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Senate Inquiry, Hearing Program 4th Nov 2011

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Senate Inquiry, Hearing Program 4th Nov 2011

Old 18th Feb 2013, 12:08
  #1061 (permalink)  
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Frank, if CASA took performance enhancing drugs their calf muscles would swell and the jackboots would no longer fit, so that's a bad idea.
Plus steroids will make you prone to outbursts of anger, and some of them already have anger management problems!

Be that as it may, L.Armstrong is looking for work! Come to think of it, as of next month so will the Pope be, and in September most of Joolia and friends also, so there is a couple of ideas for FF's new robust structure!
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Old 18th Feb 2013, 20:56
  #1062 (permalink)  
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Well done.

Once again, the great team supporting the Senate Committee have proven their worth.

The Pel Air FRMS – Special audit – has been modified and is now a very user friendly 30 second download from either the Senate site or from the link below.

FRMS Special audit.

Only use the "Download Now" button in the top right corner, watch out for the adverts.

P1. a.k.a. P1.

Last edited by PAIN_NET; 18th Feb 2013 at 20:57.
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Old 18th Feb 2013, 22:38
  #1063 (permalink)  
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Reading between the lines of the special audit it seems clear, at least in my opinion, that the fatigue risk management system (FRMS) was considered "shelfware" to use CASAs term. It also appears that their fuel planning procedures weren't any better.

In other words, it was there to satisfy CASA that it existed - just like a Thousand other regulatory imposts across all of the economy, such as "anti discrimination' or "gender equity" policies. For that is what shelfware means. A sop to the regulator unless I am mistaken..

And to make matters worse CASA couldn't identify the FRMS as "shelfware" or the fuel planning practice deficiencies without a special and detailed audit.

So Mr. McCormick, what are you going to do about identifying all the other "shelfware" that is gathering dust in a Thousand Operations offices as we speak?

But wait, it gets worse..........

Only problem was that Fatigue matters. It kills pilots and passengers. It costs employers money to observe it. No one in management really wants it anyway, realising that the chances of accident on their watch are slight, so leave it to the next manager to sort out. As for pilots, they are in the Toxic "Double Bind" problem - damned if they do and damned if they don't.

Complain about fatigue = get a reputation as a whiner and kiss the company goodbye.

Don't complain = Make a fatigue related mistake and CASA will blame you and only you, just like the Head of CASA appears to have done.

And to top it off:

The only way out of the double bind problem that I know of, apart from quitting, is an appeal to the safety auditor in the form of a confidential report to the ATSB. But the ATSB has a memorandum of understanding with CASA that requires them to pass on information capable of identifying the complainant, and in any case CASA leaks like a sieve and has its own agenda in play.

What that means as far as I can tell, is that no pilot, PPL, CPL, whatever can put any trust in the integrity of Australian Air safety systems whatsoever because the outcome of even a well meaning and constructive communication with ATSB, let alone CASA, could be firing, blacklisting, criminal prosecution or loss of licence on the flimsiest pretext depending on the political wind blowing at the time.

We are indeed "criminals who havn't been caught yet".

So to ask a question: Why does Pel Air get off with a clean slate? How and why was the Pel AIr Chief Pilot hired by CASA? Why does Dominic James have to shoulder all the blame for what CASA now apparently agrees are systemic failures at Pel AIr?

....sorry for being Captain Obvious.

Last edited by Sunfish; 18th Feb 2013 at 22:50.
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Old 18th Feb 2013, 23:13
  #1064 (permalink)  
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The pot plant in the middle of the room

Sunfish, although your last 3 questions, as you put it, are obvious, they are quite crucial in this entire sordid mess. We are awaiting a clear and concise explanation from the CASA hierarchy. Although I don't think any reasonable answers will end up coming as these guys just don't get it.

In fact, to go out on a limb when you analyze Colgan against Norfolk there are some glaring and subtle comparisons. Yes I know, different countries, different aircraft and different circumstances and outcomes, but the big equaliser is Fatigue! Both organisations operated a fatigue inducing operation with no mitigation strategies in place. The more the 'potted one' opens his mouth the more ludicrous this situation gets. The Skull has proven he does not look at broad systemic issues, he is not capable of doing so. He is purely a stick and rudder left hand seat man, nothing else. This is the wrong type of leader to be leading an authority transition from the safety systems of the 70's, 80's and 90's. He should robustly exit the building taking the CASA Board and his 2 sidekicks with him, as a starting point.

The MOU with the ATSB is a farce. It's akin to the FBI having an MOU with the state troopers.
The ATSB has been the last bastion of trust, when all else fails you have one body you can confide in. All gone!
The Minister for Mascot, Sith Mrdak, the Boards and other 'intellectuals' involved in putting the 'agreement' in place should all receive an industry vote of no confidence for allowing the parlous condition that now exists to be 'acceptable'.
The MOU should be rescinded immediately as part of an ATSB and CASA gutting.

Last edited by my oleo is extended; 18th Feb 2013 at 23:23. Reason: Fatigued and need a rest. Went and potted some new plants!
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Old 19th Feb 2013, 00:09
  #1065 (permalink)  
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UITA, what can one say?? The document speaks volumes all by itself!
Perhaps the Senators would like to ask the CASA to respond to this document??

I agree with this - If this is just a sample of one lack of oversight of an operator then what else is out there?
Hmmm. Me thinks Lockhart and a number of other accidents would have a similar lack of oversight attached to them - prior to, during and after an issue arose?
This is a disgrace. I guess it beggars the question of 'how safe are our skies really'? Don't bother answering. The proof is in the Senate.

'Reactive CASA skies for all'
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Old 19th Feb 2013, 07:34
  #1066 (permalink)  
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I was going to answer this post from blackie, but it's a wind up so I'll ignore it.

The skies are safe there being no aircraft to make them unsafe, but it's the poor poor little school kiddies that worry me having to look up all the time for falling space rocks.
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Old 19th Feb 2013, 08:04
  #1067 (permalink)  
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"flying fiend's" boys'n'gals

UITA couple of good copies there and I notice you've finally got the scale about right.

In your post http://www.pprune.org/7701732-post1099.html did you happen to notice the subject line which reads "FW: Response to Roger".

Err..perhaps flying fiends designated legal officer for the day on the FOI desk has missed the subject line while dutifully redacting the FRMS Special Audit report.

Note on FOI or Dunce's Desk: That's the desk that everyone calls the 'naughty corner' and is jammed up near where the effluent and scraps come down from the golden trough from above and sits under a shroud of cobwebs.

On those emails the one on page 42 of the PDF was very interesting, here is a quote from part of it…

“One of the key areas that we believe is missing from the action plan is a list to cover the quality assurance (QA) processes i.e. there is a lot of activity within the list but how will they determine and assure themselves and CASA the actions have been effective. For example safety culture and reporting remain an issue with the WW operators and this process takes time (minimum 6 months) to influence and determine the change has been effective.”

Q/ So did these helpful suggestions get acted on? Or, like the rest of the report appears to have been; did it get ‘shelf wared’? Sure like to take a look at that FF ‘shelf ware’ warehouse!

Last edited by Sarcs; 19th Feb 2013 at 08:39.
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Old 19th Feb 2013, 10:54
  #1068 (permalink)  
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In light of some of the comments and contact of the report looking at the effectiveness of the centralized service centre?

There was concern from old timers that the process could be a tick box process.

I wonder how many other audit reports and RCA's have been mislaid?

Anybody have an sti (safety trend indicator) audit carried out over the phone?
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Old 19th Feb 2013, 11:24
  #1069 (permalink)  
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Box ticking and audit flicking

Halfmanhalfpotplant, the CASA love those ticked boxes.
As for over the phone audits I am not sure, but the Accident Liasion Manager who is the 'not so robust' CASA/ATSB conduit in the middle of this gritty sandwich used to accept 'telephone calls to an operator' as Operational Surveillance when he was the Brisbane field office manager! Again, it ticks the boxes and meets KPI's, but just a smoke screen. I imagine it is all sitting in TRIM if one was to search for it

I have also been told for example that when Macair fell over the government panicked about not being able to service FNQ routes, so they arranged for another operator to pick up a bunch of those routes, albeit with a completely different aircraft type. No audit was done first, no full and thorough risk assessments undertaken, just a 'desktop exercise' and hey presto - the new operator had all the ports added to their AOC, which was around 10 ports I am told, and done very quickly. No risk in that is there?

Aargh yes I hear the sound of a shredder I believe!!
Poor Flyingfiend, no wonder he doesn't have time to post of late. All these spotfires erupting and not enough hoses! Maybe CASA will have to use all the trough water as well??

'Unsafe emails for all'

Last edited by my oleo is extended; 19th Feb 2013 at 11:28. Reason: Measuring the Skulls risk profile on a consequence and likelihood matrix. Doesn't look good...
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Old 19th Feb 2013, 12:00
  #1070 (permalink)  
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Just a thought.
Perhaps I've missed something or has "Flyingfiend" disappeared off the forums completely?!
Wonder why? Perhaps I'm not searching correctly?!
On a completely different note....... how does one go about a defamation lawsuit these days?Ah well.... off to bed methinks!
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Old 19th Feb 2013, 13:03
  #1071 (permalink)  
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Ff maybe monitoring for
Incoming - Friday afternoon faxes.
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Old 19th Feb 2013, 20:01
  #1072 (permalink)  
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"FW: Response to Roger".

Problem: Roger Fitzpatrick or Patrick Fitzroger. Which Woger wuz it?.

The Woger of "The Report" fame, is a lion of reform, robustly using cohorts of fearless FOI to drill down below the conflicted, scratched surfaces. Sorting the incompetent from the dopey and reflecting "CASA concern". Obviously seriously qualified as "He, who must not be named" singled him out from all of his other 'experts' to draft a secret "How to fix it" report.

The Woger of "audit management fame" has previously, under oath claimed to be no more than a simple paper shuffler at the mercy of technically qualified inspectors; some of whom told fairy stories, which Woger believed. It was unfortunate that whatever a qualified field inspector told him, he a simple paperwork shuffler, was obliged to believe, no matter how dubious or worthless the information was. "Not qualified M' lud".

Now it can't be the same chappie, that would imply complicity, or lying on oath or a seriously split personality. No!, and then, the difficulty identifying the wight "Woger" is further compounded by the inappropriate use of large words, complicated syntax and long sentences which appear to finish where they start, without actually saying anything. The available candidates for "Woger" all seem to fancy themselves with a pen.

Aye, 'tis all passing strange; a puzzle. Will the weel Woger wiggle out from the wood work? Tonight, the Bar Room Barristers have convened a special information swap night, with a guest speaker; perhaps they can determine just who's bweifs Woger was pulling.

Insert - standard "Kelpie" ending.

Last edited by Kharon; 19th Feb 2013 at 20:13. Reason: Wotten key board is wooted.
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Old 19th Feb 2013, 20:54
  #1073 (permalink)  
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GADRIVR, Flyingfiend is a little to busy for prune at the moment. Lots of work to do, trips to Montreal, paperwork to shuffle, pot plants to water, etc etc.
He may come back if asked nicely, but unlikely.
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Old 19th Feb 2013, 21:52
  #1074 (permalink)  
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Excerpts from the 'Shelfware Chronicles'

Chapter One: Jack Rabbit his cohort Wodger Wabbit and the other wily wabbits!

Love it "K"! Oh Mr Ferryman...please...please tell us a fairytale??
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Old 19th Feb 2013, 23:13
  #1075 (permalink)  
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Wanted - A ringmaster

Step right up friends the circus is in town. That's right, and completely true, Cavalia has set up in the DFO carpark, Brisbane airport, across the road from that other great circus tent - Fort Fumble!
Bring the family and bring the Inspectorate. There will be a host of activities including:

A kids petting zoo - Pat a FF executive in his natural environment. This one is not for the faint hearted.

A spinning cage - Watch as audit reports, documents and 'questions on notice' are spun around mercilessly. Spin spin spin, where it stops only Albo knows. The finale of this act is always a heart stopper.

Apple bobbing - Grab the top prize and you could be off on an all expenses paid 'working study' to Montreal with business class tickets and 5 star chamber accommodation.

The Lions Cage - Watch as a Senator walks into the cage full of hungry FF spin doctors and tries to tame the circling ferocious angry beasts! There will be hoops to jump through, whips and jackboots.

Escape artists - Watch as a group of mid tier managers attempt to free themselves from the chains of the Band D Salary and escape to the safety of an awaiting corporate executive package.

Flyingfiends flying trapeze act - You will be amazed at this robust performance. Watch as these high flyers move from one end of the tent to another at dizzying speed and almost out of sight. There will be no safety net as these boys are fully confident in their ability to defy the laws of aviation nature. (Keep an eye out for the spandex costumes!).

Laughing clowns - There will be bald headed laughing clowns aplenty. Grab an audit report and pop it in the clowns mouth and win a prize!

AOC fortune teller - Swing by the fortune tellers desk and seek a prediction on the future or your AOC, HOFO application or gaze into the crystal ball to see what your possible future is pertaining to Show Causes.

Nashing of teeth - Enjoy working with the circus folks, bearded ladies, carnies and Inspectors as you grab a shovel, dig a hole , pot a plant, cover it in circus floor pony poo and water it from a chamber pot. You will be encouraging a greener environment while making robust use of free land space. For entertainment value this one gets a big tick in the box..

So friends come to Brisbane airport, enjoy the double act of Cirque de Cavalia and Cirque de CASA. Tickets selling fast.

P.S For those who cannot afford the show there will be free evening viewing of the event from Level 3, East Wing, FF Brisbane.

Last edited by my oleo is extended; 19th Feb 2013 at 23:18. Reason: Circus elephants in the middle of the tent
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Old 20th Feb 2013, 01:49
  #1076 (permalink)  
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It kicks off with a reproduction of the 1936 Berlin Olympics where following the march past, 40,000 pigeons will be released and while circling to get their bearings, a Battery of 105mm Howitzers from The School of Artillery fire a salute which causes 40,000 simultaneous pigeon shits to descend on the audience.

It will be worth it if only to listen to the Massed Bands follow on with The 1812 Overture culminating in..........., you guessed it 40,000 more pigeon shits.

This will be salvaged for pot plant fertiliser.

I trust Brisbane ATC have been informed?
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Old 20th Feb 2013, 05:08
  #1077 (permalink)  
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Excerpts from the 'Shelf Ware' Chronicles cont:

Jack Wabbit's spin and obfuscation is laughable :
Senator FAWCETT: Going to that exact point, if you go to 4.1 of the Chambers report, it states that it is likely that many of the deficiencies identified after the accident would have been detectable through interviews with line pilots and through the conduct of operational surveillance of line crews in addition to the surveillance, the management checks.

It strikes me that the Chambers report is quite specific, and that is only one example. There are a number of other areas where it is fairly clear that there were deficiencies in the oversight that had they been addressed through effective audit the accident may well have been prevented. The point though, Mr McCormick, is not so much to say that the surveillance was deficient therefore the world is about to end.

Commissioning the Chambers report was commendable upon your taking control of the organisation. The point is, for the public to have confidence that there is transparency and due process, where there is a report in existence, a formal report conducted by a senior manager, it would be the expectation of the public—and indeed, as Senator Xenophon has pointed out, it is clearly highlighted in the MOU—that the information pertinent to an investigation by ATSB would be made available.

With the concept of a systems approach, whereby not only the operator and the piloting command but also the regulator are key parts of the safety system, where there is written evidence in the possession of one department prior to the publication—in fact, prior to even the review of the draft report coming out—it seems inappropriate to the committee that the spirit and letter of the MOU was not implemented to make that information available.

Mr McCormick: As I said, the CASA Chambers report was a report that I started. It did not even require to be done. It was not something that was in our normal procedures. Following the MOU—

Senator FAWCETT: We appreciate the fact that you started it. Our concern is the fact that, having initiated the report and having it in your possession, the report was not then made available—as required by the MOU, in writing let alone in spirit—to assist the ATSB with their subsequent investigation.

Mr McCormick: It is a balancing act tiered between what is required to be provided to the ATSB and what is an internal CASA document. I took the view that that did not, in any way—the Chambers report—should not be influencing ATSB in their deliberations. We were very specific in not allowing our report, or any of our information, to be available to the ATSB where we had reached conclusions in a parallel investigation. In actual fact, we did not provide our report, or the accident report and our special audit reports, until we received section 32 demands from the ATSB, which we did receive on 25 March 2011 and 3 August 2012 respectively. I am very aware that we do not want a contagion effect on the ATSB.

We conducted this in the best possible way we could. We did it with the most probity and the best goodwill that we could muster at the time. In retrospect, should the ATSB have an internal CASA document? That is something that I will take away and consider again. I do not think we are in violation of the MOU in that we provided the information as we were required, and we were scrupulous in avoiding telling the ATSB our conclusions or where our investigation was going—a parallel investigation but for different reasons.

As I think Mr Dolan said before, he did not want to be involved in a CASA inquiry, nor was he inquiring into possible regulatory breaches or effects that rightly fall under our jurisdiction. So in a lot of ways, to release that report would have put, I would think, the ATSB in a different position. That is a question you could ask Mr Dolan. From my point of view, if I put myself in Mr Dolan's shoes, that would have given me a great deal of difficulty from the point of view of establishing my line of inquiry and my line of decision.

Senator FAWCETT: We will come later to the issues of collaboration—I will use that word as opposed to 'cooperation'—between the ATSB and CASA.

But there is evidence and there are documents, which we will discuss, that indicate there was relatively frequent and open discussion about the content of reports and alignment between the two organisations, and yet a report that (a) would obviously embarrass CASA was not made available, despite other because they say 'there is a lack of evidence that this is a serious safety concern'—and they take the fact that there have been audits done of the FRMS system used by the company. In the audit that CASA put together, it said:
it is considered that the oversight by CASA has been inadequate as there is evidence to support that many of the problems identified by CASA during the surveillance audit of March 08 were never appropriately actioned.

There is a lack of any clear evidence to support corrective actions have been implemented, confirmed by CASA or that there were effective. If this process is indicative of broader practices of CASA, it is considered that CASA is exposed to unnecessary risk, particularly if required to provide evidence to support how it approved and operated a system, in this case their FRMS

Given that the ATSB chose to ignore the whole issue of fatigue and how that might have affected the errors that were made by the pilot, because of a lack of evidence, and CASA had a formal report within their system dealing with the issue of fatigue and chose not to disclose that to the ATSB as required by the MOU, I think you would have to agree Mr McCormick that that would seem a little unusual to the reasonable man on the street.

Mr McCormick: The issue of FRMS, or the issue of fatigue, at the time was in its infancy, shall we say—even today, the FRMS rules, where they lie and how we are going forward is a matter we can discuss at some length; we are in a regulatory development process at the moment for fatigue risk management. Put in one score forward from a FADE system, which I believe Pel-Air were using, and which is used by many others around the world, gives an answer. Using some other esoteric system, or some other mathematically based system, may give you another answer.

Mathematically based systems have not been proven to be accurate in any way, shape or form. I think the important thing is, on page 21 of the Pel-Air Aviation Safety Audit Report from CASA, where we interviewed Pel-Air pilots, under the 'Policy and application of fatigue practices', it says:
All crew interviewed stated that they felt that would be no issues in stating that they were fatigued and pulling out of duty, but also felt that they had limited opportunities to fly and had to take these opportunities when they arose.
Err good try but I'm afraid I don't think there'll be many that will swallow that codswallop!

And you guessed it Hansard is out....

Last edited by Sarcs; 20th Feb 2013 at 05:09.
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Old 20th Feb 2013, 05:20
  #1078 (permalink)  
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Huston – we have a small problem.

Don't ya just love it when the information comes straight from the "horses mouth" (play nice). This makes things very, very interesting. Woger, the wily white wabbit, wevealed.

Hansard – page 6 – Friday, 15 February 2013.

Mr McCormick: All I can say about that is go back to what I said earlier on the standard we were applying in the Chambers report. I wanted the full information, in other words, to put us to a gold standard. The Chambers report adequately reflects what Mr Chambers found when he carried out that investigation.

Mr McCormick: As I said, the points raised in the Chambers report—and I will check it on notice—are covered in our special audit report and in the accident report itself. Mr Chambers has elaborated on that,
My bold.\
Tempus fugit, but it will keep.

Last edited by Kharon; 20th Feb 2013 at 05:22. Reason: Temper fuggit
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Old 20th Feb 2013, 06:16
  #1079 (permalink)  
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Esoteric system? Oh Mr Skull.
Either somebody with a PHD in shrubbery and tautology has been coaching him or he was describing some kind of high flying trapeze act you would see at Albo's circus??
Step right up step right up the Circus is in town!
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Old 20th Feb 2013, 09:33
  #1080 (permalink)  
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Mr Skull's ridiculous responses and reactions are classic..and his anger knows no bounds
Last seen doing a rabid impersonation of a whirling Dervish. (that's a wabbit with large ears and a brain less than proportional to the head under the influence of Coriolus effect and crystal meth).

By midnight he may well disappear up his own fundamental orifice such being the laws of centrifugal effort.

But be cognizant that this is only an internal merorandum of understanding of the laws, of whatever laws, is being understood, at this time in space, (given my orientation), of events.

Birds? What birds?
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