is worth remembering the Seaview disaster of 1994.

The pilot and eight passengers on the light aircraft died just over 20 years ago when it plunged into the sea on its way from Newcastle (Williamtown) to Lord Howe Island.

That accident, the result of failed air safety oversight by the then Civil Aviation Authority (CAA) , and a total contempt for the safety regulations by the operator, is reported in very blunt terms in this article in Flight Safety Australia, which is published by CASA, which replaced the CAA following the Seaview disaster.

This is quite a remarkable article, both in its scholarship and ferocious style, and in its coming out under the auspices of CASA, since much of the criticism of Seaview and the safety regulator that it conveys might prompt readers to draw parallels with the 2009 Pel-Air crash, and the quite shocking performance of CASA, the ATSB, and this Minister and his predecessor Anthony Albanese in relation to these matters.

But the irony goes deeper. Current Minister Truss’s former coalition colleague John Sharp was the Aviation Minister who tabled the Seaview Commission of Inquiry report in Federal Parliament which found Seaview was “a slipshod, often wilfully non-compliant organisation in which breaches of regulations and unacceptable practices were . . .commonplace”.

It was in 2009 the same John Sharp as the deputy chair of REX, the owner of the Pel-Air operation, who told the media that there was “no plan B” if the corporate jet that was ditched in the sea near Norfolk Island passed the point of no return and found itself unable to land for refueling if the weather conditions deteriorated to the extent that this was no longer possible.

Mr Sharp’s indignation, concern, and with hindsight, it seems his hypocritical posturing, can be read in contemporary news reports such as this.

Now, in 2014, five years and one day after the Pel-Air crash, the lack of adequate regulations concerning the fueling of such oceanic air ambulance flights has not been remedied. The reform process in CASA is in as big if not bigger mess under Truss than it was under Albanese. Lots of words from Albanese, and fewer from Truss, but no material results from either.
Air safety regulation in Australia is a joke, and one that will backfire on the industry.

After reading the article in Flight Safety (which has been curated) please read the comments. The second comment is from Karen Casey, the nurse who was badly injured in the crash, and has as yet been left uncompensated by parties who appear to think they have no liability for the outcomes of their actions.

There is something very rotten in the administration of air safety in this country. And no-one seems to give a damn.

And from Ziggychick...

Kasey Nov 16, 2014 at 10:49 pm

Stumbling upon this article, reading and absorbing it. Checking out the MoU between CASA and the ATSB…the game of dodge. Cost lives, compromises safety, use of tax payer money for an inquiry. Bureaucrats squabbling in the name of avoiding any accountability. Yet they write the rules.

I scratch my head.

Truth and honesty trickle from the top. Have examples of strong leadership with “good will” happen yet?

I personally have not seen this displayed.

If the truth was just told from the start, perhaps history could have been different.

As I braced for death, slammed into the ocean, a Half-inflated life vest. Terrified of sharks, freezing, hurt, fighting to live with every piece of energy. Start to give up within after over an hour of treading water in an angry ocean as I held my patient close. She was brave and so was her husband. Deserved better treatment from our Government.

Some parallels.
If I knew we were flying around the South Pacific, Ad-Hoc MedeVacs with many variables, unprotected with the correct oversight in place from thy ones who make the rules/law/, informed, I would not have flown.

I don’t know what category we were under or the AOC status for that flight.
Most know of the serious safety alert from a 2008 audit. The “Special Audit” not given to the ATSB.

I have it. A no brainier would have been to alert them.

So pretty much, same as twenty years ago. Levels of failure from all three.
Conscious. No. I don’t believe so.

No Law/Policy addressing International MedeVacs. High risk field, one would think.

No Law regarding above post ditching

No protection from an Authority with statutory rights from 1996 to today, which are being examined, closely.

Why would Ministers allow (both sides) for this to continue on?
Lawyers don’t fly planes and pilots don’t right rules.

Mutual respect without inflated egos might help too.

Industry is voicing, so are ghosts of the past along with current, factual evidence which keeps bouncing off that dome.

The human element of consciousness from the Operator, CASA and the ATSB are all still questionable to this day., I believe.

That protective dome, allows the ones who write the rules to not be accountable. Ever. Stat

I would be very interested in an article regarding the same thought given to the management of the Pel-Air incident thus far.

Five, very long years. 18/09/2009

Also, why was there rope on the rear of the aircraft, the fuselage has moved it seems? Peculiar?

Just thinking. Why?

Twenty years of learning. Where?

I must ask?
Good article. Thank you
Reply Karen Casey Nov 19, 2014 at 12:28 am

I have no words to describe the past week. In particular this evening.
Vivid is an understatement.

I can assure you that the psychological trauma begins before the ditch into the endless ocean. It began in the air. As we circled.

My question, tone answered honestly please.

Were we in NZ Airspace when my legs turned to jelly and I felt my fate. Which haunts me every day as each sting of pain reminds me.

Therefore, psychological trauma could have began in NZ airspace??
Bodily injuries, full impact where I sat, into the Ocean. Norfolk jurisdiction??

If lessons could be learned with this current opportunity for a change of culture. If the truth told.

Just get it right.

Break the political cycle of bantering aviation safety laws/reforms.

Absolute nightmare. Believe me.

Tut tut…twenty years. Dear oh dear.

I shake my head. As I am wasting my time bothering anymore.

Butt heads. Be ridiculous regarding serious matters. Ignore those who needed your help not your avoidance.

MTF with CTL Part 3...

[Kharon]

Closing the Noose.

Whoa, that's quite a wish list to pin on the chimney at Christmas time, in the hope that Santa has the 'necessary' in cargo hold A. And that, is just the 'big kids' list, those that work in Scrooges factory in Can'tberra. There is still the 'littl'uns' list to consider, those that slave away in the Coroners sweat shops.

I intend to hazard a Choc frog here and perhaps steal some of the brother Sarcs thunder (if I get lucky). When Sarcs starts a story line with Part 1, you can bet your boots, parts 2 and possibly 3 are in the pipeline. David Fawcett provided the worthy duo of Heffernan and Stearle with the finer, more subtle points related matters aeronautical; they were already 'onto it', through estimates questions. But with Fawcett included, the blunt instrument became a lethal weapon and so the Senate committee, we know and admire came into full promise. Back in the day, Fawcett was rightfully curious about 'closing the loop'. When a recommendation is made was it accepted and what happened to close the loop; and, if the recommendation was rejected, what then? Time scales were also mentioned. You need a chronology to accurately track what happened through the Senate; but, there were some plain and fancy moves made to obfuscate the QON answers to 'curly' questions, CASA, ATSB and Mrdak all in mix. Fascinating. I reckon Sarcs has nutted it out and is about to join some of the outstanding, embarrassing dots.

It all began, IMO one day when Fawcett. Esq. asked about 'closing the loop' on a fatal helicopter accident. This one:-

Report - R20050002.

Issue date 14 March 2005.

http://www.atsb.gov.au/media/24411/a...304282_001.pdf

Recommendation R20050002

As a result of the investigation, safety recommendations were issued to the Civil Aviation Safety Authority recommending: a review of the night VFR requirements, an assessment of the benefits of additional flight equipment for helicopters operating under night VFR and a review of the operator classification and/or minimum safety standards for helicopter Emergency Medical Services (EMS) operations.

ATSB Safety Recommendation.

The Australian Transport Safety Bureau recommends that the Civil Aviation Safety Authority review it's operators classification and/or it's minimum safety standards required for helicopter Emergency Medical Services operations. This review should consider increasing:-
1) the minimum pilot qualifications, experience and recency requirements,
2) operational procedures and (3) minimum equipment for conduct of such operations at night.

Coroner Hennessy.

(12). That CASA consider regulating for the initial training of a helicopter pilot to include night VFR training.

(13). That CASA and the industry move towards a national system of accreditation and uniform standards for provision of EMS services in Australia.

(14). That CASA investigate reclassification of EMS helicopter operations into charter category, or create a separate EMS category of aviation in order to provide the benefits of increased level of regulation and CASA oversight, than that presently available under the aerial work category.

(15). That CASA ensure that appropriate information be provided to pilots on an ongoing basis regarding the issue of spatial disorientation.

(16). The Coroner supports CASR draft regulations point 61 and 133 becoming final.
(17). That beacons, both visual and radio, be placed on prominent and appropriate high points along routes commonly utilised by aero-medical retrieval teams, including Cape Hillsborough.

(18). The Coroner supports the ATSB recommendations 20030213,and promulgation of information to pilots; 20040052,

o assessment of safety benefits of requiring a standby altitude indicator with independent power source in single pilot night VFR; 20040053,
o assessment of safety benefits of requiring an autopilot or stabilisation augmentation system in single pilot VFR; and R20050002,
o review operator classification and minimum safety standards for helicopter EMS operations.


CASA response.

Date Issued: 29 August 2005
CASA has reviewed its previous advice in relation to this matter [provided with the directly involved parties comments to draft occurrence report 200304282] and I am advised that the Authority has no additional comment to provide in response to recommendation R20050002. However, it should be noted that resources to review this action will be allocated in accordance with CASA's reviewed priorities. For your information, a copy of CASA's initial advice is recorded below. CASA advice

CASA will:
* Review the requirements for helicopter EMS operations to include consideration for two pilots, or a stability augmentation and/or autopilot system;
* Review the special operational and environmental circumstances of helicopter EMS services, particularly with regard to pilot qualifications, training and recency including instrument flight competency; and

* Review the pilot recency requirements for helicopter EMS operations to ensure that operator check and training processes are focused on the EMS environment.
CASA 10 October 2007.

The following updates the actions previously advised in response to the recommendation:
The proposed review of EMS operation crewing and aircraft equipment requirements will take place as part of the re-instated project to finalise Civil Aviation Safety Regulation (CASR) Part 133. As you may be aware, the regulatory review aspects of CASR Part 133 have, under instruction from the CASA CEO [deleted], been on hold for some time. However I can now advise that this project is scheduled to recommence in October 2007, and that this subject matter will be incorporated in the consideration of CASR 1998 Part 133.T.3.

CASA has been considering these issues (particularly the special operational and environmental circumstances associated with EMS operations) for some time now as part of the review processes for the introduction of Night Vision Goggles (NVG) into Australian helicopter night operations. As a result of this review we have incorporated helicopter EMS operations as a Permitted NVG Operation in the new NVG Civil Aviation Order (CAO) 82.

This CAO (which is now in effect) empowers appropriately equipped, trained and approved EMS AOC holders to use NVG on their night EMS primary and secondary response taskings. Both CASA and the industry consider this to be a major safety initiative and we will be monitoring its effect over the next twelve months by way of a formal research process.

• EMS pilot qualifications, training and recency requirements will be included in the CASR Part 133 project consultation and review processes, however I can also advise the (as part of its normal surveillance processes) CASA will continue to review these matters in current operations as well.
•
Additionally I can advise that pilot qualification, training and recency requirements were also reviewed by both CASA and the industry as part of the consultation processes associated with the previously mentioned NVG implementation project, and that the industry subject matter experts at these meetings included several representatives from AOC holders who conduct EMS operations in both VFR and IFR situations at diverse operational locations.

Comment - April 2012.
CASR 133 is still not available for use. It is our opinion that essentially, the potential for the accident scenario to reoccur has not been eliminated.

The analysis above is self explanatory, but I'll leave it up to you to work out the rest. More to follow – Oh, you bet...

Toot toot.

[Sarcs]

CTL Part 3: The obfuscated QON??

Spot on "K" the person who paraphrased "Closing the loop" was indeed Senator Fawcett long before the PelAir cover-up inquiry came on the radar...:From Budget Estimates ATSB Hansard 23/05/12

Senator FAWCETT:When there is an aircraft accident and there is a fatality and the coroner becomes involved, can you describe the relationship between ATSB and the coroner?

Mr Dolan: The legislation, the Transport Safety Investigation Act, requires us to cooperate with coronial processes. Therefore, coroners have, if you like, a special relationship with us. There is a range of information and support that we are required to give to coroners that we do not give to other legal processes. We try, as far as possible, to ensure that our reports are reliable and comprehensive and therefore can be used by coroners to form their views, which are largely no blame and in parallel with what we are trying to establish.

We recognise that there are areas where coroners will investigate and we do not. We are trying to deal with that carefully. We do that mostly by making sure we are in close contact with the police who are working with the coroner so that there is clarity from the beginning as to whether we are going to be playing to any significant extent. We are always happy to explain our reports to coronial processes. In addition, we have been offering accident fundamentals training, the basics of how we approach our job, to a range of police officers across the jurisdictions who are likely to be assisting coroners in carrying out their duties.

Senator FAWCETT:Do coroners ever face the situation where they have to
choose between your advice and that of another aviation expert?

Mr Dolan: Quite often. It used to be more common than I think I have noticed in the last year or two that alternative views were put to coroners—

Senator FAWCETT:Who would those other stakeholders be?

Mr Dolan: Our experience has been that counsel assisting, in trying to do a comprehensive job in support of a coroner, sought other lines of information and brought it to bear in the process. Other parties, all of whom have their own interests in a coronial process, often find it necessary to test a range of alternative hypotheses. Sometimes the weight comes down to a different place than we placed it. That is just part of the relationship. If there is a coronial finding that is inconsistent with what we found or more information comes to light in the course of an inquest that is relevant to our investigation, we will reopen the investigation and make sure that is properly weighed up in our processes.

Senator FAWCETT: I notice CASA is often another player in the coronial inquests and often you will highlight something, the coroner will accept it and basically tick off in his report on the basis that a new CASR or something is going to be implemented. Do you follow those up? I have looked through a few crash investigations, and I will just pick one: the Bell 407 that crashed in October '03. CASR part 133 was supposed to be reworked around night VFR requirements for EMS situations. I notice that still is not available now, nearly 10 years after the event. Does it cause you any concern that recommendations that were accepted by the coroner, and put out as a way of preventing a future accident, still have not actually eventuated? How do you track those? How do we, as a society, make sure we prevent the accidents occurring again?

Mr Dolan: We monitor various coronial reports and findings that are relevant to our business. We do not have any role in ensuring that coronial findings or recommendations are carried out by whichever the relevant party may be. I think that would be stepping beyond our brief.

Senator FAWCETT:Who should have that role then?

Mr Dolan: I would see that as a role for the coronial services of the various states. But to add to that, because we are aware of the sorts of findings—as you say, it is not that common that there is something that is significantly different or unexpected for us, but when there is—we will have regard to that obviously in our future investigation activities and recognise there may already be a finding out there that is relevant to one of our future investigations.

Senator FAWCETT:Would it be appropriate to have—a sunset clause is not quite the right phrase—a due date that if an action is recommended and accepted by a regulatory body, in this case CASA, the coroner should actually be putting a date on that and CASA must implement by a certain date or report back, whether it is to the minister or to the court or to the coroner, why that action has not actually occurred?

Mr Dolan: I think I will limit myself to comment that that is the way we try to do it. We have a requirement that in 90 days, if we have made a recommendation, there is a response to it. We will track a recommendation until we are satisfied it is complete or until we have concluded that there is no likelihood that the action is going to be taken.

Senator FAWCETT:Mr Mrdak, as secretary of the relevant department, how would you propose to engage with the coroners to make sure that we,
as a nation, close this loophole to make our air environment safer?

Mr Mrdak: I think Mr Dolan has indicated the relationship with coroners is on a much better footing than it has been ever before. I think the work of the ATSB has led that. I think it then becomes a matter of addressing the relationship between the safety regulators and security regulators, as necessary, with the coroners. It is probably one I would take on notice and give a bit of thought to, if you do not mind.

Senator FAWCETT:You do not accept that your department and you, as secretary, have a duty of care and an oversight to make sure that two agencies who work for you do actually complement their activities for the outcome that benefits the aviation community?

Mr Mrdak: We certainly do ensure that agencies are working together. That is certainly occurring. You have asked me the more detailed question about coroners and relationships with the agencies. I will have a bit of a think about that, if that is okay.

Senator FAWCETT:Thank you.

Unfortunately for DF, who was still relatively new to the game, his question to M&M was not officially recognised as a QON and therefore was totally ignored until Supp Estimates a week before the PelAir Cover-up inquiry was to begin:

Senator FAWCETT:Chair, given the inquiry on Monday I do not actually have a huge number of questions, except to follow up something with Mr Mrdak. Last time we spoke about closing the loop between ATSB recommendations and CASA following through with regulation as a consequential change within a certain time frame. The view was expressed that it was not necessarily a departmental role to have that closed loop system. I challenged that at the time. I just welcome any comment you may have three or four months down the track as to whether there has been any further thought within your department as to how we make sure we have a closed loop system for recommendations that come out of the ATSB.
Mr Mrdak: It is something we are doing further work on in response to your concerns. We recognise that we do need to ensure the integrity of the investigatory response and then the regulatory response. So it is something we are looking at closely. I and the other chief executives in the portfolio will do some further work on that area.
Senator FAWCETT:Do you have a time frame on when you might be able to report back to the committee?
Mr Mrdak: Not as yet. I will come back to you on notice with some more detail.
Senator FAWCETT:If I could invite you to come back to the chair perhaps with a date for a briefing to the committee, outside of the estimates process, as to how you might implement that.
Mr Mrdak: Yes.
Senator FAWCETT:Because the work by ATSB is almost nugatory if you do not have a closed loop system that makes sure it is implemented in a timely manner.
Mr Mrdak: We will come back to you on that.

This time the good Senator's line of inquiry was listed as a QON...

However presumably due to the sensitivities in the PelAir cover-up M&M handballed the answering of the QON to Beaker...

Who in typical Beaker fashion obfuscated the QON with these weasel words...:

Answer:
One of the principal safety improvement outputs of an ATSB investigation is the identification of ‘safety issues’. Safety issues are directed to a specific organisation. They are intended to draw attention to specific areas where action should or could be taken to improve safety. This includes safety issues that indicate where action could be taken by CASA to change regulatory provisions.


The ATSB encourages relevant parties to take safety action in response to safety issues during an investigation. Those relevant parties are generally best placed to determine the most effective way to address a particular safety issue. In many cases, the action taken during the course of an investigation is sufficient to address the issue and the ATSB sets this out clearly in its final report of an investigation.


Where the ATSB is not satisfied that sufficient action has been taken or where proposed safety action is incomplete, the investigation report will record the safety issue as remaining open. In addition, if the issue is significant and action is inadequate, the ATSB will make a recommendation, to which the relevant party is required to respond within 90 days.

The ATSB monitors all safety issues (including all associated recommendations) until action is complete or it is clear that no further action is intended. At this point, the issue will be classified as closed. When safety issues are recorded as closed, the basis for this decision is also specified: whether the issue has been closed as adequately addressed, partially addressed, not addressed, no longer relevant or withdrawn.
A safety issue remains open (like a recommendation) until such time as it is either adequately addressed, or it is clear that the responsible organisation does not intend taking any action (and has provided its reasons). In the event that no, or limited, safety actions are taken or proposed, the ATSB has the option to issue a formal safety recommendation. However, experience has been that this is rarely required.


The ATSB policies and procedures for identifying and promoting safety issues, including through the issuance of a formal recommendation, is outlined in its submission to the Senate References Committee Inquiry into Aviation Accident Investigations.


The ATSB’s Annual Plan and part of the ATSB’s Key Performance Indicators specifically relate to a measurement of safety action taken in response to safety issues; in the case of ‘critical’ safety issues, the target is for safety action to be taken by stakeholders 100% of the time, while for ‘significant’ safety issues, the target is 70%. For 2011-12, there were no identified critical safety issues and 28 significant safety issues. In response to the significant safety issues, adequate safety action was taken in 89% of cases and a further 4% were assessed as partially addressed.


As previously advised to the Committee (Q59 – May 2012), CASA has a formal process for following up on recommendations and safety issues identified by the ATSB, as provided for in the Memorandum of Understanding between the agencies. Aviation safety agency heads will continue to monitor the present arrangements to provide an adequate system for addressing issues identified through ATSB investigations.

As we now all know this was where it was revealed that Beaker (BASR) had taken the bureau to beyond Reason in AAI investigative methodology -i.e. Beyond All Sensible Reason...

Now although Senator Fawcett's QON was officially obfuscated by Beaker this did not deter the Senator and closing the loop was subsequently incorporated into the PelAir cover-up report at R17-R21:

Recommendation 17 - The committee recommends that the ATSB prepare and release publicly a list of all its identified safety issues and the actions which are being taken or have been taken to address them. The ATSB should indicate its progress in monitoring the actions every 6 months and report every 12 months to Parliament.

Recommendation 18 - The committee recommends that where a safety action has not been completed before a report being issued that a recommendation should be made. If it has been completed the report should include details of the action, who was involved and how it was resolved.

Recommendation 19 - The committee recommends that the ATSB review its process to track the implementation of recommendations or safety actions to ensure it is an effective closed loop system. This should be made public, and provided to the Senate Regional and Rural Affairs and Transport Committee prior to each Budget Estimates.

Recommendation 20 - The committee recommends that where the consideration and implementation of an ATSB recommendation may be protracted, the requirement for regular updates (for example 6 monthly) should be included in the TSI Act.

Recommendation 21 - The committee recommends that the government consider setting a time limit for agencies to implement or reject recommendations, beyond which ministerial oversight is required where the agencies concerned must report to the minister why the recommendation has not been implemented or that, with ministerial approval, it has been formally rejected.

The miniscule's response to these recommendations would appear to have again obfuscated Senator Fawcett's original closing the loop concern with further weasel words that presumably were authored by M&M and Beaker...

Example R17...

"...Response
The Government supports this recommendation.
The ATSB publishes on its website a list of all safety issues and actions highlighted in
its investigation reports, including recommendations. The status of these issues and
actions is updated quarterly.
The ATSB Annual Report to Parliament also provides details of safety issues and
advices published in the ATSB investigation reports and advice on the status of
recommendations..."

The response at R18 is interesting because apparently the bureau action/inaction is contingent on the final report from the TSBC..

Response
The Government supports this recommendation in-principle.
ATSB policies and procedure$ require that the details of actions taken in response to
safety issues identified as part of an investigation are included in the investigation
report. The ATSB website provides an ongoing status report on the action undertaken
in response. The ATSB reviews and updates this information quarterly.
The ATSB will review its policy on the use of recommendations, including in relation to
international best practice and having regard to the final report of the Canadian
Transportation Safety Board peer review.

However the response to R21 is the most disturbing and highlights that there never was any intention for the government, department or bureau to close the loop..:

Response
The Government notes this recommendation.
All recipients of recommendations are required to respond with details of intended
action (if any) within 90 days and this response is published by the ATSB. This
arrangement provides for oversight of implementation and the identification of related
factors or processes impacting the timeframe for implementation of specific
recommendations.
The implementation of safety actions, including the time needed and the resources
involved, may vary on a case by case basis. Further, the implementation of some
safety actions may be tied to the implementation of others, or other regulatory
initiatives, meaning that implementation needs to be accommodated within broader
aviation safety regulatory processes.

Ministerial intervention in safety actions by its independent safety agencies is not
necessary and could undermine the proper independence of our statutory agencies in
acting in accordance with their legislative mandates.

Hmm...so I guess 'Ops Normal' & 'nothing to see here' but I do wonder if the international community will be quite so naïve when the final outcome of the MH370 search & investigation comes to its ultimate conclusion....

MTF...

[Kharon]

Corruption – Aye, but be it Biblical or Legal?

Sunny " [the] only logical conclusion is that CASA is corrupt and rotten to the core."

IF it were a 'honest' system of baksheesh, I could live with that. Slip a quick 'gift' to the system and you are in and out of the office in about the same amount time it takes the ATM to dispense the funds – fixed price, no hassles and everyone knows how the game is played. But it's not 'that' type of corruption, is it? It's a meaner, harder system where no one knows the rules – not properly at least – favours and cooperation rule, closely supported by a bizarre cronyism (for wont of better).

Sarcs 'Closing the loop' posts prove (IMO) the ego fed 'attitude' at the top. Take any one of the multitude of 'recommendations' as an example. If you were in charge of an outfit like CASA and one of those landed on your desk – you would have at least three honest options; respond in a positive – proactive manner; even if you intended to reject the notion. (i) Explain why the thing was to be rejected and what equivalent measures you had in place: (ii) Adopt the thing, explain that it was a fine idea, but beyond your budgetary means and ask for 'more', throwing the ball back to the keeper; or, (iii) have a deep and meaningful and sort it out over a cuppa. What you would not do is to ignore it – or wriggle around it – or simply promise a result then renege. And that is only looking at the 'top tier'.

Down the ladder, among the snakes, there is an entirely different culture, which takes it's lead from the layer above – the signers of documents; blokes like Hood. When one of the third tier are 'on a mission' they bring the 'paperwork' to a Hooded look-alike, for processing and 'the signature'; the juice if you like to effect what they propose. What they are seeking to do may reflect the wishes of various parties, depending on the mood. McComic and his cats paws used this system to catastrophic effect against those 'in the gun' and to the great benefit of those who were in vogue. Thus divide and control, ensures the silence of those granted privilege, ensuring 'industry support' and the isolation of those who were to be used an examples of a big R regulator, honestly toiling for safety's sake. Thus, the term without fear or favour, becomes perverted, corrupted to a juxtaposition where fear and favour rule the weak and destroy the strong.

But the really despicable creature lives in the grass roots, there we find the antithesis of fair, honourable dealing. You don't need to search very far or cast your net wide to find an example of how the creatures at the bottom of the swamp operate. Ever watch a hyena pack go work – same -same. There is one extraordinary tale, told at BRB which was only ever exposed because the antagonist was of such an inherently 'dubious' character, that his masters were forced to abandon both him and his corrupt evidence; when even those that ordered the fix dare not, not even in the AAT support it, and that, boys and girls, says a lot. The masters were quite prepared to 'go with it', they could stomach it alright; but the risk of taking that one step too far and being exposed for what they were, by a wily barrister, was the only thing troubled their minds. They happily turned on one of their own and then had the neck to claim the moral high ground; so much honour amongst thieves.

Reading through the Sarcs offering, you can see where the skeleton is riddled with a cancer and why the flesh is rotten. Corruption, yes, but of the conscience and spirit. Most certainly not the honest, cheerful, wealth sharing kind a little baksheesh brings.

Selah.

Ay, marry, is’t.
But to my mind, though I am native here
And to the manner born, it is a custom
More honoured in the breach than the observance.
This heavy-headed revel east and west
Makes us traduced and taxed of other nations.

[thorn bird]

Ah Kharon,

there are many Dubious characters strutting their stuff on the CAsA stage.

Some are called blowflies, they blow in, spread their corrupt opinions about, then blow out, generally to prime industry jobs, obtained largely because they can save their employers considerable sums of $$$ by using their influence to grease the wheels.

Takes one operator 18 months and $100K to get a new type on their AOC, another 8 weeks and a few grand, and surprise, surprise, their new chief pilot is???.

One of the people who perverted the course of justice to stitch up John Quadrio, suddenly turns up in a highly prized GA job.

Love to know who's signature appears on that companies approval's.

We are, as an industry, unfortunately, a bunch of hookers. We are quite prepared to prostitute our integrity, morals and soul in a desperate attempt to get across the line.

It could be said, but maybe I'm a tad harsh?... Yeah okay, when desperate people are teetering on the brink, they will clutch at any straw, but please people, bending over and taking it where the sun don't shine achieves nothing and just encourages these corrupt ass.oles.

The Industry must circle the wagons, slap down the egotists amongst us and confront, not CAsA, but their political masters, and say enough is enough.

[Sarcs]

M&M/Beaker merely paying lipservice to ICAO/FAA.

These days whenever the muppet Beaker utters a single syllable in public the 'man at the back of the room' cringes and subconsciously a thought bubble appears with one single word - BOLLOCKS!

Example -

DPM Warren Truss/ATSB Martin Dolan - MH370 tender announcement 06/08/14 Part 1 - YouTube

And so it was with equal cynicism that most on here would have switched off to Beaker's whinge announcement in relation to the bureau's AR that..

“It was indeed sobering to see more than 200 years of combined corporate and investi­gation experience leaving the ATSB.’’

Regurgitated and lovingly PC'd here by SC - Air safety investigator warns of cuts to capacity

What is interesting is to see how an international MSM publication, with no associated domestic political interests, viewed the same story...



Love this headline...:Will the search for MH370 be called off due to Australian budget cuts? Ten investigators have already been scrapped from the mission by bean counters

• Australian Transport Safety Bureau has lost 12 percent of staff due to $2 million budget cuts
• Chief Commissioner says the agency has lost more than 200 years of combined experience in the same year as two Malaysian Airlines disasters
• ATSB has been tasked with leading the search for missing MH370 flight
• They also deployed two investigators to Ukraine following MH17 disaster

The lead agency behind the search for the missing MH370 flight has warned it will be forced to undertake fewer investigations after cutting 12 percent of its staff due to $2 million budget cuts.

The Australian Transport Safety Bureau's annual report detailed losing more than 200 years of combined corporate and investigative experience in the same year as the disappearance of MH370 and the shooting down of MH17.

Ten transport investigators are among those to go from the transport safety regulator after cutting its staff from 116 to 104 since July 2013.

The Australian Transport Safety Bureau who are the lead agency in the search for MH370 warns investigations may be hampered due to budget cuts ATSB's Chief Commissioner Martin Dolan said investigating the missing Malaysian Airlines flight MH370 was the 'greatest challenge' the bureau had faced to date.

'We have more than 12 per cent fewer staff and we have been required to task some of our investigation and administration staff to the major and ongoing investigations into the two Malaysia Airlines disasters,' Mr Dolan said.

'For the foreseeable future, we will be able to undertake fewer investigations and we will need to carefully consider and constrain the scope of investigations initiated.'

The Malaysia Airlines plane disappeared en route from Kuala Lumpur to Beijing in March with 239 people on board, including six Australians.

The ATSB detailed losing more than 200 years of combined corporate and investigative experience in the same year as the disappearance of MH370 (pictured) and the shooting down of MH17.

While the safety body was given additional funding from the Federal Government for the extensive search, Mr Dolan said there would continue to be pressure on ATSB resources.

'(MH370) is the most serious aviation occurrence ever to involve the ATSB and its precursors, and is arguably the most mystifying, expansive and difficult search operation ever undertaken in the history of commercial aircraft,' Mr Dolan said.

'At the same time as we were required to undertake difficult decisions in relation to our staffing and resources, we received the news of the loss of Malaysia Airlines Flight 370 and of its possible location in the Southern Indian Ocean, in Australia’s Search and Rescue Zone.

'The decision to reduce our staff numbers was particularly difficult as it was made in the knowledge that there is no contingent workforce of highly skilled transport safety investigators available in the marketplace to be deployed at short notice in the event of a new crisis.

'It was indeed sobering to see more than 200 years of combined corporate and investigation experience leaving the ATSB.'

The ATSB also deployed two investigators to the Ukraine in July after Malaysian Airlines flight MH17 was shot down by a missile with a number of Australians on-board.

Certainly a very much different spin and mainly focussed on the possible implications for the ongoing search for MH370. I also now wonder if Beaker may have diverged from the government (M&M) briefed script/spin when he said...

'For the foreseeable future, we will be able to undertake fewer investigations and we will need to carefully consider and constrain the scope of investigations initiated.'

This innocuous, throw away, line would appear to be quite damning when you consider the findings & recommendations from two previous ICAO/FAA audits...:2004 -

RECOMMENDATION:

The ATSB should endeavour to establish its budget based on its actual requirements to meet its international

obligations under Annex 13 and its national obligations under the TSI Act 2003.

CORRECTIVE ACTION PROPOSED BY THE ATSB:
The ATSB has incorporated detailed workforce planning for its staff requirements in its 2004-05 business plan.
The plan also provides for revision of workforce planning, recruitment and organizational structures to take
account of revised funding and pending retirements. Funding for aviation investigation is provided by the
Federal Government through the Department of Transport and Regional Services and was increased by about
A$2 million from 2004-05. The new funding level will enable the ATSB to increase the annual number of new
aviation accident and incident investigations commenced from about 60 to up to 100. This is approximately half
the average number of accidents and serious incidents reported to the ATSB each year. All accidents and serious
incidents involving international airlines are investigated as are all fatal accidents that do not involve sport
aviation aircraft.
The ATSB will, before the end of August 2004, advise the Deputy Prime Minister and Minister for Transport
and Regional Services, the Departmental Secretary and the Department of Finance and Administration of the
ICAO audit recommendation that budget funding for the ATSB should be based on a demand-driven approach
based on the number of accidents and serious incidents each year and their severity, complexity and safety
significance to enable the ATSB to investigate them all. However, the ATSB is not aware of many, if any,
ICAO states that do not face a budget constraint that impacts the number and extent of accident and serious
incident investigations.

2008 -


While trolling through the internet to see if I could find where the outstanding issues identified by the FAA ended up I came across a fascinating document - that was published on M&M's website - that outlined a Tripartite (MoU) agreement between the Department, ASA & CAsA labelled - ARRANGEMENTS FOR AUSTRALIA'S PARTICIPATION IN THE INTERNATIONAL CIVIL
AVIATION ORGANIZATION

Still reading through this document but a couple of strange coincidences and anomalies have already perked my interest...

First was the day of signing of this agreement which just so happened to have been the day after the 1st hearing held into the PelAir cover-up Senate inquiry...

Also it would appear that M&M has ultimate responsibility for the administering of Annex 13..

13 Aircraft Accident Investigation Infrastructure

...and therefore M&M not only signs off on the notified differences to Annex 13 (relevant section see here page 74 Chapter 5) but also administers all follow up actions in audits of the ATsB...:

7. Audits

7.1 The three agencies recognise that ICAO regularly conducts audits of
Australia's safety and security systems. Australia will fulfill its
obligations in accordance with Attachment B of this MOU.
7.2 An interagency USOAP CMA Working Group, chaired by Infrastructure
will meet quarterly or as required to review actions in relation to
Australia's USOAP CMA obligations in accordance with the USOAP
CMAMOU.
7.3 The Office of Transport Security will be responsible for handling all

transport security related audits and obligations in accordance with the
USAP MOU. Working arrangements for agencies involved in the audit
of safety related Annexes are detailed as follows:
a) Following an onsite USOAP CMA activity by ICAO an
interagency USOAP CMA Working Group, chaired by
Infrastructure, will meet to review actions in relation to
Australia's Findings and Recommendations as a result of the
onsite activity and to coordinate and monitor the corrective
actions resulting from the onsite activity and the implementation
plan. The group will comprise of members from Infrastructure,
CASA, Airservices Australia, the Australian Transport Safety
Bureau (A TSB), Bureau of Meteorology (BOM) and the
Australian Maritime Safety Authority (AMSA).
Responsibilities of the Working Group will include:
1) Overseeing implementation of Australia's Corrective Action Plan
(CAP),
2) Ensuring Australia's completion of information required under
the CMA online in accordance with Attachment B of this MOU;
3) Providing updates, at least every 6 months, to AIG (refer to
paragraph 6.3) including implementation of the Corrective Action
Plan; and
4) Updating the DGCA Directory.

Still trolling and I reckon there are many more dots to join in this tale...

Love to be able to track the changes to that Tripartite MoU but my bet is Doc Hoodoo Voodoo has probably put a curse on it...

MTF...

[Kharon]

And, the best bit – is.

ATTACHMENT A - ANNEXES TO THE CHICAGO CONVENTION.

Respective Departmental, Airservices Australia and CASA responsibilities for ICAO Annexes are set out below. These are the prime responsibilities only - does not account for "shadow" arrangements or provision of technical/policy advice by another agency.

But is it coincidence? Are there not subtle forces at work of which we know little?”. Holmes - the Blanched Soldier.

Coincidence is a queer thing; most of the famous detectives won't have a bar of it. MOU - Date, timing and wording – but "shadow" arrangements do not, in any way deflect the liability of the 'ultimately' responsible person.

Quiz show compare - "And now I can reveal our mystery guest - the star of our show?" (pause) (delay) "Come, come - Don't be shy - Step out into the spotlight" (big ruck back stage, then, suddenly, propelled onto centre stage, into the bright lights: a minion, slightly battered and definitely looking confused). "Our volunteer" pipes a voice off stage.

"Oh bugger" say the minion....

[Sarcs]

Addendum - Beaker & the MH370 spotlight??

Kharon - Coincidence is a queer thing; most of the famous detectives won't have a bar of it. MOU - Date, timing and wording – but "shadow" arrangements do not, in any way deflect the liability of the 'ultimately' responsible person.

Hmm...so does that mean that our pumpkin headed Mandarin has ultimate carriage of the final outcome of the MH370 search mission...

While on the subject of Beaker & Co and the FAA/ICAO...

The following comment from Confirmed Sceptic to Ben's article - Pel-Air and Seaview anniversaries highlight safety failures - hits the nail on head...

Confirmed Sceptic

Posted November 19, 2014 at 3:30 pm | Permalink
The NTSB, and now the ATSB are both suffering from underfunding. The ATSB is also suffering from a massive credibility deficit. Don’t get me started on the unspeakable CASA. Among my corespondents in other air regulators CASA is a joke in search of a punchline. There is a small but very real chance that the FAA may find the time to do the unpalatable and find CASA unreliable, and hence impugn all airlines regulated by it.

I think the Abbott government should bitch a little louder about Obama’s words on climate change. It would be fun to see a little diplomatic pissing contest involve CASA, which is very low hanging fruit.

Rumour has it that the FAA definitely have a strong desire to conduct a follow up audit of Australia but are simply under resourced (i.e. cash strapped) to do so. However could that situation drastically change if ICAO were given further evidence of the State aviation safety authorities taking the Mickey bliss to their obligations as a signatory to ICAO...

Moving on for now and back to the subject of Beaker & MH370...


The following is interesting as it is addressed to our infamous muppet:

Brock McEwen
PostedSeptember 24, 2014 at 9:33 AM


Open Letter: Request for Public Disclosure on MH370 Investigation
September 24, 2014
Dear MH370 Search Team Leadership (c/o Martin Dolan, Commissioner, Australian Transport Safety Bureau),
Hundreds of experts – both inside and outside the formal investigation – have been working for 200 days, now, in an effort to determine MH370’s fate. The collective failure even to search properly, let alone find anything, has sparked frustration and finger-pointing, as a baffling lack of consensus on basic data has pitted stakeholders against each other. Families of MH370’s passengers and crew – stretched taut on the rack between hope and grief – deserve better than this.
A more fulsome disclosure of your team’s working assumptions – in support of performance and radar-tracked path analysis in particular – would not only “clear the air”, and dispel growing suspicions concerning the veracity of this search, but is quite likely to expedite search zone refinement: “crowd-sourced” insights stemming from the eventual partial publication of Inmarsat data have already demonstrated clearly the value of such disclosure.
Accordingly, we ask the Search Team Leadership to disclose the following elements of its basic internal working assumptions. For each assumption, please publicly disclose initial (i.e. mid-March), all interim, and current (i.e. mid-September) working best estimate(s), as well as date ranges over which each was effective:
PART A: DATA (all items have already been referenced in public statements, and are thus, we trust, readily available)
1. Full set of Inmarsat ping ring radii (in nmi), and associated satellite position (latitude/longitude in degrees/minutes)
2. Amount by which radar-indicated speeds were judged to reduce post-radar range, as percent of initial post-radar range
2a. for each version of the above: minimum and maximum speeds (in KTAS) outside of which fuel exhaustion was assumed to occur prior to 00:19 UTC (i.e. feasibility limits, expressed in KTAS)
3. Point at which MH370 turned south around/near Sumatra, expressed as a specific coordinate (latitude/longitude in degrees/minutes); where a range was contemplated, please supply the range – but indicate clearly the single coordinate which drove the “highest priority/probability” search location. If a slow turn was modeled, please indicate its north-western extreme.
4. Feasibility ranges derived from the above, expressed as a coordinate pair along the 7th Inmarsat arc (where a range of turn south points informs the feasibility coordinates, please also disclose what these coordinates would be if the “later turn south” assumption were abandoned (i.e. “early turn south only”).
PART B: RECONCILIATION: In addition, please reconcile each of the above to each of the following:
a) Original search zone, based (presumably) on neither “heavier fuel burn” nor “later turn south”
b) Mar.28 ATSB Media Release #2 announcing 600nmi shift NE, expressing confidence in “heavier fuel burn”
c) Apr.1 JIT advice to ATSB causing a further 750nmi shift NE, expressing confidence in “later turn south”
d) May 1 release of maps accompanying MH370 Preliminary Report (especially the “highest probability” path)
e) June shift back SW, (in Jun.24 Malaysia Chronicle interview) retracting confidence in “heavier fuel burn”
f) Jun.26 “MH370 – Definition of Underwater Search Areas” Report: all performance limits and search zones
g) August shift further SW, (in Aug.28 statement by Warren Truss) retracting confidence in “later turn south”
Thank you in advance for your attention. Please be advised that failure to supply PART A by Day 210 (Oct 4) and PART B by Day 225 (Oct 19) will trigger an online petition designed to gauge international public opinion on this matter.
Should evidence of MH370’s fate surface in the interim, the need for this disclosure will remain. If the jet is located, the above documentation will be required to dispel any suspicions of evidence tampering, and will prove vital to what we trust is surely our shared goal: getting to the truth, to offer closure for passengers’ families and friends.
Sincerely,
Brock McEwen, on behalf of a frustrated general public

Not sure if Brock got a satisfactory response from Beaker but if he did I would be inclined to heavily scrutinise the factual content (in amongst the weasel words) of the reply...

I also came across an interesting story from NBC news titled - Girlfriend of MH370 Passenger: 'Something Is Being Covered Up' - that has many disturbing parallels to the PelAir cover-up...

Examples:

As relatives marked the six month anniversary of the Boeing 777’s disappearance Monday, Sarah Bajc told NBC News she believes that there “are active steps being taken to interfere with finding the plane.”

“Our opinion, the family members’ opinion, has been the same since the very beginning that we need an independent investigating group who has access to all the native information, so including military radar records, to be able to go back and start the investigation from the beginning to see if we can find out what happened,” she said.

“I think that if the existing investigation team is left in charge … we may not ever find the plane. Because I believe there are active steps being taken to interfere with finding the plane,” she said,

Asked what she meant, Bajc said she wasn’t sure. “Failure to release information - whether its obfuscation, you know, actually covering something up - or dishonesty… creating false evidence or just hiding something, right? We don’t know why or what is being covered up, but something is being covered up.”

She said the Australian investigators, who have been working alongside the Malaysian team to find the jet in its presumed location in the southern Indian Ocean, “should be very embarrassed by their behavior so far,” adding: “They pursued a path of underwater pings long after it was very clear they weren’t accurate. They have not had the strength of will to force Malaysia to open up all if its records.”

Hmm...no comment required except to say TICK...TOCK Beaker and the Mandarin providing top cover for him...

MTF...

[PAIN_NET]

Sarcs there seems to be a problem with the link to the Tripartite Memorandum of Understanding (MoU) - post #2543. For those interested in reviewing the MoU the link below will take you to Zippyshare, where a user friendly version may be downloaded.

Only click on the



to avoid unwanted spam.

MoU_Tripartite.

Nice work boys.....

P26. a.k.a. 36-24-36.