Safety In The Skies

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-The National Transportation Safety Board’s statistics show an accident rate of 5 fatal accidents for each 10 million flights on scheduled and nonscheduled service by U.S. airlines operating under part 121 of the Federal Aviation Regulations from 1982 through 1998. -Federal Aviation Administration (FAA) is responsible for examining an airline’s operations when the airline seeks a certificate to operate and for conduction periodic inspections to ensure continued complained with safety regulations. -FAA has nearly 3300 safely inspectors located in 101 district offices throughout the U*S. One of the inspector’ primary functions is conducting what FAA calls “routine surveillance” – a process of continuous periodic safety inspections of airlines and aviation – related activities. -The inspections cover four main areas: -Operations inspections focus on such items as pilots’ certification and performance, flight crews’ training, and in-flight record keeping. Maintenance inspections examine an airline’s overall maintenance program, including the training of aviation mechanics, the development of maintenance manuals, and procedures for repairing aircraft and their components. Avionics inspections focus on electronic components of the aircraft. Cabin safety inspections concentrate on cabin procedures, passenger safety, and carry – on baggage. -Air Transportation Oversight System is largely reponsive to past concerns raised about key aspects of FAA’s aviation safety inspections and the usefulness of inspection data. -To inprove inspection qualtity, the new program emphasizes a system safety approach that goes beyond spot-chicking irlines for compliance with Federal Aviation Regulations. Using safety principles originally created for the nuclear industry, it calls for a systematic review of airlines’ policies and procedures to ensure that they incorporate basic safety priciples, such as clear lines of responsibility and written documentation. It fosters more consistent, structured inspections by standardizing inspection tasks, linking inspectors’ training more closely to their assigned responsibilities, and using teams rather than individual inspectors to perform many inspections. The program also calls for a number of enhancements to improve the usefulness of inspection database for reporting inspection results and the addition of data quality assurance managers and analysts. The goal of this redesign is to target inspection resources to those areas that present the greates safety risks. -FAA emphasizes a system safety approach in ATOS that replaces routine surveillance and goes beyond spot-checking airlines for compliance with aviation regulations. System safety involves the application of technical and managerial skill to identify, analyze, assess, and control hazards and risks. It covers every aspect of and airline’s operations, from the design of the hardware to the culture and attitudes to the airline’s personnel. -Under ATOS, FAA assigns a team of inspectors to oversee each airline. Three principal inspectors lead the team, one for each major area of inspections (operations, maintenance, and avionics). Additional team members can be based in one of two ways. Inspectors based at the FAA office that holds the airline’s operating certificate work full time on the ATOS team. -FAA included two kinds of guidance in ATOS to help a team plan and carry out inspections of the airline it oversees. First, automated ATOS planning guidance is used to develop the comprehensive surveillance plan for each airline. The planning guidance calls for using existing safety data, risk indicators, and the inspectors’ knowledge of an airline’s operations to determine whether the airline has systems in places to ensure safety and a second series of inspections to verify that the airline is actually using those systems. -In the past, flight standards typically allocated a large portion of its inspection resources to thousans of unstructural inspections that produced few reports of problems. We reported last year, for example, that inspectors reported no problems for 96% of the inspections thye conducted in fiscal years 1990 through 1996. -Past concerns also included problems with inspectors’ training. Specifically inspectors have performed inspections for which they did not have appropriate or current credentials, in part because of limited finding for training. Providing adequate technical training for FAA’s inspector work force has proven difficult because of the rapid change in aviation technology. -Airlines can meet regulatory requirements in a variety of ways, making it difficult for FAA’s inspectors who inspect many different airlines to be familiar sometimes resulted in airlines’ being unfairly cited for noncompliance. -Finally, our review of aircraft repair facilities noted that individual inspectors generally identify far fewer deficiencies that teams do. The unstructured inspection activities and the underreporting of violations by inspectors resulted in inaccurate, incomplete, and inconsistent information that was not very useful for analyzing safety risks or targeting the agency’s resources to the problems that pose the greatest risks. -FAA also included several features in ATOS to address past concerns about inspectors’ training by more effectively linking inspectors’ technical training and qualifications to their job responsiblities. First, FAA designed ATOS to link inspection assignments to the technical background of each inspector and to identify any additional technical training needed to accomplish the work plan. Second, inspectors assigned to an airline, including field inspectors, must complete training on both ATOS and the airline’s specific polices and procedures before they can conduct inspection activities. The training on the airline’s policies and procedures familiarizes inspectors with the approved operating procedures of the airline they oversee. -FAA included several features in ATOS to address past concerns about the usefulness of inspection data for analysis and targeting. First, the standardization of inspections and the development of guidance for planning and conducting inspections are steps intended to improve the quality of FAA’s data by making inspections more systematic and thorough. Second, FAA created a new position within the ATOS team overseeing each airline: a data evaluation program manager, whose job will be to review data for validity, accuracy, and completeness before they are finalized in theATOS database for analysis. ATOS also added a new position for an analyst on each team. The analyst is responsible for collecting and analyzing data to support inspection planning and retargeting. Finally, FAA included features in ATOS to improve the targeting of inspection resources. FAA designed ATOS to allow the targeting of inspections based on an airline’s size, operations, past history, and known problem areas. Finally, ATOS gives inspectors the flexibility to retarget resources at any point during the year based on inspection results. -Although ATOS calls for (1) more systematic, structured inspections, (2) closer links between inspectors’ training and their assigned work responsibilities, and (3) greater use of team inspections to improve inspection quality, its success in the first 6 months has been limited to: -Inspection guidance is not complete and is not sufficiently clear and detailed to accomplish the systematic, structured inspections promised by the ATOS concept. -ATOS has not resolved the long-standing problems with matching inspectors’ qualifications to their work assignments. -Team inspections are hampered by problems with assigning inspectors, including turnover, work locations that do no match inspection needs, an unwillingness of inspectors to travel, and FAA’s inability to estimate the resources, needed to complete ATOS inspections. -To strengthen FAA’s inspection and enforcement processes, GAO recommends that the Secretary of Transportation direct the FAA Administrator to take several actions, including the following: -Revise FAA’s order to compliance and enforcement to specify that FAA’s inspection staff are required to report all observed problems and violations in their respective program office’s database for tracking the results of inspections. -Provide guidance to FAA’s inspection staff on how to distinguish major form minor violations and to legal staff on how to identify major legal cases. -Improve and integrate FAA’s inspection and enforcement databases to (1) identify major violations and major legal cases; (2) target inspection and legal resources to the violations and enforcement cases with the greatest potential impact on aviation safety and security; and (3) link inspection and enforcement data so that violations can be tracked from their identification through their resolution. -Nearly 96% of the inspections conducted by Flight Standards and Security in fiscal years 1990 through 1996 resulted in no findings of problems or violations. The rate of regulatory violations is probably higher than the reported rate because problems and violations are underreported. In addition, inspections do not detect all instances of noncompliance and test only a small fraction of the industry’s operations. -Security inspectors recorded no violations for 91% of their inspections. For Security, the percentage of inspections with violations varied more widely across the different types of entities inspected that for Flight Standards. Airport security inspections consistently generated the highest percentage of violation reports, averaging 22% compared with 8% for air carrier station and hazardous materials inspections. -Security managers said that inspector’s use of the new inspection protocols resulted in more systematic, comprehensive, and consistent inspections. They also noted that Security followed up on its efforts, reviewing both the implementations of the new protocols and the new AAIRS inspection reports after 6 months. Security then provided additional guidance to inspectors, stressing the importance of reporting all violations and of differentiating clearly between violations and observations. Because the guidance was issued late in fiscal year 1996, insufficient data were available to determine the effect of the follow-up reviews and guidance on inspectors’ reporting practices. Other possible reasons for the increase in the percentage of reported violations, according to the Director of the Office of Civil Aviation Security Operations, include Security’s aggressive testing of compliance with security directives, which started in November 1995, and Security’s extension of hazardous materials inspections form large air carriers to smaller carriers and freight forwarders, whose rates of noncompliance are often higher. -While FAA does not require the use of a checklist for routine surveillance, teams are more likely than individual inspectors to use checklists or other job aids. According to FAA headquarters officials, such lists are provided by each inspector without removing the flexibility required to evaluate a repair station’s compliance. In our view, the use of a checklist or other job aids would not diminish an inspector’s flexibility during inspections but would help to ensure that comprehensive inspections are being performed. At a minimum, the use of such tools would remind inspectors to check the most safety-critical elements of a repair station of other aviation facility. -S

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