`ageing – It`s Not Just Chronology` `mixed Blessings`

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‘Ageing – it’s not just chronology’ Older aircraft and the Madonna effect Jan-Feb 2011 Issue 78 i The year that was Safety trends of 2010 i Corroded to death A flying boat's last flight i Close calls And ... more ‘Mixed blessings’ The dangers of GPS reliance CASA at 2011 AUSTRALIAN INTERNATIONAL AIRSHOW AND AEROSPACE & DEFENCE EXPOSITION Visit the CASA stand in Hall C at the Avalon Airshow and talk to our specialists. Subject specialists will be available to answer your questions on the following days: TUESDAY „ „ „ „ Propulsion—rotary wing, piston engines & GA Unmanned aircraft systems PBN/RNP AF & Boeing 737/787 Human factors in maintenance WEDNESDAY „ „ „ „ „ Propulsion—rotary wing, piston engines & GA Unmanned aircraft systems PBN/RNP AF & Boeing 737/787 Human factors in maintenance Flight testing officer, available to answer all flight testing enquiries „ Maintenance regulations „ Maintenance regulations „ Industry delegations FRIDAY „ Flight testing officer, available to answer all flight testing enquiries „ Industry delegations „ Ageing aircraft „ GPS & new aviation technology „ Sport aviation SATURDAY & SUNDAY „ Ageing aircraft „ GPS & new aviation technology „ Sport aviation THURSDAY „ Unmanned aircraft systems „ Flight testing officer, available to answer all flight testing enquiries PLUS: CASA’s Aviation Safety Advisors will be on the stand daily to assist with your general aviation safety enquiries. ISSUE NO. 78, JAN-FEB 2011 DIRECTOR OF AVIATION SAFETY, CASA John McCormick MANAGER, SAFETY PROMOTION Gail Sambidge-Mitchell EDITOR, FLIGHT SAFETY AUSTRALIA Margo Marchbank WRITER, FLIGHT SAFETY AUSTRALIA Robert Wilson DESIGNER, FLIGHT SAFETY AUSTRALIA Fiona Scheidel ADVERTISING SALES P: 131 757 or E: [email protected] CORRESPONDENCE Flight Safety Australia GPO Box 2005 Canberra ACT 2601 P: 131 757 F: 02 6217 1950 E: [email protected] W: www.casa.gov.au CHANGED YOUR ADDRESS? To change your address online, go to http://casa.gov.au/change For address-change enquiries, call CASA on 1300 737 032 DISTRIBUTION Bi-monthly to 88,000 aviation licence holders, cabin crew and industry personnel in Australia and internationally. CONTRIBUTIONS Stories and photos are welcome. Please discuss your ideas with editorial staff before submission. Note that CASA cannot accept responsibility for unsolicited material. All efforts are made to ensure that the correct copyright notice accompanies each published photograph. If you believe any to be in error, please notify us at [email protected] PRINTING IPMG (Independent Print Media Group) NOTICE ON ADVERTISING Advertising appearing in Flight Safety Australia does not imply endorsement by the Civil Aviation Safety Authority. Warning: This educational publication does not replace ERSA, AIP, airworthiness regulatory documents, manufacturers’ advice, or NOTAMs. Operational information in Flight Safety Australia should only be used in conjunction with current operational documents. Information contained herein is subject to change. The views expressed in this publication are those of the authors, and do not necessarily represent the views of the Civil Aviation Safety Authority. © Copyright 2011, Civil Aviation Safety Authority Australia. Copyright for the ATSB and ATC supplements rests with the ATSB and Airservices Australia respectively– these supplements are written, edited and designed independently of CASA. All requests for permission to reproduce any articles should be directed to FSA editorial (see correspondence details above). CONTENTS Features 8 ‘Ageing – it’s not just chronology’ It’s no news that aircraft are getting older, but what are the implications for safety? 14 ‘Ageing aircraft 101’ The nuts and bolts of aircraft ageing, for those a little rusty on the subject. 20 ’Avalon safety procedures’ Everyone’s going to be at the air show, so everyone had better know what to do. 24 ‘Mixed blessings’ Academic studies of GPS use have produced some worrying conclusions about pilot interface and performance – weekend warriors and commercial pilots alike. 28 ‘Maintaining safety’ A short course is giving sport aircraft builders the legal and technical background to maintain their own aircraft. 31 ’What happened to my SDR?’ What happens when you submit your service difficulty report. 32 ‘Conquest extended’ A case study in giving an ageing aircraft type a new lease of life. 44 ‘That was the year that was’ The trends and themes of air safety in 2010. 58 ‘Corroded to death’ Macarthur Job on an old flying boat, a heavy schedule, flawed maintenance and corrosion. 62 ‘An inspector calls ... again’ The next chapter in that story of loose-packed oxygen generators. Regulars 4 16 18 19 31 35. SDRs 40. Directives Registered–Print Post: 381667-00644. ISSN 1325-5002. 46 Close Calls COVER: Fiona Scheidel This magazine is printed on paper from sustainably managed forests and controlled sources Recognised in Australia through the Australian Forestry Standard Flight Bytes–aviation safety news ATC Notes–news from Airservices Australia Accident reports–International Accident reports–Australian Airworthiness pull-out section 46 ‘The old man was right’ 48 ‘The sky between my knees’ 50 ‘See and avoid’ 52 66 70 71 ATSB supplement Av Quiz Calendar Quiz answers Flight Safety Australia: winner of the international Flight Safety Foundation’s 2010 Cecil A. Brownlow Award for aviation safety journalism. Advertorial AUSTRALIAN INTERNATIONAL AIRSHOW AND AEROSPACE & DEFENCE EXPOSITION TEXT HERE AVALON2011 Text here 1-6 March 2011 Geelong Victoria The 2011 Australian International Airshow to be held at Avalon Airport in Victoria from March 1-6 is set to be the most exciting Airshow in the event’s history. AVALON2011 will celebrate several milestones in Australia’s aviation history, and is set to attract the most comprehensive array of aircraft seen in Australia for many years. “Avalon will be the centrepiece of celebrations for the 90th anniversary of the Royal Australian Air Force,” says Airshows CEO Ian Honnery, “and we are expecting a significant increase in the number of international military aircraft to help join in the RAAF celebrations.” The RAAF will showcase its latest acquisitions including the hightech F/A-18F Super Hornet and the Wedgetail airborne early warning and control aircraft. “The USAF has indicated that it will have some of the USAF’s latest combat aircraft at the showincluding, perhaps, stealth aircraft rarely seen in Australia and never previously on display at an Australian air show” Mr Honnery says. The Australian International Airshow is a unique mix of military, commercial, air sport and general aviation and the event brings together all kinds of aviation enthusiasts. Another aviation milestone to be celebrated at AVALON2011 is the centenary of passenger flight in Australia, and commercial operators are expected to showcase their latest aircraft at the event. The Historic Aircraft Restoration Society and the Temora Aviation Museum will also have a significant presence at AVALON2011. The Spitfire, Gloster Meteor, Sabre, Vampire, Lockheed Hudson, Kittyhawk, Mustang, Boomerang, Catalina, DC3, DC4 and Super Constellation will be just some of the “classic” historical military and commercial aircraft on display as part of the celebrations. Highlighting the future direction of aviation and defence capabilities UAV’s will also be a feature of AVALON2011. For the first time at the event there will be a dedicated demonstration facility for unmanned aerial vehicles, unmanned ground vehicles and intelligence surveillance reconnaissance systems. Smaller UAV’s will be demonstrated inside a specially created theatrette within the T H E A E R O S PA C E A N D D E F E N C E S H O W C A S E F O THE ESSENTIAL SHOWCASE The Australian International Airshow and Aerospace & Defence Exposition is the essential industry event for Australia and the Asia Pacific region. A comprehensive industry exhibition, featuring 599 participating companies from 17 nations, it will attract industry, military and government leaders from Europe, North America, Asia, Middle East, Australia, New Zealand and the Pacific. Showcasing the latest developments in technology and equipment, it is a unique networking forum for aviation, aerospace and defence professionals from around the world. Celebrating the 90th Anniversary of the Royal Australian Air Force 1921 - 2011 some operational restrictions will be put in place. exhibition pavilion, while larger unmanned vehicles will be accommodated at a specially created outdoor facility within the Airshow precinct. This demonstration facility will be under the direction of a Civil Aviation Safety Authority (CASA) certified unmanned aerial system controller. As a result of the expected increase in aircraft participation both on the ground and in the air, Access to Avalon Main will be restricted to participating (static and flying) display aircraft only. The only exceptions will be Charter Aircraft carrying exhibitor sponsored passengers from Tuesday 1 - Thursday 3 March 2011. However, extended arrangements have been made at Avalon East so general aviation and recreational aircraft can arrive and depart during daylight hours on all six days of the Airshow (including during flying display periods). There will be ample aircraft parking at Avalon East and a free shuttle bus will ferry aircraft occupants to and from the main Airshow site. www.airshow.com.au AVALON2011 will also mark a milestone in the event’s own history. It will be the tenth occasion the event has been staged at Avalon Airport. Every two years the paddocks around the airport are transformed into a city of portable buildings and displays. Up to 200 thousand people pour through the gates across the trade and public days of the event. The 2011 Australian International Airshow is one of the most exciting and thrilling events on the entertainment calendar in Victoria and is not to be missed. For more details about the 2011 Australian International Airshow, including gate times and ticket information, go to www.airshow.com.au Photo supplied by Boeing CONTACT PO Box 4095, Geelong VIC 3220, Australia Telephone: +61 (0)3 5282 0500 Email: [email protected] O R A U S T R A L I A A N D T H E A S I A - PA C I F I C R E G I O N ANNUAL AOC SURVEY AVALON SAFETY CONFERENCES In early 2011, CASA will be conducting its annual survey of all holders of Not only … air operator’s certificates—the AOC holder safety questionnaire, which Safeskies Conferences Australia will deliver two short seminars at has been in use since 2008. the Avalon International Air Show on To continue to make informed Thursday and Friday mornings, 4 and judgements and decisions about 5 March 2011. aviation safety across Australia, CASA requires detailed and accurate Recognising the 90th anniversary industry operational information. The of the formation of the RAAF on 31 survey will collect data from all AOC March 1921, the Thursday seminar holders about their activities, including will have a strong military component the types of aircraft operated, hours with a presentation by the Directorate flown, categories of operations and of Defence Aviation and Air Force factors that might impact safety. Safety. There will also be a paper by CASA will continue to use the data to a senior ATSB air safety investigator. prioritise safety oversight activities, Friday morning will be devoted assess risks within the industry and primarily to general aviation issues, target safety support for industry. with papers presented by Roger FSA JAN-FEB 2011 4 Further information will be provided to all AOC holders before the survey. If you have any questions or concerns, please email: aocsurvey@ casa.gov.au. Alternatively, you can phone 131 757 and ask for Julie Codyre on extension 1841. Weeks, CASA manager of Flying Standards and by Steve Tizzard, chief executive of Recreational Aviation Australia. These seminars are free to all air show attendees. They start at 10am and finish at 11:30am to leave plenty of time for industry exhibitions and afternoon flying programs. 2011 CPL and ATPL Examinations Scholarship The biennial Safeskies conference will be held in October this year (2011). But also, before the Avalon Airshow CASA will hold a conference for aviation regulation authorities focusing on the theme ‘Regulations on UAS developments in civil airspace and the way ahead’ incorporated with the AUVS Australia Conference. On Sunday 27 and Monday 28 February 2011, the conference will be held at the Etihad Stadium, Melbourne; moving on site at Avalon on Tuesday 1 March, 2011. For more details, email Phil Presgrave, CASA Operations: philip.presgrave@ casa.gov.au. For more details and program updates of the 2011 Avalon International Airshow, go to the Airshows Downunder website: www.airshow. net.au/avalon2011. The Guild of Air Pilots & Air Navigators (GAPAN) Assessment Services Limited (ASL) Applications are invited for the 2011 CPL and ATPL examinations scholarships. Two scholarships will be awarded. One will cover the CASA/ASL examination fees for the complete set of CPL examinations. The second will cover the CASA/ASL examination fees for the complete set of ATPL examinations. For further details and application form visit www.gapan.org.au or email [email protected] Applications close 25 March 2011 BUREAU SETS RECORD STRAIGHT Australian Transport Safety chief commissioner, Martin took on media assumptions bureau’s press conference findings into the explosion oxygen cylinder on board flight 30 in July 2008. Bureau Dolan, at the on its of an Qantas Answering a reporter’s question that asserted ‘Qantas seems to have had a bad run of incidents of late,’ Dolan set the record straight about the Australian international airline’s incident rate. ATLANTIC MYSTERY REVIVED There was no evidence that handling or maintenance procedures had contributed to the failure. The report also found the flight crew and cabin crew had acted effectively. The White Bird, flown by French World War I ace Charles Nungesser, and navigator François Coli, disappeared without trace. But French investigator Bernard Decré says aviators made it to the North American east coast. He believes the White Bird put down close to the French islands of St Pierre et Miquelon, near Newfoundland, in what is now Canada, but that Nungesser and Coli were killed in the ditching. One of the oldest mysteries in aviation may be solved this year when a French expedition goes looking for the remains of L'Oiseau Blanc (The White Bird), a French plane that attempted to fly from Paris to New York 10 days before Charles Lindbergh’s celebrated New York-Paris crossing in 1927. Decré will search the waters off St Pierre and Miquelon in the northern summer in the hope of finding the aircraft's engine. 5 FLIGHT BYTES ‘We don't have comprehensive data to compare Australian operators against international operators. What we do know is that if you map occurrences, the number of occurrences, severity of occurrences against level of activity, that the trends for the last number of years have been pretty much stable. There hasn't been an increased number of events,’ he said. The ATSB found the oxygen cylinder failure was the only recorded incident of its type and could not be reproduced. TRENT 900 BACK IN SERVICE Rolls-Royce’s Trent 900 engine is back in the air after CASA cleared Qantas to resume flights of its A380 fleet. Qantas grounded its Trent 900-powered A380s after an incident on 4 November, 2010, where one of the engines had an uncontained failure. Rolls-Royce headquarters in Derby, England would have known of the failure at once thanks to the Trent 900’s advanced engine health monitoring system, which transmits engine condition data in real time. Qantas submitted a detailed A380 plan to CASA, setting out how the aircraft will be operated, additional safety measures and required inspections. Qantas will comply with relevant airworthiness directives, as well as service bulletins from Rolls-Royce, relating to the Trent 900 engines on the A380 aircraft. CASA's Director of Aviation Safety, John McCormick, said the A380 return to service had been closely analysed by CASA's technical staff. Flight Safety Australia will cover developments in the aftermath of the 4 November incident, including an indepth look at advanced engine health monitoring, later this year. FSA JAN-FEB 2011 6 photo courtesy of Scott Palmer, Dreamstime CONCORDE FALL-OUT A French judge has found Continental Airlines and one of its engineers guilty of involuntary homicide for their role in the Air France Concorde crash of 2000. In December 2010, Continental was ordered to pay civil damages of more than $US1.3 million to Air France, and a fine of $265,000. The engineer was fined $US2650 and given a suspended 15-month prison sentence; three others involved in the Concorde’s design and certification were acquitted. A French investigation found the Paris crash had been caused by a metal strip that fell from a Continental DC-10 on to the runway. Aviation safety commentators said the verdict would inhibit reporting of safety concerns and obstruct investigation of accidents. Flight Safety Australia, which analysed the crash in its July–August 2010 issue, will examine criminalisation of aircraft accidents in depth this year. A READER WRITES … An article in Nov-Dec 2010’s Flight Safety concerning a jet take off out of Melbourne into a thunderstorm reminded me of something I witnessed many years ago. It may be timely for all those who aren't aware of, or have forgotten, what happens to the wind with the passage of a thunderstorm cell. As the storm cell passes a position on the ground, the wind veers 180 degrees as the wind at low level feeding the storm is overtaken by the wind and gusts associated with the direction of the storm. We were ready to depart Alice Springs for Perth in a B727-200 with a full load of passengers, when a forecast storm front was seen rapidly approaching the aerodrome from the south-west. We informed the passengers that we would be delaying our departure until the line of storms had passed. Shortly after, another company B727 started its engines behind us, and called ‘taxiing for Adelaide’. We wondered what our passengers thought of this, seeing this aircraft taxi past after our recent announcement. That aircraft rotated almost at the end of runway 12 - with a great deal of relief, we watched it climb away. As the aircraft taxied out and They would have had an over 20kt backtracked on runway 12 for tail wind and contributing to their takeoff to the south-east, the wind performance-affected take-off, and sock indicated horizontally above the potential for catastrophe, there 20kt from the east. Looking out was also the possibility of a downburst to the south-west, I could see the under the overhang. first part of the storm – heavy rain A check captain was commanding and lightning – approaching the the aircraft - a further reason why we aerodrome perimeter. were less than impressed with what As the other B727 lined up and we had just witnessed. commenced its take-off roll, the The lesson to be learned from this type wind swung round to a strong southof incident is not to take off or land westerly and large balls of spinifex with a well-developed thunderstorm rolled across the tarmac in front of in the vicinity of any aerodrome. us. They were now taking off with The accident records in the US on a substantial tailwind, which the downbursts support this. windsock confirmed. IddbVcneZdeaZ]VkZY^ZY^chjgk^kVWaZXgVh]Zh! i]Vc`hidi]Z^g:AI# I]ViÉhl]nlZÉkZ^ckZciZYhe^YZgigVX`hÄVXgVh]"egdd[! ZbZg\ZcXnadXVi^dchnhiZbi]ViÉhbVYZidhVkZa^kZh# >iigVchb^ihndjgedh^i^dcZkZgnildb^cjiZhk^VhViZaa^iZ [gdbiV`Z"d[[idaVcY^c\#Hd^[ndj\dYdlc!ndjggZhXjZgh l^aaWZldg`^c\idVcVXXjgViZaVhi`cdlcedh^i^dc! cdihZVgX]^c\[dgVh^\cVa[gdbVh]ViiZgZY:AI# I]ZgZhjai4NdjÄa^k^c\egdd[he^YZgigVX`hldg`h# JeÓdZekjceh["l_i_jekhm[Xi_j[ehYWbb&.&&*,'--,$ 7 FLIGHT BYTES mmm$if_Z[hjhWYai$Yec I>B:IDH6K :A> K : H In the cockpit, the three of us remarked, ‘this is going to be interesting,’ and it was. Ageing – it’s not just chronolog y Flight Safety reports on CASA’s A’s on ongoing ngoiing ageing aircraft project FSA JAN-FEB 2011 8 In her own inimitable way, the pop singer Madonna provides an excellent metaphor for the issues surrounding ageing aircraft. The 52-year-old’s vigorous stage routines are a vivid demonstration of how, with diligent maintenance, attention to detail, and appropriate replacement of critical parts perhaps, it is possible to continue to perform at a high level for much longer than typically thought feasible. In a world of veteran rock singers and youthful prime ministers, the significance of age is no longer easy to define. This truth came to light in the Civil Aviation Safety Authority’s investigation into the implications of Australia’s ageing aircraft fleet. In 2007, the Australian Transport Safety Bureau (ATSB) reported that the Australian piston engine fixed-wing aircraft fleet had an average age of 30 years. The ATSB found that if current trends continued, by 2015 the average age of the single-engine general aviation fleet would be 37 years, and the average age of the multi-engine fleet would be 40 years. How many people continue to operate their business or family car beyond 40 years? There are some jurisdictions where the maximum permissible age of a taxi is six years. A casual browse of a recent aviation classifieds newspaper revealed half a dozen aircraft more than 45 years old for sale, including one made in 1953. But, as Madonna demonstrates, there’s more to ageing than simple chronological age. Ageing aircraft management plan project (AAMP) manager Pieter van Dijk says the many facets of the ageing aircraft question soon became apparent when CASA began consulting with industry on the issue. ‘You cannot compare the airworthiness of one aircraft which has been regularly hangared, meticulously maintained, and flown well within manufacturer’s design assumptions, to an identical aircraft that has been exposed to the elements, continually, with high utilisation and only the bare minimum of maintenance.’ ‘When you’re buying an older aircraft, quite often the initial purchase price will be the cheapest cost you will ever have associated with that plane. In some cases, the economics of operating an ageing aircraft are not fully understood by the operators,’ Pieter van Dijk reflects. CASA’s ageing aircraft project is a multi-staged activity in response to a government initiative to investigate the impact of Australia’s increasing ageing aircraft fleets on safety. This industry consultation so far shows that there is a dearth of knowledge amongst aircraft maintainers and operators about the negative impact many environmental and operational conditions can have on the ‘age’ of an aircraft. ‘Initially, we thought we were just asking the question: “How old is too old?”’ he said. ‘But that proved to be far too simplistic: there is no “one size fits all” solution to the ageing aircraft situation. ‘You cannot compare the airworthiness of one aircraft which has been regularly hangared, meticulously maintained, and flown well within manufacturer’s design assumptions, to Again, each aircraft has to be considered on an individual basis, he says. ‘Think of a 40-year-old aircraft owned by an experienced private pilot, flying a few hundred hours a year and maintained to exacting standards. Then consider a 20-year-old aircraft flying 50 hours a week, hauling seafood from coastal and island aerodromes and being maintained to the CASA maintenance schedule 5 (minimum standard). Which one would be more affected by what we call ageing?’ The former could be likened to a classic car owned by an enthusiast, who pampers their old but pristine pride and joy. The latter could be equated to a white HiAce delivery van as is prevalent on all roads today. Pieter van Dijk says some of the factors affecting what might be called the ‘true age’ of an aircraft include: Certification basis Standard of manufacture Flying hours Landings Pressurisation cycles Standard of maintenance Standard of repairs Proximity of aircraft to ocean and/or corrosive environments Storage i.e. in the open vs hangar, on grass vs on bitumen Incorporation of manufacturer’s ageing aircraft management programs such as SIPs/SIDS/SIRMs. 9 AGEING AIRCRAFT Stage 1 of the management plan was a factfinding mission to scope the magnitude of the ageing aircraft problem in Australia, and make recommendations to CASA senior management. The project used independent ageing aircraft specialists as part of the team to engage with industry representative bodies and maintenance organisations. A comprehensive and objective collection and analysis of the engineering data has identified the challenges associated with the continued safe operation of the ageing aircraft fleet. CASA management and the engineering specialists then developed proposed solutions. an identical aircraft that has been exposed to the elements, continually, with high utilisation and only the bare minimum of maintenance.’ ‘What the bathtub curve tells us is while there’s no reason why an older aircraft should be inherently unsafe, there’s also no escaping the increased time, effort and money needed to keep it airworthy.’ Decreasing Failure Rate Constant Failure Rate Increasing Failure Rate Early Mortality Failures Constant / Random Failures Wear Out Failures Failure Rate FSA JAN-FEB 2011 10 Time Bathtub curve These factors combine into an engineering concept known, disarmingly, as the bathtub curve. As a general statement on system reliability the bathtub curve is applicable to software, motor vehicles and aircraft. It can be expressed as a set of mathematical functions, but in plain language it says that the reliability of a system measured against time starts with a high incidence of problems, as parts of the system bed in to each other, then settles into a period of comparative reliability, before the problem rate climbs steeply as the system enters its old age. When this process is shown on a graph, it looks like the cross-section of a bathtub. For a well-maintained aircraft, the imaginary bathtub will have a wide, flat floor. For one used harshly and which only sees the inside of a hangar when absolutely necessary, the bathtub could approach being V-shaped. This bathtub curve principle is the reason why new cars come with a plea to visit the dealer after about 1500km. It’s a long time since most general aviation aircraft in Australia were comparably new, Pieter says. Rather, the majority are over on the right side of the conceptual bathtub curve—where maintenance and repair costs start to climb, and decisions, such as continuing to repair the aircraft or replace it outright with a newer version, need to be made. According to Pieter van Dijk: ‘What the bathtub curve tells us is while there’s no reason why an older aircraft should be inherently unsafe, there’s also no escaping the increased time, effort and money needed to keep it airworthy.’ The project team’s travels around Australia for consultation revealed examples of operators who were familiar with the implications of the bathtub curve, and a few worrying examples of operators who try to ignore it. ‘What I can definitively say is that CASA is not seeking to ground aircraft just because they happen to be old,’ he says. ‘We don’t intend to put a blanket ban on all older aircraft, but we not only have an obligation, but also a government direction, to ensure that all ageing aircraft continue to fly safely.’ ‘We saw several examples of excellent practice from private and commercial operators of older aircraft. These operators recognised that some of what they saved on the purchase price of an older aircraft they had to reinvest in maintenance and ongoing repairs,’ Pieter van Dijk explains. 11 AGEING AIRCRAFT It’s an issue also confronting the US Air Force, where the average age of aircraft is 23.5 years, up from 17 years in 1990. Retired USAF major Karl Hart told the Airworthiness and Sustainment Conference in Brisbane in August that operations and maintenance costs since the 1996 financial year had increased by an average 11 per cent per annum. ‘Obviously cost is a big factor, but with older aircraft these sorts of comprehensive tests are really the only way we can be reasonably assured of their safety and airworthiness, short of replacing major structural items.’ FSA JAN-FEB 2011 12 He was particularly impressed by the operation of type clubs, where owners and enthusiasts of an aircraft type band together to share operating expertise, and often, to order batches of replacement or reengineered parts. which Pieter van Dijk says is willing to spend serious money refurbishing older types to revive them as substitutes for a new aircraft. Mining companies value safety and understand that it requires investment, he says. ‘Knowledge is the other element in this equation, along with the aircraft, the operator and the regulator. Type clubs are an excellent way of harvesting and spreading knowledge so all operators can benefit from the discoveries of a few.’ ‘We saw some aircraft which any reasonable observer would say were restored to a better condition than when they left the factory. However, to say they are better than a new aircraft is another question because certification standards have changed, and are more stringent for new types. Then again, many people will say there are no new aircraft available in certain categories, such as light turbine twins.’ But knowledge must be spread in all directions he says. Submitting a service difficulty report to CASA is only one of a range of measures that aircraft operators and engineers can (and should) do to enhance the continued safe operation of older aircraft. ‘Type clubs, other operators and internet forums are three ways to get the message out there. Because CASA is obliged to prioritise safety in commercial aviation, usually involving larger aircraft, it can only devote limited resources to SDR issues in general aviation, and these tend to be focused on safety-critical rather than operational availability matters,’ Pieter says. When it comes to sheer willingness to spend money to overcome the inherent problems of ageing aircraft, Pieter says none do it better than the best warbird operators, although he concedes their cost-no-object and time-noobject approach is a tough one to emulate. ‘They are at the extreme because their aircraft are a labour of love—but they show what’s possible,’ he says. The other new element in the ageing aircraft picture is the resources and mining industry, A concern of the team is that some older aircraft are being pressed in to the demanding schedules expected of newer machines with a more modern approach to design and maintenance philosophy, without a corresponding increase in inspection time, maintenance actions and repair. However, there is at least one way for ageing aircraft operators to increase maintenance intensity to the levels demanded of older aircraft without crippling costs—nondestructive testing (NDT). Pieter van Dijk says NDT has a long history in military and heavy commercial aviation, but remains relatively rare in general aviation, despite the obvious advantage for maintenance of Australia’s ageing fleet. Non-destructive testing methods became especially critical for the airline transport sector after the Aloha Airlines incident of 1988, when part of the cabin roof separated from a 19-year-old Boeing 737, killing a flight attendant who was ejected from the aircraft. New techniques were required to meet the more stringent inspection regimes adopted in the wake of the incident. The ageing aircraft management project team met with the engineering department at Monash University and the National Aerospace Non-Destructive Testing Board to discuss new technologies that may be available to assist the industry with the future management of ageing aircraft. The successor to that technique—the dye penetration test—remains a staple of NDT, but many new non-destructive testing technologies and techniques, which offer significant benefits to aircraft safety management, are becoming available. ‘The latest developments in ultrasonics, time lapse photography and heat measurement are truly astounding,’ Pieter says. ‘The potential benefits of these technologies are enormous: we can use this equipment to assure ourselves an aircraft is safe to continue flying when otherwise it would be grounded. ‘Although some of these technologies are already used in heavy commercial aviation, the general aviation community tends not to employ them. ‘Obviously cost is a big factor, but with older aircraft these sorts of comprehensive tests are really the only way we can be reasonably assured of their safety and airworthiness, short of replacing major structural items.’ Anyone who’s ever filled in a ‘how-healthyare-you?’ magazine quiz in a doctor’s waiting room will be familiar with the risk matrix. Enter details about your aircraft, such as its age, servicing regime, original certification standard and location and the matrix will crunch these numbers to provide a risk index for your aircraft and operations. ‘It’s a way for the individual operator to assess their risk by utilising the collective knowledge of CASA and the industry,’ Pieter says. To sum up: Stage 1 of the ageing aircraft management project has considered the many issues facing Australia’s ageing aircraft fleet. The project’s major finding? There is no one simple solution to effectively manage the ageing-related problems of the Australian fleet. Each aircraft must be assessed individually according to its use, history and the environment it operates in. CASA has no intention of ordering blanket restrictions on ageing aircraft, but intends to work with owners and operators to provide information and guidance on how to fly safely in aircraft of any age. 13 AGEING AIRCRAFT Principles of NDT have been used in other modes of transport, the railways, for example, since the late 19th century. Then, railway operators would coat parts in oil, clean them and then dust them in chalk, to detect otherwise invisible cracks. The chalk would react with oil trapped in the cracks. With so many factors involved, how is an aircraft operator to determine if ageing is a problem for their aircraft? How deep and wide is their bathtub and where does their aircraft sit in relation to it? The project has answered this question with an ageing aircraft risk management matrix tool. This will take the form of an online calculator, intended to be available on the CASA website later this year. The facts of lifespan Or, the nuts and bolts of aircraft ageing Mechanisms that cause ageing in aircraft include: fatigue, engine and systems wear, and decay of protective coatings. FSA JAN-FEB 2011 14 Fatigue mostly takes place in metal components, but it can also affect other materials. Repeated loading causes fatigue. The classic lecture demonstration of fatigue is bending a metal paper clip; the clip does not break from one bending, but if flexed repeatedly, it snaps. Fatigue failures will often take place at loads much lower than the material’s ultimate strength. Generally, the first sign of fatigue will be a microscopic crack at a location of high stress, such as a hole, notch, or imperfection. The crack grows as stress is repeatedly applied. Eventually, if not detected and dealt with, the crack grows to a critical size and causes failure at a load less than the ultimate strength the material is able to sustain. Fatigue is very much a function of the number of repetitive loads the aircraft has sustained, and this in turn is broadly associated with aircraft flying hours and cycles. Components susceptible to fatigue include structural components such as the wing spar; and the fuselage (both in the form of the loads transferred through the longerons, as well as the pressurisation loads on the cabin structure); and also internally within the engines. Increasing the structural loading on an aircraft increases its potential rate of fatigue. Operations involving high-G manoeuvres, such as aerobatics, aerial mustering and agricultural flying, will increase the rate of fatigue on an airframe, particularly in conjunction with low-level operations. In these instances, the wing spar will be subject to cumulative loading substantially above that experienced during normal point-to-point cruise. This effect is further compounded by the presence of modifications and/or repairs on or to the structure, such as wing tip tanks, winglets etc. These changes to the aircraft’s configuration may well serve to enhance the aircraft’s performance and/or range, but they could also have an unintended detrimental effect on the expected longevity characteristics of the wing if they result in additional loading beyond the manufacturer’s original plan. This could accelerate the wing’s ageing process. For pressurised aircraft there’s another form of fatigue. As an aircraft climbs, its cabin structure expands due to internal cabin pressurisation, necessary to keep the passengers and crew more comfortable at higher altitudes. As the aircraft depressurises during descent, the cabin structure contracts accordingly. While the amount of expansion and contraction involved may be relatively small, over many pressurisation cycles this effect produces fatigue in the structure. This is what brought down the Comet aircraft in the 1950s, serving to focus the world’s understanding of fatigue processes. The number of pressurisation cycles is more important for calculating fatigue than the length of time an aircraft is actually pressurised. Corrosion is a chemical or electrochemical degradation of metal. It mostly affects aircraft structures, but can also affect electrical connectors and flight control cables. Corrosion tends to occur more frequently in marine and coastal environments with high humidity and salt water. Humidity and salt accelerate the chemical reactions that initiate corrosion. This has significant safety implications particularly for seaplanes, which are constantly exposed to salt and humidity. However, not only seaplanes are exposed to these corrosive effects. Normal aircraft that are not hangared and are kept close to the coast can suffer similar effects to seaplanes over time if they are not washed or maintained appropriately. In an effort to prevent or slow corrosion, an aircraft’s design can incorporate corrosion control methods. These can include material selection, material coatings, appropriate joint design and water drainage. But the potential for corrosion damage can never be totally eliminated, so there must be regular maintenance and inspections. Moreover, you cannot assume that protective coatings will last forever. The amount of protective coating applied at manufacture, or subsequently during ongoing maintenance or repainting activity, will eventually degrade and wear away – even if only exposed to the air. Sooner or later, once the protective coating begins to break down, ten, fifteen or twenty years down the track, the bare metal will be exposed to the elements and the corrosion process will begin. This aspect of the ageing process is always there, irrespective of how many hours or cycles the aircraft is flown. Wiring Fatigue and corrosion can also interact, leading to an increased likelihood of structural failure. This is known as stress corrosion cracking. Corrosion can weaken a material and create points of stress concentration. These locations of high stress can become initiation points for fatigue, and can lead to the failure of the structure earlier than predicted. The failure can also occur in unexpected locations, making detection before failure difficult. Small objects, such as metal shavings from structural repairs, have been known to work their way into wire bundles and cut the insulation. Some fluids, such as washing solutions and hydraulic fluids, can change the properties of insulation over time if they are in frequent contact. Operating hours and the calendar age of the engine are both important when defining the time between overhaul. An engine in an infrequently flown aircraft can deteriorate at a faster rate than an engine in an aircraft flown more frequently. In engines sitting idle for long periods, cylinders can rust and result in excessive or premature wear in piston rings; and seals can deteriorate, resulting in loss of oil and potentially, loss of power. Systems Aircraft systems are non-structural, but are still extremely important for the inherent safety of an aircraft. This includes parts such as electrical wiring and cables; control cables; fuel, hydraulic and pneumatic lines; electro-mechanical systems; such as pumps, sensors and actuators; and instruments. Aircraft systems also age with usage and time. This ageing will often take the form of wear, deterioration, contamination and brittleness. In the worst case, ageing systems can generate fires and/or failures in flightcritical systems. Wiring ages from a combination of factors, including contamination; physical abuse; environmental factors; and long-term changes to the chemical properties of the insulation—oxidisation. Physical abuse can also break the conductor or insulation. This abuse can occur in many ways, including hanging items from wire bundles; rough-handling the wire; using the wire bundles as hand or foot holds; forcing the wire around small-radius bends; and when wire flexes or rubs against other components due to poor installation. 15 AGEING AIRCRAFT 101 The piston engines that typically power general aviation aircraft have a defined life, known as the time between overhaul. At the scheduled overhaul, components that are susceptible to ageing are replaced, including those components operating under high and repeated stresses. Generally, the major moving parts in piston engines are replaced before they are susceptible to fatigue damage. The problem with ageing aircraft wiring is often the insulation, rather than the internal copper wiring itself. Degraded insulation can lead to arcing and electrical shorting, which can result in equipment failure, smoke, or even an in-flight fire. $7& Notes FSA JAN-FEB 2011 16 Non-standard levels: ‘Due operational requirement’? Last year a loss of separation assurance occurred between two opposite direction aircraft cruising at the same level. One of the aircraft was maintaining a non-standard level due to ‘light chop’. While the non-standard level was not the only cause of this incident, cruising at a non-standard level removed an important system safety defence and allowed this conflict to develop. Standard levels are a long-standing system defence in aviation, designed to minimise the risk of aircraft cruising in opposite directions coming into conflict. Previously pilots could only request a non-standard level in controlled airspace if it was due to an ‘operational requirement’; however this term was not defined and was interpreted various ways. Since 18 November 2010, AIP has been amended to provide more detail on the circumstances in which a pilot may request a non-standard level. A pilot must now only request a level not conforming to the table of cruising levels when it is determined by the pilot in command to be essential to the safety of the flight and its occupants. Pilots must also add the phrase “DUE OPERATIONAL REQUIREMENT” to a non-standard level request. ATC may assign non-standard cruising levels, however only when traffic separation or other operational circumstances require. ATC will endeavour to return you to standard levels as soon as possible. So remember: Next time you think about requesting a non-standard level, is it essential to the safety of your flight and its occupants? And if you do need it, return to standard levels as soon as is practicable and safe to do so. Flight plan vs SARTIME Cancelled flights and your responsibilities Joe’s Story Joe is a private pilot who takes his flying very seriously. He is computer savvy and always obtains a thorough briefing and then submits his Flight Plan nominating a Sartime via the internet. On this particular day his plans are on track until his mate Bob rings him to say that his ‘leave pass’ has been cancelled and that he can’t make the flight today. Joe is disappointed but shrugs his shoulders and decides not to go alone. He does the right thing and rings Flightwatch/CENSAR on 1800 814 931 to cancel his Sartime. After a fun filled day of flying and fishing Joe and Bob return safely to base. Joe has set his mobile phone to remind him to cancel his Sartime and rings Flightwatch to cancel. Unfortunately he is told by the Flightwatch operator that they are not holding any Sartime for his aircraft. What went wrong? What Joe did not realise was that when he cancelled the old flight plan an automatic cancellation message was sent to the CENSAR operator. By the time the operator was able to deal with the cancellation message (he was ringing Doug who had forgotten to cancel his Sartime) the NEW Sartime had automatically been placed in the system. When the operator processed the cancellation message he compared the details to those in the system and since they matched he cancelled the Sartime. End result: No Sartime held! Sue’s Story Sue is a student pilot who is scheduled for a cross country flight with her instructor Dave. She was told the night before that they would be using VH-ABC for the flight. Sue arrives early at the flying school and submits her flight plan by FAX . She is a conscientious student and rings the Briefing Office to confirm that the flight plan had been received and confirms the nominated Sartime. Dave is running a little late and arrives with the news that there had been a change of plan and that they would be using VH-DEF instead. Sue in a hurry quickly changes the callsign on her copy of Fellow student Tim arrives shortly after Sue departs and submits a flight plan for his cross country flight in VH-ABC. There are now two flight plans and two SARTIMEs being held for VH-ABC. Sue returns safely three hours later and cancels her Sartime for VH-DEF with Flightwatch without incident. 17 When Tim returns and tries to cancel his Sartime he is told that there are two Sartimes being held for VH-ABC and could he get the instructor to ring Flightwatch to clarify the situation. End result: Confusion and wasted time and resources for all involved. What’s happening Behind The Scenes? When a flight plan containing a Sartime is submitted by phone, fax or internet, the Sartime is directly linked to the flight plan within NAIPS. Cancelling the flight plan will automatically cancel the Sartime. One call to the Briefing Office to cancel the flight plan is all that is required. The only exception to this rule is if you forget to submit a SARTIME with your flight plan and do so at a later time directly to Flightwatch/CENSAR via phone or radio, in which case the flight plan and SARTIME are not automatically linked and you will need to separately cancel your SARTIME. If you submit multiple flight plans using different callsigns each will generate an active SARTIME. Food For Thought If a SARTIME flight plan has been submitted and the flight does not go ahead, then you need to cancel your flight plan first, then consider how you submitted your SARTIME and separately cancel your SARTIME if necessary. If you have a last minute change of callsign ring the Briefing Office to effect the change. ATC NOTES Thirty minutes later Bob rings back to say his luck has changed and he is on his way. Joe logs back on to the computer and tries to re-submit his original Flight Plan but gets an error message stating that there is already a flight plan held with those details. Joe has seen this before and rings the Briefing Office to cancel the original Flight Plan and then is able to re-submit. the flight plan and re-submits via the FAX. She forgets to cancel the original flight plan. International Accidents/Incidents 12 October - 28 November 2010 Date Aircraft 12 Oct Lockheed L-1-00 near Kabul, Hercules Afghanistan 21 Oct Fatalities Damage Description 8 Destroyed A witness said the plane burst into flames after crashing into mountains near Mahipar pass on the Kabul-Jalalabad highway. Let 410 Near Bugulumisa, 2 Democratic Republic of Congo Destroyed Reports indicate that an engine failed during climbout. The airport elevation is 5,643 feet (1,720 m) and surrounded by hills. 27 Oct A PZL-Mielec M28-05PI near Wami, Indonesia 5 Destroyed Aircraft went missing after delivering aid to flood victims in West Papua. Press reports said crash was weather-related. 2 Nov Boeing 737-400 PontianakSupadio Airport, Indonesia 0 Substantial Aeroplane bogged after overrunning runway on landing. The nose gear collapsed. 4 Nov ATR 72-212 near Guasimal, Cuba 68 Destroyed Airliner crashed in mountainous terrain, after crew made emergency radio call. Witnesses say aircraft was on fire before hitting ground. 4 Nov Airbus A380 near Batam Island 0 Minor Airliner had uncontained failure of no.2 engine in climb. Fragments struck wing and fuselage, damaging some systems. Flight returned to Singapore safely. 5 Nov Beechcraft 1900 Karachi, Pakistan 21 Destroyed A Pakistani CAA spokesman said the aeroplane had had engine failure on climbout, and the pilot had radioed that he was returning to the airport. 11 Nov Antonov 24B Zalingei Airport, Sudan 6 Written off Two tyres on the cargo plane burst on landing, and the fuselage split in two and burst into flames. 15 Nov CASA C-212 Aviocar 400 Bunger Hills (Antarctica) 0 Substantial The aeroplane, operating for the Australian Antarctic program, unexpectedly hit some sastrugi (hard, ridged ice) on landing. Plane's main gear on one side was displaced, and there was some buckling of the fuselage. 19 Nov Cessna 501 Citation I/SP Birmingham Airport, UK 0 Written off Jet carrying liver for transplant hit the ILS antennae on final approach and crashed, catching fire and seriously injuring one of two crew. The liver was recovered and was able to be transplanted. 19 Nov Lockheed C-130H-30 Hercules Paris-Le Bourget Airport (France) 0 Substantial Damaged in runway excursion accident. 24 Nov Antonov 32B MonterreyGeneral Mariano Escobedo International Airport (Mexico) 5 Written off The aircraft, on a logistics flight to Santa-Lucia AB, took off from rwy 11, and crashed to the right side of rwy 16/34, near the side of Terminal B, narrowly missing two parked biz jets. 28 Nov Ilyushin 76TD 5km west of Karachi-Jinnah International Airport, Pakistan 8+4 Destroyed 18 FSA JAN-FEB 2011 Location The jet, carrying 31 tons of relief supplies for the Sudan, crashed into buildings under construction inside a naval base, close to Jinnah Airport. Four people on the ground, believed to be construction workers sleeping inside the buildings, were also killed. Notes: compiled from information supplied by the Aviation Safety Network (see www.aviation-safety.net/database/) and reproduced with permission. While every effort is made to ensure accuracy, neither the Aviation Safety Network nor Flight Safety Australia make any representations about its accuracy, as information is based on preliminary reports only. For further information refer to final reports of the relevant official aircraft accident investigation organisation. Information on injuries is unavailable. Australian Accidents/Incidents 1 October - 24 November 2010 Date Aircraft Amateur-built Vans RV-8A Location Lancefield (VFR), NW M 7km, VIC 3 Oct Amateur-built Vans RV-7A Bunbury (ALA), NE None M 20km, WA Serious 4 Oct Robinson R22 Beta Robinson R22 Beta Robinson R22 Beta BOFOR (IFR), 073° M 75km, NT Boulia Aerodrome, S M 93Km, QLD Brighton Downs (ALA), 54° M 63km, QLD Sydney Airport, 278° M 67km, NSW Kalgoorlie/Boulder Aerodrome, WA Serious 1 Oct 5 Oct 5 Oct Injuries Minor Fatal Damage Serious Serious Serious During mustering operations, the tail rotor struck the ground causing damage to the tail boom, tail rotor transmission and blades. Minor Serious It was reported that the helicopter collided with terrain. The investigation is continuing. None Serious While landing, the aircraft veered right, and the right landing gear leg collapsed as it slowed down. The right main landing gear leg torque link failed. During mustering, the helicopter hit trees and then the ground. 11 Oct Cessna 402C 12 Oct 18 Oct Robinson R22 Beta Gippsland Aeronautics GA-8 Cessna 172S 18 Oct Piper PA-39 21 Oct PZL WarszawaOkecie M-18A near Bourke Aerodrome, NSW None Serious 22 Oct Cessna 177RG Serious 23 Oct DHC-2 MK 1 Bowen Aerodrome, None QLD Green Island None (Cairns) (ALA), QLD 30 Oct Mooney M20J None Serious 31 Oct Amateur-built Vans RV-6A Normanton Aerodrome, QLD Serpentine (ALA), WA None Serious 31 Oct Cessna TU206C South Grafton (ALA), NSW None Serious 8 Nov Serious None Nil Fatal Serious Serious Serious 24 Nov Cessna U206G Bathurst Aerodrome, 276° M 15km, NSW near Richmond (Vic) (HLS), VIC Rolleston (ALA), 237° M 44Km, QLD Innisfail Aerodrome, 216° M 32km, QLD Moree Aerodrome, NE M 74km, NSW Serious 17 Nov AMS-Flight D.O.O. DG-500 Elan Orion Kavanagh Balloons E-240 Robinson R22 Beta Cessna 172N/A1 None Serious 9 Nov Torwood (ALA), Serious 120° M 15km, QLD near Flinders Island Aerodrome, TAS Fatal Durham Downs (ALA), 026° M 1km, QLD Shepparton None Aerodrome, VIC Serious Serious After inadvertently entering cloud, the aircraft collided with high terrain. The investigation is continuing. Serious It was reported that the aircraft collided with terrain. The investigation is continuing. Serious During the landing roll, the right landing gear collapsed, resulting in the aircraft veering off the runway. The right wing and propeller struck the ground and the aircraft ground looped before coming to rest on the gravel. The right main landing gear trunion failed at the forward pivot point. During the takeoff and initial climb, the aircraft's performance was reduced by a tailwind and the aircraft settled back on the runway. While dumping the load, the pilot lost directional control of the aircraft and the aircraft veered off the runway to the right. The main landing gear collapsed. The pilot landed with the landing gear retracted. Serious After becoming airborne, the pilot was unable to maintain directional control of the floatplane and elected to reject the takeoff. The aircraft contacted the water heavily. Investigation is continuing. The pilot landed with the landing gear retracted. During landing, the nose landing gear dug into the grass airstrip. The aircraft stopped abruptly, and bounced onto the wings before falling back onto the main landing gear. While turning final at 400ft, the engine failed and the pilot conducted a forced landing into a field, short of the aerodrome. Investigation is continuing. During final approach, the headwind was stronger than expected and the glider landed short of the runway. The nose of the glider dug into the ground, the tail collided with a mound and the glider groundlooped. While leaving the basket after landing, a passenger fell and sustained serious injury to an elbow. It was reported that during mustering operations, the helicopter collided with terrain. Investigation is continuing. The aircraft unsuccessfully attemped to climb over rising terrain. During cruise the pilot saw the fuel pressure dropping. When the pilot attempted to adjust the mixture the control lever detached. The pilot conducted a forced landing into a paddock where the nose landing gear dug into soft ground. Text courtesy of the Australian Transport Safety Bureau (ATSB). Disclaimer – information on accidents is the result of a co-operative effort between the ATSB and the Australian aviation industry. Data quality and consistency depend on the efforts of industry where no follow-up action is undertaken by the ATSB. The ATSB accepts no liability for any loss or damage suffered by any person or corporation resulting from the use of these data. Please note that descriptions are based on preliminary reports, and should not be interpreted as findings by the ATSB. The data do not include sports aviation accidents. 19 ACCIDENTS Eurocopter AS.350B 9 Nov The helicopter was overdue. A search located the wreckage of the helicopter with the pilot deceased. Investigation is continuing. During mustering operations, the helicopter collided with terrain. None 10 Oct 15 Oct Description During cruise, the engine failed. The pilot conducted a forced landing into trees. An engineering inspection revealed that the upper left camshaft sprocket and the timing belt had failed. During landing roll, the nose landing gear entered a depression on the runway. The aircraft flipped onto its back. AVALON: FSA JAN-FEB 2011 20 Everyone who’s anyone in Australian aviation will be there, so Avalon is not the place to make an embarrassing or dangerous mistake because you weren’t aware of the correct procedures. For one week in March every odd-numbered year, Avalon airport near Geelong in Victoria, becomes if not quite the busiest, certainly the most varied aerodrome in the country. The Australian International Airshow attracts flying machines from jet fighters to powered parachutes, and typically has more than 1000 aircraft on airborne or static display. This year’s airshow, celebrating the centenary of the first passenger flight in Australia and the 90th anniversary of the Royal Australian Air Force, runs from 1-6 March. It’s an aviation and defence industry-only affair from Tuesday 1 March until Thursday 3 March. Friday is a mixed industry and public day and the weekend of March 5-6 is entirely for public enjoyment and appreciation. Avalon is going to be a busy place, and safety at the airshow will depend on every pilot who flies there being well informed about the specific regulations and practices which apply there, and following them. During rehearsal and flying display periods for the show, Avalon’s normally class D airspace will be reclassified to restricted airspace with associated air traffic control (ATC) procedures. This means a restricted area extending above the runways to flight level 245, and shaped like the proverbial ‘upside down wedding cake’, with higher level layers wider than those below, to allow other aviation activity in the vicinity of the airport at lower altitudes. Details on these conditions will be found in the airshow air information publication supplement (AIPSUP) to be issued by Airservices Australia early this year. Normally, recreational aircraft are not allowed in restricted airspace but, subject to final confirmation, CASA has advised that approval may be given to permit recreational aircraft to fly into Avalon controlled airspace for the purpose of attending or participating in the airshow, providing certain conditions are met. Details on these conditions will also be given in the airshow AIPSUP. 'Any pilot given the task of providing a display for the public should set out to thrill the ignorant, impress the knowledgeable, and frighten no one.’ (Squadron Leader Ian Dick - Red Arrows) the weekend warrior’s what, how and where guide Fundamentals of flight and contingency planning will be particularly important in the crowded rush and inevitable delays that usually occur on Sunday after the show has ended. Be prepared for these delays, especially if you’re not night rated. Light aeroplanes (below 5700kg MTOW) visiting the airshow will be able to land at Avalon East (ICAO identifier: YAVE), a temporary unlicensed aircraft landing area (ALA) approximately 2000m east of Avalon Main’s (YMAV) runway 18/36. Avalon East has two 1000 x 28m parallel grass runways, orientated north-south, associated taxiways and parking areas. Should weather or traffic delay you, an alternative accommodation plan will be essential – and it had better be different from everyone else’s. Simply calling directory assistance for the number of the nearest motel is probably not going to work for you on that particular Sunday evening. A contingency plan is important to avoid the insidious and often unconscious pressure to fly home in weather or light conditions that you normally wouldn’t, or shouldn’t, consider. Avalon East will be available for day only, VFR fixed-wing operations from Tuesday 1–Monday 7 March. Arrivals and departures are essentially unrestricted except they must be day only in VMC. Airservices Australia will provide ATC (class D-type procedures) and aircraft rescue and fire service capability at Avalon East. These procedures will be detailed in the airshow AIPSUP. On the airshow’s public days, Friday 4–Sunday 6 March, no charter aircraft flights will be accepted into Avalon Main. Charter aircraft weighing less than 7000kg MTOW and capable of operating from Avalon East’s grass runways may use it for daylight operations. There will be a temporary terminal and a shuttle bus to the airshow. The refreshing news for pilots landing at Avalon East is that no landing or other charges will apply. Avgas will be available at Avalon East at specific times. Again, the airshow AIPSUP will have details. There’s also the airshow factor to be considered. ‘What we don’t want is anything other than a normal arrival and departure from visiting GA and recreational pilots, says CASA flying operations team leader David Farquharson. 21 AVALON SAFETY Access to Avalon (known as Avalon Main, for the duration of the airshow) will be restricted to participating (static and flying) display aircraft only – and they have to pre-register their arrivals and departures. The only exceptions will be charter aircraft carrying exhibitor-sponsored passengers from Tuesday 1–Thursday 3 March 2011, but they too must pre-register their arrivals and departures. ‘Airshows tend to bring out a certain bravado. But remember, you’re not part of the airshow, you’re there to view,' Farquharson says. ‘So be patient – it’s a normal operation.’ The Red Arrows squadron leader’s injunction about not scaring anyone applies to all pilots at the show, he says. 22 FSA JAN-FEB 2011 For the airshow, Avalon Main gains a temporary runway in addition to its 3048m runway 18/36. The temporary runway 01/19 is a 1400 x 30m grass strip. It is 800m west of 18/36 and allows simultaneous VFR arrivals and departures when 18/36 is in use. A helicopter complex consisting of helipads and adjacent helicopter parking will be located south of the expo site and about 500m west of Avalon Main’s primary runway. Regular public transport (RPT) flights into Avalon Main will continue during the airshow. The temporary class C air traffic control will give RPT movements a high priority, second only to aircraft in an emergency. Other noteworthy aspects of Avalon Main during the airshow are a pyrotechnic area for firework displays; a parachute landing area; and a military aircraft arresting system (a cable similar to that on an aircraft carrier’s deck) on runway 18/36. Aviation Tour Specialists 2PDND&ODVVLF)LJKWHUV$LUVKRZ%OHQKHLP $SULO QLJKWVIURP 6XQ )XQ$LUVKRZ)ORULGD86$ 0DUFK QLJKWVIURP 2VKNRVK$LUVKRZ86$ LQFOXGLQJFKDUWHUӿLJKWIURP /$WR:LWWPDQ)LHOG QLJKWVIURP 5HQR$LU5DFH1HYDGD86$ 6HSWHPEHU  HPDLONDUHQH#DYWRXUVFRPDX 3OHDVHQRWHDOOSULFHVTXRWHGDUHEDVHGRQWZLQVKDUHDQGLQFOXGHDOOWD[HVDQGVXUFKDUJHV/LF7$ There will also a premeditated ejection area, should a military aircraft with an ejection seat get into such serious trouble that the pilot is forced to ‘reach for the handle’. This area will be 5nm from Avalon Main on a heading of 350M. Aircraft are to be positioned at 2500 feet and tracking 350M if possible. Participants in the airshow (except those specifically taking part in the flying display) must arrive at Avalon no later than 1700 on Thursday 3 March and remain until the close of the Airshow on Sunday 6 March. Finally, CASA’s alcohol and other drugs policy will be enforced, so you can anticipate random checking if you’re associated with safety sensitive aviation activity (SSAA). As this story emphasises, simply flying to the airshow is a safety-sensitive activity that requires planning and a level of commitment as thorough and to a standard as high as any of the airborne displays. Check out our website at www.bobtait.com.au BAK & PPL Coming soon! Bob Tait’s Aviation Theory School’s Online CPL Performance Course. * * * * * * Virtual classroom presentation. Audio/visual lessons. e-textbooks plus hardcopy text. Heaps of new questions. Worked solutions. and much more. Keep an eye on our website for details. All CPL Subjects plus IREX Home Study and Full-Time Courses available Hangar N Wirraway Drive, Redcliffe Aerodrome QLD 4021 PO Box 2018 Redcliffe North Post Office, QLD 4020 Ph 07 3204 0965 Fax 07 3204 1902 Web www.bobtait.com.au Email [email protected] 23 AVALON SAFETY Whether you are flying, displaying or just visiting, the organisers request that you bring your own tie-downs. ‘Picket sets should include six or eight steel stakes, three or four crossover tubes, a suitable mallet and ropes of appropriate length. Tie down ropes need to resist a pull of around 1400kg. Nylon or Dacron rope is preferred to Manila rope. Use an anti-slip knot like a bowline figure eight or round turn and two half hitches. Do not use reef knots because they are unreliable, particularly for synthetic rope.’ The global positioning system (GPS) is a precious gift to aviation. But several new studies have found there are real issues about how pilots use the system, and these issues apply to both private and commercial licence-holders. FSA JAN-FEB 2011 24 On a good day, GPS easily fulfills science fiction writer Arthur C. Clarke’s dictum that ‘Any sufficiently advanced technology is indistinguishable from magic’. When the system is working perfectly it can locate an aircraft to within a wingspan (or a rotor diameter) and guide it with similar accuracy. GPS is the US military navigation system that was made available for full-performance civilian use in 2000. It is one of several global navigation satellite systems (GNSS), along with the Russian GLONASS, European civilian Galileo systems, and the Chinese Beidou-2 system known as Compass. GPS is the only one of these systems in widespread civilian use in Australia. Alas, GPS is not magic, but technology, and a fallible one at that. The results when it goes wrong or is used wrongly can range from hairraising to deadly. Under GPS guidance, aircraft have crossed restricted areas, taken detours to waypoints that were not on the flight plan and flown their own version of the flight plan based on out-of-date data. General aviation pilots using, or attempting to use, GPS have had collisions and nearcollisions with other aircraft, and have crashed into the ground when distracted by the sometimes-cryptic interface of many GPS receivers. GPS has been embraced by Australian aviation. GPS receivers can be found on 85 per cent of Australian aircraft, and why wouldn’t they be, when prices for aviation-specific receivers start at under $500? But there’s growing disquiet about how misuse and occasional failure can turn it from an acknowledged safety aid into an unrecognised risk factor. There is a strong perception among general aviation trainers that some private and commercial pilots are letting GPS do what they should be doing - or should at least be aware of - themselves. ‘If there is a crisis in flight planning, then it’s GPS that’s the culprit,’ a chief flying instructor (CFI) with a university-linked flying training organisation says. Another CFI mentioned being in outback Queensland, and talking to the pilot of a light twin who had flown there from the east coast with no charts, relying instead on a GPS receiver. ‘He was only a battery failure away from being totally lost,’ the appalled instructor said. The benefit of planning is not that you have a schedule you can follow at all costs, but that the act of planning builds this picture of your flight in your head. You build the foundation of your situational awareness. ‘To follow GPS prompts is to do exactly the opposite,’ the guide says. ‘Now situational awareness resides in a machine, and you merely follow its directions. Your ignorance will become a problem if the machine stops.’ The guide reminds pilots that errors can occur from outdated databases, or from the inaccurate press of a finger entering flight data into a system. Private flying is not the only area of aviation where the down side of GPS is causing unease. A GPS failure was implicated, although not conclusively established as having been involved, in the crash of a Piper PA-31T Cheyenne that killed a 14,000 hour commercial pilot and five passengers, including a Qantas jet captain and a military helicopter pilot. The crash near Benalla, Victoria, in July 2004, happened after the aircraft diverged left of its westerly track. The pilot reported commencing a GPS non-precision approach to Benalla aerodrome, but the aircraft flew into high ground 34km southeast of the airfield. In 2008, the Australian Transport Safety Bureau (ATSB) reopened its investigation into the crash to examine the possibility the GPS unit might have been operating in deadreckoning mode, rather than by reference to satellites overhead. ‘Planning is important because it constructs a four-dimensional picture of the flight in your mind. The benefit of planning is not that you have a schedule you can follow at all costs, but that the act of planning builds this picture of your flight in your head. You build the foundation of your situational awareness. 25 MIXED BLESSINGS CASA’s Flight Planning Guide for VFR pilots, due for release in March 2011, highlights the role of GPS in flight: ‘Planning is important because it constructs a four-dimensional picture of the flight in your mind. It also argues pilots should only use GPS if they have a functional understanding of how the system works, and all the current information and charts—VTC, weather and NOTAM. In dead-reckoning mode, when satellites are unavailable, the Cheyenne’s GPS was designed to operate as a human navigator would and calculate probable position based on time, heading and speed. FSA JAN-FEB 2011 26 The ATSB investigation found that deadreckoning navigation could not be positively established. Inconsistencies between deadreckoning principles and the recorded radar data made it seem unlikely, as did the alerts and warnings the GPS receiver and instrument indications would have provided. Regardless, the ATSB issued a safety advisory notice alerting users of GPS navigation receivers to take appropriate action to ensure familiarity with dead-reckoning operation and any associated receiver-generated warning messages. ‘The investigation found that there was little, if any, information about the in-flight DR [dead reckoning] operation of GPS receivers in any of the operating manuals published by manufacturers of GPS navigation receivers,’ the ATSB said. ‘Some users of these navigation receivers may not have been aware that the GPS receiver display unit would provide tracking guidance, including the legs of a GPS instrument approach, during DR navigation. This is a safety issue.’ The ATSB’s second look at the Benalla crash highlighted some other incidents with the technology. Errors have been reported that can’t be explained or reproduced. ‘On 9 February 2003, a Bombardier Dash 8 was observed on radar to diverge 9nm left of track during a flight from Emerald to Brisbane. The aircraft’s crew reported that the aircraft was navigated by GPS and that the autopilot was engaged. No GPS warnings or error indications were observed and it was not determined if the receiver was navigating by dead reckoning. When the controller informed the crew of the track divergence, they reverted to ground-based navigation aids and continued to Brisbane. After landing, the GPS indicated a position 59nm to the north of Brisbane.’ The operator advised the ATSB that crews had reported numerous other GPS anomalies involving the Dash 8. ‘Between February and September 2003, there were three occasions when the aircraft turned and tracked well left of the intended flight path while being navigated by GPS. In two of those occurrences, the cabin crew detected passengers using laptop computers and compact disc players. Following each of those events a functional test of the receiver was unable to detect any faults.’ The results of a recent study by Cranfield University in Britain into the use of GPS for area navigation (RNAV) in airline operations were considered alarming enough for the International Civil Aviation Organization (ICAO) to recommend its results be widely publicised. The study focused on human factors in RNAV operations. One of its first findings was a severe criticism of the location of the GPS-linked flight management system (FMS) on the aircraft used in the study (a working regional airliner). ‘The architecture of the system means that errors are likely to be made,’ the study found. ‘The human factors associated with control design and how they are actually used by pilots is an important consideration—putting a button in and expecting a pilot to use it is not always the answer.’ ‘A point is made about the method of selecting an arrival runway where the crew have to enter a number to make the selection rather than selecting the required runway with a line select key. Entering codes to make selection requires the crew to verbalise the code to transfer it to the keypad. This creates a high risk that an error will be made because of other cockpit activity. Its position on the flight deck was another problem. ‘To access the FMS control display unit (CDU), the large angles involved make operating the system difficult through parallax, dexterity and the angle of force transfer to the keypad. This out of normal reach installation makes operating errors more likely. A further problem is the likelihood of unintentional operation of the power levers.’ Reading the FMS display could be very difficult, particularly in bright sunlight, the study found. ‘In bright sunlight the display was often unreadable.’ ‘The location of the control display unit discouraged first officers from using the system since it was not located in their personal space, resulting in a lack of practice.’ ‘The human factors associated with control design and how they are actually used by pilots is an important consideration—putting a button in and expecting a pilot to use it is not always the answer.’ During the sector with the induced GPS integrity fault, approximately 75 per cent of crews made significant errors. About 25 per cent of crews flew the procedure with the integrity light on. This highlighted considerable misunderstanding of the meaning of the light and the actions needing to be taken. In one case, the crew attempted to fly the RNAV missed approach procedure using the VOR. Discussion with pilots revealed a disquieting level of faith in the GPS-linked FMS and lack of knowledge of its limitations. ‘Many of the pilots had come through general aviation where flight management systems are rare; they appeared to be impressed by it and not understand its weaknesses. Many confused the multiple inputs and system accuracy with reliability.’ ‘In the interviews and exercises it was apparent that crews treated the FMS as a primary navigation source and were failing to monitor the secondary system. The analysis work showed that the redundant systems are not actually redundant, because there is a low probability that the crew will detect a failure in the primary navigation system. Whether in the cockpit of a sport aircraft flown by a 100-hour pilot, or the FMS of an airliner with thousands of hours experience residing in its two flight deck seats, GPS presents the same issues. Arthur C. Clarke summed up not only the potential, but also the problem. We must fly by knowledge, not faith, and never confuse technology with magic. 27 MIXED BLESSINGS FMS operations and the method of making selections is a human factors problem that needs to be addressed with the manufacturers.’ The study found pilots using the FMS made a significant number of errors. Maintaining safety FSA JAN-FEB 2011 28 Sport aviation is not just about flying a distinctive aircraft, but also about building and maintaining it. The Sport Aircraft Association of Australia (SAAA) and CASA have worked out an agreement allowing amateur builders to maintain their aircraft with professional knowledge of regulations and inspection techniques. In Australia, a growing number of amateur builders are constructing their own aircraft. It’s a remarkable privilege that enriches the aviation environment with an array of distinctive and often remarkably advanced aircraft. Amateur-built aircraft can be built as experimental aircraft, which allows the amateur builder to use whatever engines, construction methods and other technologies they see fit; and they can be built from a kit, or from scratch, based on either original or established designs. However, until recently, there were some anomalies with maintenance requirements for such aircraft, where some amateur-built aircraft were required to be maintained by certified CAR 30 maintenance organisations; others were not. For aircraft allowed to be maintained by their builders there was no requirement for them to keep up to date with regulatory standards and maintenance practices. Sport Aircraft Association of Australia technical manager, Mark Rowe, says there was a strong case for allowing all amateur builders to maintain their own aircraft – with appropriate training. ‘Many of our members earn their living in science, engineering or aviation, and they bring that dedication to their aircraft projects,’ Rowe says. Such distinctive aircraft can present powerplant, structural and avionic challenges quite different to those facing the typical licensed aircraft maintenance engineer. Additionally, sport aviation and general aviation have been moving apart geographically, with sport aviation more common in regional or urban fringe aerodromes, many of which have few or no CAR 30 maintenance organisations. For this reason, amateur-built aircraft are now allowed to be maintained by the people who made them. This authorisation was issued by CASA in 2009, following an initiative by the Sport Aircraft Operations Group (SAOG) in Queensland. As part of the process, SAOG and CASA developed a course designed to meet the requirements of the CASA basic airworthiness administration syllabus and to demonstrate practical maintenance skills. The Sport Aircraft Association of Australia working with SAOG has adopted and further developed the maintenance procedures course and now delivers the training for all amateur builders. The maintenance procedures course covers regulations governing maintenance of an amateur-built aircraft. The idea is to enhance the skills and knowledge gained in building the aircraft and ensures the builder can safely manage their aircraft’s continuing airworthiness and maintain it throughout its life. There is a particular focus on inspection, with emphasis on recognising and repairing corrosion, ageing wiring problems and fatigue cracks. The course highlights CASA regulations and advisory material applicable to aircraft maintenance, so the maintainer knows their legal responsibilities. More than 360 builders and others have now undertaken the two-day course. Course graduates will be equipped to maintain their aircraft under the new maintenance authority conditions that come into effect from January 2011. The new conditions will include demonstrated competency in regulatory knowledge and maintenance inspection and practices. 29 ‘We can use it as one of the foundations of a robust safety system.’ ‘The builder is the person who has the most knowledge of the aircraft. It makes sense for the person who’s built the aircraft to maintain and operate it,’ he says. Rowe says embracing the legislative side of aviation demonstrates a professionalism that belies the supposedly amateur status of sport aircraft enthusiasts. ‘It makes more sense than having a licensed aircraft maintenance engineer (LAME) with no specific knowledge of what might be a very distinct and unusual aircraft, try and come to terms with it.’ Rowe says the value of the course is how it educates all amateur builders. The SAAA National Council says completing the course enables builders and owners to: be better able to meet their legal obligations secure a better insurance premium achieve greater aircraft resale value (subsequent owners can only get LAME maintenance for an aircraft with a properly documented maintenance history) contribute to safety, safety, and enhanced safety through knowledge for pilots, passengers other airspace users and those on the ground. The safety benefits are already becoming apparent, Rowe says. ‘We’re seeing our members who have completed the course not only maintaining their aircraft but maintaining its risk profile, doing risk assessments of engineering changes.’ Changes in legislation and practice can be communicated in newer versions of the course which all active SAAA members are encouraged to undertake regularly, Rowe says. ‘We’re amateurs in the sense that it’s not our full-time employment, but if you’re looking for a description of the membership’s skill set and attitude then amateur is the wrong word.’ Sport aircraft builders and pilots tend to be intellectually curious and constantly seeking to challenge and add to their aeronautical expertise. ‘Even those who are not airline pilots or commercial pilots typically maintain their licence to a high standard. There tend to be a lot of instrument ratings among our pilots,’ Rowe says. ‘And they’ve embraced the maintenance course in the same spirit. It adds to their education and the safety culture in our segment of aviation.’ Courses are held throughout the country to meet local demand. You can register your interest with the SAAA national technical coordinator: Alison Shannon [email protected] MAINTAINING SAFETY Courses run Australia wide and are held almost every weekend, Rowe says. S E R V I C E S Multi-Engine Command Instrument Rating Course 4 week course - accommodation included Training on Beechcraft Baron Includes GNSS RNAV $14,525.00 - Leaders in M/E command instrument ratings. - PPL and CPL Courses - Initial issue & renewal - all grades of instructor ratings - Accomodation provided Flight Instructor Rating Course 7 week course - accommodation included Maximum 3 students per course Comprehensive resources package provided $15,500.00 For further information and pricing please contact us Phone: (02) 6584 0484 Email: [email protected] Web: www.johnstonaviation.com.au FSA JAN-FEB 2011 30 For these and many other free* safety promotion products visit the CASA online store www.casa.gov.au/onlinestore * please note that a postage and handling fee applies View our students achievements on Facebook at Johnston Aviation Every single service difficulty report (SDR) you send is valued, so please keep them coming, Roger Alder says. You have found and fixed a very nasty surprise somewhere in the bowels of an aircraft, decided that this defect could affect air safety and urgently filled out a defect report and sent it to CASA. Then, quick as a flash – nothing! You feel totally ignored and your safety message to the world seems to have been lost! If you choose to use our online facility to submit your report, and assuming you have entered your correct email address on your SDR, you will receive an automatically generated email to confirm our receipt of your SDR. Using the online system on our website should produce a response to the email address on your submission. It's quite possible that a lot of ‘black hole’ activity happens at this point. We have no way of telling, except when someone rings up and tells us they did not receive a receipt number for a certain SDR submitted via the CASA website. So I thought I would take a moment of your time to tell you a little of what goes on behind the scenes when your defect report comes to CASA and explain why you might not hear anything. It doesn’t matter if an aircraft defect report comes in written on the ‘back of a beer coaster’ or by electronic form into the website; it is never dropped into any legendary ‘black hole’. All reports are examined at least twice before they are assigned to a technical specialist for assessment. All reports are read upon initial receipt and entered into the CASA SDR system; they are then read again when they are coded. Initial and all follow-up defect reports are entered into the SDR database as ‘raw’ data. Spelling and grammar are not altered. The ‘beer coaster’ is then scanned (both sides) and attached to the report. Then, as I said before, it gets coded. Coding is another word for tagging the key elements of the report with standard and special codes to enable rapid searches on the database. For example, what happed just before the defect occurred is allocated a particular code. How and when the defect was found gets another code etc. If you didn’t include the Airline Transport Association (ATA) code to classify the defective item, we look at the system affected and assign it the correct ATA. If you gave the aircraft registration, but not the aircraft model, the coder looks up the aircraft details and the aircraft model is then entered, and so on. Coding your report gives the best chance to detect possible trends. As soon as the report is coded, a de-identified, summarised report is compiled and this version goes up on the CASA website for all the world to see—and I mean all the world. I think it’s important to emphasise at this point that your de-identified defect report really does go global. This is because while the SDR system is recognised as a very useful tool for monitoring the health of the Australian fleet, the prime purpose of the system, under our ICAO obligations, is to collect and transmit defect reports to the aircraft’s state of design. Your de-identified report is transmitted to other national airworthiness authorities to be included in their systems. After all, it’s the NAA and the type certificate holder who should be aware of the defects because they have the responsibility to correct them, not CASA. continued on page 34 31 AIRWORTHINESS CASA airworthiness specialist However, there are a number of reasons that you might not hear again from CASA for some time. First: no matter how aircraft defect reports are submitted—and there are many ways—they are entered into the database for assessment. We are happy to take a defect report by CASA form or letter via snail mail, fax, email, phone – particularly if it is an urgent defect, or our preferred method of online via the CASA SDR section of the website. PULL-OUT SECTION WHATEVER HAPPENED TO MY SDR? PULL-OUT SECTION FSA JAN-FEB 2011 32 Conquest life extension Cessna’s 441 Conquest II is a twin turboprop, pressurised aeroplane made between 1977 and 1986 that found a niche in Australia flying mining company charter operations in the outback. Of the 362 built, thirty found themselves wearing VH registrations. Australian charter operators embraced the 441 because it offered a sweet-spot combination of speed and economy. It was a smaller lighter aircraft than the turbine twin-class yardstick, the Beechcraft King Air B200 (and had 10 passenger seats rather than 13) but could perform many missions typically flown by a King Air. Conquest IIs modified with dash 10 versions of the Garrett TPE331 turboprops and four blade propellers performed even better. The 441 appeared headed for the aviation history books in 2007, when a Cessna supplemental inspection document (SID) declared the type to be limited to a life of 22,500 hours after extensive cracking had been discovered in high-time aircraft. As a result, all 441s in Australia with more than 22,500 hours flight time were grounded by CASA. Conquest IIs in Australian skies had had much more intense use than the majority of the type in the US. In 2008, Business Jet Traveller reported that among the approximately 320 Conquest IIs still flying, the average flight time was 8,000 hours, with a typical US operator adding about 294 hours a year. In 2008, Australian aerospace engineering company TAE Group began developing a life extension program to take the Conquest II up to a 40,000-hour life (or 40,000 cycles, whichever comes first). TAE, and aeronautical design company Aeronautical Engineers Australia, made a detailed engineering analysis of the aircraft and its components. The result was the development of a program of major modifications to be made to Conquest IIs when they reached 22,500 hours. Among the program’s discoveries was that the Conquest II’s pressurised fuselage tended to bow out after repeated pressurisation cycles. The cross-section subtly changed from rectangular with rounded corners, to a more circular shape. Internal and external metal straps were added to correct this. A new, rigorous maintenance program was developed using modern damage tolerance philosophies. The analysis concluded that the wing and empennage were safe for a 40,000hour/cycle life, with additional inspections; and that the fuselage was safe for 40,000 hours/cycles after modifications, reinforcements and additional inspections. CASA was closely involved in the development of the Conquest II Iifeextension program to ensure the aircraft will be safe to 40,000 hours and there will be compliance with the type certification. CASA issued a supplemental type certificate for the Cessna 441 life extension program in August 2010, allowing the type to continue flying. An additional 18,500 hours means the Conquest II is cleared to operate, all other things being equal, until the mid 2040s. 33 AIRWORTHINESS And more detailed fine mesh models were created for wing attachment fittings, fuselage frame and skin, the forward pressure bulkhead top and the bottom stringer. The models were validated by comparison with strain gauge test results for the wings and ground pressurisation tests for the fuselage. Flight surveys were carried out on aircraft in Australian use, to discover actual usage and loadings of the aircraft. New angle flanges were developed for the forward pressure bulkhead after inspections revealed cracks in several aircraft. The bulkhead is hard to inspect due to its location, ahead of the instrument panel. PULL-OUT SECTION Computerised, finite-element models were used for structural analysis. A coarse mesh main model was developed to represent the whole airframe. PULL-OUT SECTION continued from page 31 FSA JAN-FEB 2011 34 All initial ‘breaking news’ reports and followup reports are made available to the global aviation community in the interests of safety, as soon as possible. So, you will spot your de-identified SDR on the web when it has been posted. By the way, you may also find this web version of your SDR published in Flight Safety Australia magazine, particularly if you send in good quality pictures. Good quality pictures means sharply focused, with no close-ups of engineers’ fingernails and hairy knuckles. When the reports are entered, coded and combined with any attachments you may have provided, they go to a central point to be read again and be given a high-level technical assessment. Here comes the tricky bit. If you have classified the SDR as ‘minor’ and described something like a badly worn main wheel tyre on a Cessna 150, with no further details as to why you thought this was so important, then it is very likely that the SDR will be given ’statistical purposes‘ status and put to one side as possible useful information in the future. This is the case especially if the corrective and preventive action taken by the operator appear to be adequate. However, we are aware that any ‘minor’ report may later develop into a trend that may require highlevel analysis and urgent action. As I said, it’s tricky; one can never tell. What can appear to be very minor at first can quickly develop into a major nationwide investigation, and may result in an airworthiness directive being issued. If an SDR is assessed as ‘statistical information‘, it will still appear on the CASA website, but you may well not hear anything from CASA for a while. If interested, why not give us a call? Another instance where you may not hear from us straight away is when an SDR states that it has been submitted in response to a defect found as a result of complying with an AD to inspect for that defect, (currently a legal requirement). It is likely that it will be put in the ‘statistical’ category, noting that the AD is still doing its job and nothing more may be done; unless, of course, it is a recent urgent AD which is under strict monitoring, or there is some other factor signalling that it needs further investigation. For example, where the reporter says something such as ’while doing AD/ PLU/12 Amdt. 3, I noticed another serious problem just outside the area of interest specified in the AD‘. See, as I said, it’s tricky. Depending on the outcome of this initial technical assessment, each SDR is routinely assigned to an appropriate technical specialist (TS) with expertise in the relevant area, for example, engines, airframes, systems, electronic/avionics, for further assessment and action, if required. While there is no legal obligation on the part of CASA to contact anyone who submits a defect report, it is usually at this point, during the technical specialist’s assessment, that you are most likely be contacted to clarify some aspect of your report, or to obtain further details of the result of your investigation. That’s right: your investigation. It’s the operator who is responsible to conduct the investigation, not CASA. Under CAR 51A (4)(a) and 52 (2)(a) the operator is responsible for investigating the defect. This investigation may need to include the manufacturer. When you think about it, who else is best suited to determine the appropriate corrective and preventive actions? Whenever we can, we will try and contact you, because we have proven time and again, that it’s the phone call that provides assurance that the SDR system is working, and that personal exchange of information has very often changed the direction of a defect investigation. As a result of the feedback that CASA has received during the Ageing Aircraft Management Project, we are actively considering what can be done to provide improved access to your submitted defects, and a better SDR database search engine to enable you to see if your defect is part of a trend. Remember, too, that there is nothing preventing you from contacting CASA to find out what may have been done in regard to your defect report. You can use the contact details provided below. Phone: 131 757 Email: [email protected] Web: www.casa.gov.au SELECTED SERVICE DIFFICULTY REPORTS 1 October 2010 – 26 November 2010 Note: occurrence figures not included in this edition. AIRCRAFT ABOVE 5700KG Airbus A320212 Aileron Blue servo inoperative. Ref 510011452 RH aileron Blue servo control inoperative. Green servo control was inoperative on MEL. P/No: 31073068. Airbus A320212 Air conditioning system cabin odour. Ref 510011602 Fuel smell in rear cabin. Fumes affected cabin crew. Investigation could find no definitive cause for the smell and no further odours occurred. Airbus A320231 Hydraulic Blue system pipe cracked. Ref 510011544 Blue hydraulic system rigid pipe cracked. Loss of hydraulic fluid. P/No: D2777022305100. TSN: 55,314 hours/20,116 cycles. Airbus A321231 Nose landing gear suspect faulty. Ref 510011500 Nose landing gear failed to retract. Investigation continuing. Airbus A380842 Toilet burning smell. Ref 510011306 Burning smell in vicinity of LM14 lavatory. Smell traced to dusty overhead vents. Investigation continuing. Airbus A330202 Hydraulic pressure manifold check valve loose. Ref 510011604 Yellow hydraulic system high pressure manifold supply check valve loose and leaking. Lockwire broken and valve found to be rotated approximately 90degrees from witness mark. P/No: CAR401. BAC 146200A Landing gear selector valve actuator unserviceable. Ref 510011331 Landing gear selector valve actuator unserviceable. Suspect faulty brushes. Investigation continuing. P/No: HTE210014SN589GB391H. TSN: 12,840 hours/10,285cycles/149 months. TSO: 8 hours/4cycles/4 months. Airbus A330202 Total air temperature probes failed. Ref 510011489 Total Air Temperature (TAT) probes failed. Investigation continuing. P/No: 102LA2AG. BAC 146RJ100 ADF controller failed. Ref 510011474 ADF system failed. Replacement ADF controller failed on fitment. P/No: G676205. Airbus A330203 Aircraft oxygen system faulty. Ref 510011620 Loss of oxygen from flight crew oxygen system. Investigation continuing. Airbus A330203 Toilet V waste compartment door fire seal damaged. Ref 510011594 Lavatory V waste compartment door fire containment seal damaged. Investigation continuing. Airbus A330303 Air conditioning recirculation fan smoke/fumes. Ref 510011327 RH recirculation fan suspect faulty. Investigation continuing. Airbus A330303 APU interface seal between FCU lubrication unit leaking. Ref 510011317 APU leaking oil into pneumatic system. Investigation found the interface seal between the FCU and lubrication unit leaking. Airbus A320232 Elevator and aileron computer faulty. Ref 510011335 No2 Elevator and Aileron Computer (ELAC) faulty. P/No: 3945128209. Airbus A330303 Hydraulic ‘B’ case drain on strut leaking. Ref 510011427 Hydraulic system ‘B’ case drain tube located in No1 strut leaking. Investigation continuing. Airbus A320232 Engine hydraulic shutoff valve actuator intermittent. Ref 510011591 No1 engine hydraulic shutoff valve actuator intermittent in operation. P/No: A06L00. TSN: 21,292 hours/12,727 cycles. Airbus A380842 Fuel tank FOD. Ref 510011535 FOD found in LH inner fuel tank during inspection. FOD consisted of a plastic scraper and rubber parts of a clamp. Airbus A320232 Landing gear safety valve to hydraulic manifold attachment bolt sheared. Ref 510011565 (photo below) Landing gear safety valve to hydraulic manifold body upper attachment bolt sheared. The upper portion of the mating surfaces separated forcing the remaining two bolts to bend under hydraulic pressure. Loss of "Green" system hydraulic fluid. P/No: MS2125004008. Airbus A380842 Fuel tank probe crimp joint broken. Ref 510011428 RH outer tank fuel probe 42QT2 had a broken crimp joint in terminal lug connector HI Z. Investigation continuing. Airbus A380842 Hydraulic ‘Green’ system pressure line leaking. Ref 510011318 Loss of fluid from ‘Green’ hydraulic system. Investigation found a loose hydraulic pressure line on the No1 engine driven hydraulic pump. Investigation continuing. P/No: 3032782000. Airbus A380842 Landing gear brake torque rod pin missing. Ref 510011426 No5 brake assembly torque rod pin missing. Investigation continuing. Airbus A320232 Wing landing light missing. Ref 510011592 Landing light lamp missing from LH wing. P/No: Q4559X. Airbus A330202 Engine intake anti-ice switch incorrectly positioned. Ref 510011626 Engine intake anti-ice valve switch suspect incorrectly positioned. Investigation continuing. Airbus A380842 Seat power supply faulty odour. Ref 510011477 Seat 4A controls not working and overheated with smoke smell. Seat 1A controls intermittent with heavy smell of smoke. Both seat Passenger Service Units (PSU) faulty. Investigation continuing. P/No: SP22505302. Boeing 717200 APU leaking oil from the oil cooling fan driveshaft . Ref 510011404 APU leaking oil from the oil cooling fan driveshaft interface with the APU gearbox. P/No: 4502440. TSN: 16,262 hours/16,860 cycles. Boeing 717200 Cabin odour. Ref 510011454 Strong acrid oil smell in forward cabin. Coalescer bags changed and air conditioning pack burn carried out. Nil further problems. Boeing 717200 Engine bleed air PRSOV suspect faulty. Ref 510011496 P/No: 33991564. RH engine bleed air system Pressure Regulating and Shutoff Valve (PRSOV) suspect faulty. Investigation also found PRSOV to pilot valve hose bulged at pilot valve end. Boeing 717200 Flight control computer system wire broken. Ref 510011543 Flight control computer system wire between J2-181 to P1-7742 broken and open circuited. P/No: N92739716. Boeing 717200 Galley coffee maker faulty. Ref 510011343 Electrical burning smell from galley area. Initial investigation could not determine the source of the smell. Further investigation found coffee brewer water tank heater elements overheated and split. Caused by occasional failure to correctly fill the water tank. Boeing 737476 APU exhaust system damaged. Ref 510011424 APU exhaust muffler forward inner wall severely torn and distorted between leading edge and acoustic section. Rivets sheared and sheet metal torn. Outer wall heat distress. Fire wire damaged. Investigation continuing. P/No: 656257532. Boeing 737476 Battery relay faulty. Ref 510011309 Battery relay R355 faulty. Investigation found intermittent contacts in the relay. P/No: R355. Boeing 737476 Captain’s electronic horizontal situation indicator failed. Ref 510011448 Captain's Electronic Horizontal Situation Indicator (EHSI) failed with associated electrical burning smell. P/No: 622799003. TSN: 549,414 hours. TSO: 149,414 hours. 35 AIRWORTHINESS Airbus A320231 Rudder travel limitation unit failed. Ref 510011386 Rudder Travel Limitation Unit (TLU) failed. P/No: DV84567015. Beech 1900D Wing rib cracked and corroded on flange and spar cap. Ref 510011624 RH main inboard wing rib cracked and corroded on flange and spar cap. Crack confirmed using NDT inspection. P/No: 11812004826. TSN: 21,766 hours/20,891 cycles. PULL-OUT SECTION Airbus A320212 Hydraulic manifold cracked. Ref 510011420 Hydraulic manifold cracked and leaking. Loss of system "Y" hydraulic fluid. P/No: D2907019000200. Airbus A330202 Fuel tank densitometer wiring ‘P’ clips unserviceable. Ref 510011595 Fuel tank densitometer wiring ‘P’ clips (2off) unserviceable due to deteriorated grommets. P/No: NSA5516C02NF. SELECTED SERVICE DIFFICULTY REPORTS ... CONT Boeing 737476 Engine EGT indicator unserviceable. Ref 510011393 EGT indicator failed. Indicator had just been fitted. P/No: WL202EED6. PULL-OUT SECTION Boeing 737476 Fuselage skin chemically milled step cracked. Ref 510011518 Fuselage skin chemically milled step cracked in area located at S25L. Found during inspection iaw EI 734-53-149R1. FSA JAN-FEB 2011 36 Boeing 737476 Galley oven contaminated. Ref 510011532 Light electrical smell in aft galley. Suspect faulty oven. Investigation found oven heavily contaminated with cooking oil around heating elements. P/No: GENM2585015. TSN: 43,684 hours. TSO: 6,701 hours. Boeing 737476 Horizontal stabiliser hinge pin bushing incorrectly assembled. Ref 510011423 LH and RH horizontal stabiliser hinge pin bushing retainers incorrectly assembled. Bushing retainers were installed on top of hinge bushings. Bushing retainer attachment bolts found loose (finger tight). Investigation continuing. Boeing 737476 Horizontal stabiliser trim actuator failed. Ref 510011333 Horizontal stabiliser trim actuator failed followed by trim control circuit breaker popping. P/No: AR7077M3. TSN: 40,105 hours. TSO: 209 hours. Boeing 737476 Inertial reference system failed. Ref 510011450 No2 Inertial Reference System (IRS) failed. P/No: HG1050AD05. TSN: 55,107 hours. TSO: 26,613 hours. Boeing 737476 Hydraulic pump system relay R317 stuck closed. Ref 510011360 "A" system electric hydraulic pump continued running with switch in "Off" position. Investigation found relay R317 stuck closed. P/No: 106144524. Boeing 737476 Symbol generator failed. Ref 510011508 Captain's Electronic Attitude and Direction Indicator (EADI) and Electronic Horizontal Situation Indicator (EHSI) failed. Investigation found a faulty No1 symbol generator. P/No: 6229436101. TSN: 42,822 hours. TSO: 42,822 hours. Boeing 7377FE Cabin pressure controller unserviceable. Ref 510011572 No2 cabin pressure controller failed. P/No: 71211997101AC. TSN: 18,697 hours/10,399 cycles. Boeing 7377Q8 Autopilot ‘A’ and ‘B’ disengage – damaged wires. Ref 510011529 Autopilot ‘A’ and ‘B’ disengage due to damaged wires from stabiliser trim motor plugs D700 and D381. P/No: W391101316. Boeing 7377Q8 Cabin window outer pane cracked. Ref 510011504 Cabin window outer pane cracked with a piece approximately 152mm (6in) in diameter missing. Window is located at row 12/13F. Passenger reported a bird impact to the outer pane but nil evidence of bird remains found. P/No: 140N21391. Boeing 73782R Air data internal reference Unit unserviceable. Ref 510011633 No2 Air Data Inertial Reference Unit (ADIRU) failed. P/No: HG2050AC07. TSN: 24,300 hours/14,344 cycles. Boeing 737838 Aft galley door 2R area odour. Ref 510011525 Petrol like odour in area of aft galley near door 2R. Investigation could find no definitive source for the smell. Boeing 737838 Cabin and flight deck fumes. Ref 510011392 Fumes in cabin and on flight deck. Suspect residual fumes from overnight compressor wash on RH engine. Boeing 737838 Centre tank boost pump relay failed test. Ref 510011519 LH centre tank boost pump relay R936 in J20 failed. Found during inspection iaw EI N37-28-35R4. P/No: BACR13CJ2. Boeing 737838 Engine bleed air regulator faulty. Ref 510011510 RH engine bleed air system regulator suspect faulty. Investigation found chaffed wire on regulator. P/No: 1074926. TSN: 23,449 hours. TSO: 6,781 hours. Boeing 737838 In flight entertainment overheated. Ref 510011314 In Flight Entertainment (IFE) unit hot to touch accompanied by a burning plastic smell. Investigation could find no definitive cause for the burning smell but found IFE monitor 2D screen blank. Boeing 737838 Integrated flight system display battery charger failed. Ref 510011465 Integrated Standby Flight Display (ISFD) battery charger faulty. P/No: 312BS1011. TSN: 16,368 hours. TSO: 6,713 hours. Boeing 737838 Integrated flight system display battery charger failed. Ref 510011617 Integrated Flight System Display (IFSD) battery charger faulty. Investigation continuing. P/No: 312BS1011. TSN: 16,611 hours. TSO: 7,192 hours. Boeing 737838 Window overheat system faulty. Ref 510011391 LH No2 window overheat system faulty. Window replaced. P/No: 141A481014. Boeing 7378FE Aileron feel and centring unit attachment bolt bushing missing. Ref 510011615 Aileron feel and centring unit lower attachment bolt bushing missing. P/No: BACB28AK04075. Boeing 7378FE Weather radar cooling fan seized. Ref 510011505 Weather radar cooling fan seized. P/No: 6426012001. Boeing 7378FE Wheel misaligned on axle – hub and bearing mount broken away. Ref 510011431 No4 wheel misaligned on axle. Investigation found the inner hub and bearing mount broken away from the wheel assembly. Boeing 747438 CVR and ULB failed test. Ref 510011479 Cockpit Voice Recorder (CVR) Underwater Locator Beacon (ULB) failed operational test. Battery out of date. Found during inspection iaw EI767-0230068R01 and AD/Rec/1. P/No: ELP362D. Boeing 747438 Electronic flight instrument system control panel smoke/fumes. Ref 510011546 Smoke/fumes from Electronic Flight Instrument System (EFIS) control panel. EFIS circuit breaker tripped. Investigation continuing. P/No: 6228590113. Boeing 747438 Fuselage skin cracked in area forward of horizontal stabiliser. Ref 510011413 LH fuselage skin cracked in area forward of horizontal stabiliser. Crack was found visually and confirmed using NDI. Investigation continuing Boeing 747438 Interphone handset wiring had insulation/wiring burnt. Ref 510011312 Door 1 interphone handset wiring from HTC-P1 to HTC-P2 had insulation burnt and wiring burnt and damaged. P/No: H48044. Boeing 747438 Main fuel tank access panel leaking. Ref 510011400 No2 main fuel tank access door leaking. Investigation continuing. Boeing 747438 Oxygen cylinder installed to ceiling location. Ref 510011316 Incorrect PNo B42365-1 oxygen cylinder fitted to ceiling location. Correct PNo 801307-00. AD 200921-10 R01 refers. P/No: 8423651. Boeing 747438 Oxygen masks tangled with the ‘Pull for Oxygen’ lanyard. Ref 510011348 Oxygen masks at 73JK tangled with the ‘Pull for Oxygen’ lanyard wrapped around the masks and associated oxygen lines. Found during inadvertent deployment. Boeing 767336 Leading edge slat torque tube disconnected. Ref 510011575 Leading edge slat asymmetry. Investigation found RH outboard leading edge slat still extended while all others were retracted. Investigation found the outboard slat torque tube disconnected. Boeing 767336 Wing to body fairing missing. Ref 510011369 RH wing to body fairing panel missing. Structural damage to additional panel. P/No: 49T7500160. Boeing 767338ER APU inlet door faulty. Ref 510011600 Vibration in flight controls. Suspect faulty rudder Power Control Actuator (PCA). Investigation found that the vibration was caused by the APU inlet door opening when the aircraft was in air mode and the APU was selected "Off". Boeing 767338ER Cabin ceiling panel dislodged. Ref 510011328 Cabin ceiling strip dislodged and injured passenger. Investigation continuing. Boeing 767338ER CVR and ULB failed test – low battery voltage. Ref 510011528 Cockpit Voice Recorder (CVR) Underwater Locator Beacon (ULB) failed operational test due to low battery voltage. Found during inspection iaw EI767023-0068R01 and AD/Rec/1. Boeing 767338ER Engine bleed air bypass check valve failed. Ref 510011390 Engine bleed air system suspect faulty. Investigation found LH and RH isolation bypass check valve springs broken and RH valve also with a cracked butterfly. P/No: 7321175003. SELECTED SERVICE DIFFICULTY REPORTS ... CONT Boeing 767338ER Engine exhaust smell in rear galley. Ref 510011310 Engine exhaust odours smelt in rear galley. Investigation found that under certain wind conditions the fumes entered the aircraft through the R2 door due to a small gap in the seal when the aircraft was unpressurised. Boeing 767338ER Generator drive failed. Ref 510011307 LH generator drive failure. Integrated Drive Generator (IDG) replaced. Embraer EMB120 Inboard flap actuator unserviceable. Ref 510011425 RH inboard flap actuator unserviceable. P/No: 3203001005. TSN: 8,481 hours/95 months/6,812 landings. Embraer EMB120 Main landing gear door actuator hose leaking. Ref 510011502 (photo below) LH main landing gear door actuator hydraulic hose leaking. Loss of hydraulic fluid. P/No: 12045381007. Boeing 767338ER Pedestal trim switch panel contaminated. Ref 510011609 Pedestal trim switch panel contaminated by coffee spillage. P/No: 233T62021. Boeing 767338ER Rudder trim actuator faulty. Ref 510011481 Rudder trim actuator faulty. P/No: 658D1005. Bombardier DHC8202 DC distribution box relay and bus bar relay damaged. Ref 510011623 DC distribution box relay 2431 K21 and bus bar damaged due to arcing. P/No: AA4N10382410041101. Bombardier DHC8202 Flight management system smoking Ref 510011515 No2 Flight Management System (FMS) screen blank. Smoke observed coming from FMS. Investigation continuing. P/No: 201731211. Bombardier DHC8402 Fuel quantity computer failed. Ref 510011628 Fuel quantity computer failed. TSN: 4,510 hours/5,371 cycles. Bombardier DHC8402 Hydraulic pump failed. Ref 510011437 No2 hydraulic pump failed. Pump had been running excessively hot. Pump had only been fitted for approximately six days. Investigation continuing. Bombardier DHC8402 Landing gear selector valve failed. Ref 510011444 Landing gear selector valve failed. TSN: 5,393 hours/6,542 cycles. CVAC 340 Wing tank fuel boost pump failed. Ref 510011395 LH wing tank fuel boost pump failed. P/No: TF39002. TSO: 3,785 hours. Embraer EMB120 Cargo floor beam corroded. Ref 510011380 Cargo floor beam corroded. P/No: 12006429001. TSN: 29,175 hours/31,805 cycles/31,805 landings/251 months. Embraer EMB120 Hydraulic Blue system filter contaminated. Ref 510011285 Hydraulic ‘Blue’ system primary return filter Fokker F28MK0100 Horizontal stabiliser fitting bushes missing. Ref 510011551 Horizontal stabiliser fitting bushes missing. Inner sleeve internal diameter inspected and nil wear found with no wear patterns from bolt. The only damage seen is on outer face caused from bolt head shoulder. P/No: D03000019. Fokker F28MK0100 Wing angle bracket cracked. Ref 510011588 LH wing angle bracket located at WS 1825 cracked. P/No: D12493005. Fokker F28MK0100 Wing trailing edge flap skin delaminated. Ref 510011585 LH inboard trailing edge flap trailing edge and adjacent upper and lower skin surfaces delaminated. P/No: D17003449. Embraer EMB120 Windscreen post doubler cracked. Ref 510011303 (photo below) LH windscreen post doubler cracked. On removal of the doubler, extensive cracking was found in the LH windscreen post and surrounding skin. P/No: 14530236001. Embraer ERJ170100 Spoiler actuator leaking. Ref 510011296 LH No4 spoiler actuator leaking. Investigation found two of four body attachment bolts failed. Loss of No1 hydraulic system fluid. P/No: 4148001009. TSN: 7,419 hours/7,445 cycles. Embraer ERJ190100 Central computer power module unserviceable. Ref 510011290 Central computer power module failed. P/No: 7024401903. TSN: 6,620 hours/4,541 cycles. Embraer ERJ190100 Electrical power distribution suspect faulty. Ref 510011574 Aircraft powered down then powered up again. Embraer ERJ190100 Flight control primary actuator control electronic unserviceable. Ref 510011370 No3 Primary Actuator Control Electronic (PACE) unserviceable. P/No: 7028273822. TSN: 5,680 hours/3,736 cycles. Fokker F28MK0100 Fuel tank probe incorrectly repaired. Ref 510011376 Centre fuel tank probe wiring incorrectly repaired. Harness has been cut and spliced with bare metal exposed which could result in a short circuit. Wiring manual specifies nil splicing in this area and damaged wiring should be completely replaced. P/No: 0108KTU04. Fokker F28MK0100 Fuselage coupling plate cracked. Ref 510011590 RH side fuselage coupling plate cracked. Plate is located beneath RH cockpit sliding window at FRA 2650. P/No: A24000037M38. Raytheon 850XP Hydraulic pressure switch incorrectly fitted. Ref 510011475 No1 and No2 hydraulic pressure switches incorrectly connected during previous maintenance. Saab SF340B Aircraft oxygen cylinder sparking. Ref 510011566 During disconnection of the high pressure oxygen line connecting the LH and RH lower oxygen cylinders, a stream of sparks was noticed coming from the cylinder connection point. The sparks stopped when the internal check valve inside the regulator closed. Third occurrence of sparking during oxygen line disconnection. Investigation continuing. P/No: 80335801. AIRCRAFT BELOW 5700KG Beech 200 Aircraft lightning strike. Ref 510011375 Lightning strike on aircraft. Inspection found damage to RH propeller, RH inboard flap and upper tail cone assembly. Beech 200 Landing gear wiring clamp failed – wiring damaged by downlock system. Ref 510011631 LH main landing gear wiring clamp failed allowing wiring to be damaged by landing gear downlock assembly. Beech 200 Windshield inner layer shattered. Ref 510011497 RH cockpit inner windshield inner layer shattered. Windshield had been fitted on 2nd November 2010 and had accumulated 10 hours and 11 cycles since installation. P/No: 10138402518. Beech 58 Nose landing gear steering rod end failed. Ref 510011385 nose landing gear steering system rod end failed in threaded area. P/No: 1315534M. Britten Norman BN2 Landing gear tyre damaged. Ref 510011445 Following discovery of fine wire embedded in tube which caused a slow leak, a pre-installation inspection found the same type of wire in new tyres. The wire is approximately 0.127mm (0.005in) in diameter and approximately 25.4mm (1in) in length and appears to come from a wire wheel used to 37 AIRWORTHINESS Bombardier DHC8102 Engine torque indicator analogue needle fluctuates. Ref 510011286 LH engine torque indicator analogue needle fluctuating. Digital reading was steady. P/No: 1016N01. Fokker F28MK0100 Fuselage floor beam top cap/strap corroded. Ref 510011559 Fuselage floor beam top cap/strap corroded at BL600L FRA 4850. Depth of corrosion approximately 1.52mm (0.060in). P/No: D20584001. PULL-OUT SECTION Boeing 767338ER Overwing exit squib failed test - battery pack disconnected. Ref 510011451 LH overwing exit squib failed test. Investigation found emergency battery pack unplugged and dislodged. indicator pin popped and filter element very dark in colour. Investigation found all other hydraulic filters similarly contaminated. P/No: 332419. SELECTED SERVICE DIFFICULTY REPORTS ... CONT scuff the inside of the tyre prior to vulcanising the balance patch to the inside of the tyre. P/No: 706C863UG. PULL-OUT SECTION Cessna 172F Vertical stabiliser spar corroded. Ref 510011408 (photo below) Vertical stabiliser main spar contained severe exfoliation corrosion. P/No: 05310069. TSN: 7,795 hours. FSA JAN-FEB 2011 38 Diamond DA40 Wing flap and aileron rigging pin holes not incorporated. Ref 510011523 RH wing centre flap and centre aileron rigging pin holes not incorporated. Diamond DA42 Landing gear bearing housing cracked and corroded. Ref 510011291 (photo below) RH main landing gear rear bearing support housing cracked and corroded. P/No: D6032176151. TSN: 874 hours. Cessna 172P Avionics cooling fan bearing failed. Ref 510011373 Avionics cooling fan bearing failed. P/No: C4140070101. TSN: 99 hours. Cessna 182Q Wing leading edge skin cracked and corroded. Ref 510011621 RH wing inboard leading edge skin PNo 072218074 corroded and disbonded from nose rib PNo 0722204-2 located at WS 31.62. Corrosion evident between rib and bond material and bond material and skin. Investigation also found a span wise crack across the forward section of the bond and slight bulging of the skin adjacent to the crack. P/No: 072218076. TSN: 6,184 hours/375 months. Cessna 210M Pilot’s rudder bar cracked at pedal attachment. Ref 510011399 (photo below) Pilot's rudder bar cracked at RH rudder pedal attachment weld. P/No: 12604566. TSN: 10,954 hours. Cessna 402C Landing gear torque link bolt failed. Ref 510011379 RH main landing gear torque link centre bolt failed. RH main wheel turned 90 degrees to direction of travel and tyre impacted on a concrete block on the edge of the runway causing the gear to collapse. Cessna 404 Landing gear hydraulic pipe cracked. Ref 510011476 Landing gear hydraulic pipe cracked and leaking. P/No: 572710040. Cessna 404 Landing gear indication system wire broken. Ref 510011488 LH main landing gear indication system earth wire broken at terminal. Wiring loom support missing. Cessna 441 Elevator trim tab control rod corroded. Ref 510011354 (photo below) Elevator trim tab control rod severe internal corrosion. Found during radiographic inspection. P/No: 571515823. Grob G115 Engine airbox carburettor heat valve sticking. Ref 510011406 Engine air intake airbox carburettor heat valve assembly seized. P/No: 1156600. Mooney M20J Wing spar cap corroded. Ref 510011417 (photo below) LH wing spar cap contained exfoliation corrosion in area inboard of wheel well. Rivet heads missing. P/No: 210001007. TSN: 4,959 hours. Swearingen SA227DC Flap hydraulic pipe worn and damaged. Ref 510011625 Flap ‘Up’ hydraulic pipe worn and holed due to chafing on LH wing de-ice system scat hose. Loss of hydraulic fluid. P/No: 27810061071. TSN: 16,649 hours/20,172 cycles/20,172 landings/176 months. Swearingen SA227DC Wing leading edge skins cracked. Ref 510011553 LH and RH inboard wing leading edge skins PNo 27-31000-8003 (LH) and PNo 27-31000-8004 (RH) located at WS81 cracked in skin and doubler. P/No: 27310008003. TSN: 14,008 hours/12,018 landings. ROTORCRAFT Agusta-Bell A109E Transmission oil cooler fan pulley shaft failed. Ref 510011513 Transmission oil cooler fan pulley shaft section broken off. Following removal of the fan assembly, significant wear was found on the shaft and pulley retaining pin. The internal pulley bearing was also seized. Oil cooler is post AW BT 109EP-99. P/No: 4611047900AMDTB. TSN: 397 hours. Bell 206B3 Engine/transmission coupling drive shaft broken. Ref 510011381 (photo below) Engine to transmission main Kaflex drive shaft failed. P/No: SKCP2348101. TSN: 2,264 hours. Piper PA24250 Stabiliser horn cracked. Ref 510011487 Stabilator horn assembly cracked. Found during inspection iaw SB 1189. P/No: 20399005. TSN: 8,190 hours. Piper PA31350 Aileron spar flange cracked. Ref 510011302 RH aileron upper spar flange cracked in radius located behind actuating attachment brackets. Crack length approximately 12mm (0.47in). Found during inspection iaw AD/PA31/118 Amdt2. P/No: 4020043. TSN: 19,397 hours. Reims F406 Co-pilot’s rudder pedal brake link broken. Ref 510011441 Co-pilot's RH rudder pedal brake link broken. Investigation continuing. Reims F406 EADI intermittent. Ref 510011439 Electronic Attitude Direction Indicator (EADI) failed. Investigation continuing. P/No: SA4550701SN102049. Socata TB10TOBAGO Vertical stabiliser post corroded. Ref 510011365 (photo following) Vertical stabiliser post upper portion corroded. Suspect dissimilar metal corrosion at screw location. P/No: TB1031000001. TSN: 11,492 hours. Robinson R44 Engine/transmission coupling clutch worn. Ref 510011573 Engine to transmission sprag clutch worn excessively. P/No: C1883. TSN: 2,200 hours. Robinson R44 Engine/transmission coupling flex plate cracked. Ref 510011407 (photo below) Eight of eight flex plate bonded washers have cracks in the glue line around the washer. Flex plate is from Lot 35. P/No: C9471F. TSN: 1,881 hours. SELECTED SERVICE DIFFICULTY REPORTS ... CONT Robinson R44 Engine muffler distorted. Ref 510011459 (photo below) Muffler distorted and deformed in area of tailpipe join. P/No: C16932. TSN: 590 hours. TSO: 590 hours. Lycoming TIO540A2C Engine oil system loss. Ref 510011492 RH engine oil loss. Investigation found nil oil on the dipstick. Small leak from oil filter. Metal particles in filter. Aircraft had an oil and oil filter change two days prior to incident. TSO: 1,410 hours. TURBINE ENGINES Allison 250C20R Power turbine governor failed. Ref 510011422 Power turbine governor drive gear separated from input shaft. P/No: 23086749. TSO: 672 hours. PISTON ENGINES Continental IO360 Engine fuel flow indicating hose fitting broken. Ref 510011429 Front engine fuel flow indicating system hose failed at right angle fitting between the transducer and manifold valve. Investigation also found that the fittings had been subjected to some form of twisting motion. Hose had been installed as part of EO EA 1900301. Lycoming IO360L2A Engine camshaft/tappets worn and damaged. Ref 510011579 Engine camshaft PNo LW18840 and associated tappets PNo 72877 worn. Metal contamination of engine oil filter. P/No: O5K22720CAMKIT. TSN: 258 hours/4 months. Lycoming LTIO540J2BD Engine cylinder studs broken. Ref 510011471 RH engine No2 cylinder holdown studs sheared allowing cylinder to migrate away from crankcase. Inlet manifold tube moved out of inlet manifold and cylinder base "O" ring seal disturbed. P/No: 3813X25015X1. TSO: 1,140 hours. Lycoming O235L2C Engine cylinder induction pipe bolt missing. Ref 510011402 No2 cylinder induction pipe attachment bolts missing and retaining clamp laying at the base of the induction pipe. Further investigation found five of the six remaining bolts were of an incorrect length and only holding by two threads. Engine had been recently overhauled. Lycoming O235L2C Engine cylinder piston pin worn. Ref 510011378 (photo below) Cylinder piston pin plug worn away. Piston pin then wore two grooves in the cylinder wall. P/No: LW11625. TSN: 2,124 hours. TSO: 2,124 hours. GE CF680C2 Engine turbine disc cracked. Ref 510011540 Engine High Pressure Turbine (HPT) stage 2 disc had crack indication at pressure face. Found during inspection. Investigation continuing. P/No: 9362M43P02. GE CF680C2 Engine vibrates. Ref 510011547 LH engine vibration coupled with light airframe vibration. Other engine parameters normal. Investigation continuing. Rolls Royce RB211524G Engine surge/stall. Ref 510011506 No1 engine surge/stall. Initial investigation found metal in tailpipe and boroscope inspection found HP1 stator and blade damaged with pieces missing. Engine EGT exceeded 963 degrees. Investigation continuing. P/No: RB211524GT. Rolls Royce TRENT97284 Engine failed. Ref 510011470 No2 engine failed during climb after takeoff. Investigation continuing. Turbomeca MAKILA2A Engine oil pump driveshaft sheared. Ref 510011583 (photo below) No2 engine oil pump driveshaft sheared. P/No: 0298145020. TSN: 568 hours. 39 GE CF680E1 Engine turbine disc faulty manufacture. Ref 510011461 Engine High Pressure Turbine (HPT) disc manufacturing error. Found during overhaul. Investigation continuing. P/No: 1863M36G06. TSN: 7,296 cycles. GE CT79B Engine leaking oil – smell in cockpit. Ref 510011287 Oil fume odour in cockpit which ceased when the RH engine bleed system was turned off. Initial investigation found slight oil wetting in the RH engine inlet. Engine removed and investigation continuing. IAE V2527A5 Engine failed. Ref 510011401 LH engine failed. Initial investigation found the engine seized and metal debris in various parts of the engine. Investigation continuing. IAE V2527A5 Engine stage one turbine hub cracked. Ref 510011325 Engine Stage 1 turbine hub contained 50 cracks in blade slot fir trees. Found during NDT inspection. P/No: 2A5001. TSN: 18,979 hours/9,690 cycles. TSO: 18,979 hours/9,690 cycles. IAE V2533A5 Engine variable stator vane actuator pressure supply pipe worn. Ref 510011352 (photo below) RH engine Variable Stator Vane Actuator (VSVA) high pressure supply tube chafed and holed by VSVA control rod bolt. P/No: 6A2145. COMPONENTS Kavanaugh Double T 43X15 Frame fractured. Ref 510011491 Balloon basket stainless steel frame fractured at top weld joint. TSN: 1,664 hours. Kavanaugh KLF201088 Load frame cracked. Ref 510011300 Balloon load frame contained several hairline cracks in area of welded joints. P/No: KLF201088. TSN: 1,273 hours/134 months. AIRWORTHINESS Continental TSIO520N Engine crankshaft cracked. Ref 510011557 Crankshaft cracked at alternator drive gear mount bolts. Investigation found incorrect fitment of alternator drive coupling. Metal contamination of engine. P/No: 646895. TSN: 582 hours. TSO: 582 hours. Garrett TFE73120R Engine accessory drive bearing failed. Ref 510011463 LH auxiliary gearbox alternator drive bearing rear cage broken. Metal contamination of oil system. P/No: 30728851. PWA PW121 Engine oil filler cap incorrectly fitted. Ref 510011338 No1 engine oil filler cap incorrectly fitted. Loss of approximately 5.68 litres (5 quarts) of oil. PULL-OUT SECTION Continental GTSIO520M Engine crankcase cracked. Ref 510011468 LH engine crankcase cracked and leaking oil. TSO: 1,304 hours. PWA PW120A Engine fuel filter blocked. Ref 510011466 No1 engine LP fuel filter blocked. Investigation continuing. P/No: 7589141. APPROVED AIRWORTHINESS DIRECTIVES 10–23 September 2010 24 September–7 October 2010 Rotorcraft Kawasaki BK 117 Series Helicopters Rotorcraft Agusta AB139 and AW139 Series Helicopters TCD-7558A-2010 - Jettisonable Sliding Door TCD-7483A-2010 - Rescue Winch Boom Support Part Number 44307-500 Sikorsky S-76 Series Helicopters PULL-OUT SECTION 2010-17-16 - Detect Fatigue Cracking in Vertical Stabiliser 40 2010-0190-E (corrected) - Doors - Passenger Sliding Doors Locking Receptacles - Inspection / Modification Kawasaki BK 117 Series Helicopters 2010-0195 - Fuel - Fuel Pilot Valve Wiring Modification (Fuel Tank Safety) 2010-0194 - Fuel - Fuel Pilot Valve Wiring Modification (Fuel Tank Safety) 2010-0200 - Lights - Emergency Lighting Tritium Exit Signs - Inspection / Replacement Fokker F50 (F27 Mk 50) Series Aeroplanes 2010-0197 - Fuel - Fuel Pipes in Engine Nacelles Inspection / Replacement (Fuel Tank Safety) Below 5700kg Airparts (NZ) Ltd. FU 24 Series Aeroplanes AD/JBK 117/30 - Flight Controls - Fixed Bearing CANCELLED Fokker F100 (F28 Mk 100) Series Aeroplanes DCA/FU24/179 - Parachuting Operations Limitations and C of G Determination TCD-7358A-2010 - Flight Controls - Fixed Bearing 2010-0200 - Lights - Emergency Lighting Tritium Exit Signs - Inspection / Replacement Pacific Aerospace Corporation Cresco Series Aeroplanes DCA/CRESCO/16 - Vertical Stabiliser - Replacement Above 5700kg Airbus Industrie A319, A320 and A321 Series Aeroplanes AD/A320/143 Amdt 2 - Fuel Tank Electrical Bonding Airbus Industrie A330 Series Aeroplanes FSA JAN-FEB 2011 2010-0189 - Navigation - Modular Avionic Unit Inspection / Replacement / Modification Fokker F28 Series Aeroplanes 2010-0083-CN - Operational Test of the Fuel Pump Non-Return Valve (NRV) Beechcraft 1900 Series Aeroplanes AD/BEECH 1900/50 - State of Design Airworthiness Directives Boeing 737 Series Aeroplanes AD/B737/307 Amdt 3 - Main Slat Track Downstop Assembly 2010-19-03 - Deactivation or Modification of PATS Aircraft, LLC, Auxiliary Fuel Tanks Bombardier (Boeing Canada/De Havilland) DHC-8 Series Aeroplanes CF-2010-30R1 - Cracking of the Nacelle Attachment Fitting(s) Gates Learjet 35 and 36 Series Aeroplanes AD/LEARJET 35/42 - Aileron Control Cables Turbine Engines Pratt and Whitney Turbine Engines PW4000 Series AD/PW4000/17 - Turbine Exhaust Case 2010-18-13 - HPC Drum Rotor Disk Assembly Inspection Above 5700kg Airbus Industrie A330 Series Aeroplanes AD/A330/7 Amdt 2 - THSA Transfer Tube CANCELLED AD/A330/89 - Flight Control Primary Computer CANCELLED 2010-0187 - Exhaust - Thrust Reverser Opening Mechanism - Inspection 2010-0191 - Flight Controls - Flight Control Primary Computer (FCPC) - PRIM 3 Dispatch Restriction / Modification 2010-0192 - Flight Controls - Trimmable Horizontal Stabilser Actuator Screw/Nut Assembly Inspection / Lubrication Boeing 747 Series Aeroplanes 2010-20-12 - Electrical Hot Short from a Source Outside the Fuel Quantity Indicating System 2010-20-08 - Number 5 Main Entry Door Cutout Forward Edge Frame British Aerospace BAe 146 Series Aeroplanes 2010-0201 - Landing Gear - Main landing Gear Shock Absorber Lower Attachment Pins 2010-0202 - Landing Gear - Nose Landing Gear Main Fitting AD/CF34/18 - Master Variable Geometry (VG) Actuators AD/CF34/19 - Master Variable Geometry (VG) Actuators AD/CF34/20 - Critical Time Limited Parts International Aero Engines AG V2500 series 2010-20-07 - High Pressure Compressor (HPC) Stage 3-8 Drum Pratt and Whitney Turbine Engines PW4000 Series AD/PW4000/21 - 2nd Stage High Pressure Turbine Air Seal Assembly Rolls Royce (Allison) Turbine Engines AE 3007 Series AD/AE 3007/6 Amdt 2 - High Pressure Turbine Stage 2 Wheels - CANCELLED 2010-19-01 - High Pressure Turbine Stage 2 Wheels Turbomeca Turbine Engines - Arriel Series 2010-0198 - Engine - Module M03 (Gas Generator) Turbine Blade - Modification British Aerospace BAe 3100 (Jetstream) Series Aeroplanes Equipment Propellers - Variable Pitch - Dowty Rotol AD/JETSTREAM/107 - Nosewheel Steering Selector Valve AD/PR/35 Amdt 4 - Propeller Hub Wall Cracking CANCELLED Cessna 750 (Citation X) Series Aeroplanes 2010-0196 - Propellers - Propeller Hub Wall Cracking - Inspection AD/CESSNA 750/4 - Elevator Inboard - Hinge Brackets - Inspection - CANCELLED AD/PW4000/18 - State of Design Airworthiness Directives 2010-20-10 - Elevator Inboard - Elevator Hinge Brackets and Horizontal Stabiliser Hinges Inspection / Repair AD/PW4000/19 - High Pressure Compressor Rear Case Fokker F27 Series Aeroplanes AD/PW4000/20 - 15th Stage High Pressure Compressor Turbine Engines General Electric Turbine Engines CF34 Series 2010-0195 - Fuel - Fuel Pilot Valve Wiring Modification (Fuel Tank Safety) 2010-0200 - Lights - Emergency Lighting Tritium Exit Signs - Inspection / Replacement Radio Communication and Navigation Equipment AD/RAD/92 Amdt 1 - Rockwell Collins TDR-94/94D Transponder/Honeywell AZ800/810 Air Data Computer Selected Altitude Data Inputs APPROVED AIRWORTHINESS DIRECTIVES ... CONT 8–21 October 2010 Rotorcraft Bell Helicopter Textron Canada (BHTC) 407 Series Helicopters CF-2010-33 - Over-torque of Tail boom Attachment Hardware Bell Helicopter Textron 427 Series Helicopters CF-2010-32 - Over-torque of Tail boom Attachment Hardware 2010-0207-E - Indicating and Recording Systems - Instrument Control Panel - Flight Limitation / Modification Eurocopter EC 135 Series Helicopters 2010-0207-E - Indicating and Recording Systems - Instrument Control Panel - Flight Limitation / Modification 2010-0213 - Main Rotor Drive - Main Transmission Housing Upper Part - Modification Below 5700kg Cessna 336 Series Aeroplanes Cessna 337 Series Aeroplanes 2010-21-18 - Wing Overload Failure - Due to installation of Aviation Enterprises Supplemental Type Certificates (STCs) that are now or have ever been installed Above 5700kg Airbus Industrie A319, A320 and A321 Series Aeroplanes AD/B747/262 - Number 5 Entry Door Cutout CANCELLED 2009-19-06 - Flight Deck Door 2010-0165 (Correction) - Oxygen System Passenger Oxygen Masks - Identification / Modification / Replacement 2010-0209 - Flight Controls - Inboard Flap Trunnion and Sliding Panel Airbus Industrie A330 Series Aeroplanes 2010-0191 (Correction 2) - Flight Controls - Flight Control Primary Computer (FCPC) - PRIM 3 Dispatch Restriction / Modification AD/CT58/2 - Centrifugal Filter 'T' Bolt CANCELLED AD/CT58/3 - Combustion Casing Adapter Boss CANCELLED 2010-21-04 - Fuselage Upper Lobe - Skin Lap Joints AD/CT58/4 - Compressor Stator Vanes CANCELLED Boeing 767 Series Aeroplanes AD/CT58/6 - Centrifugal Fuel Purifier - CANCELLED 2010-22-01 - Nacelle Strut Upper Link Fuse Pins AD/CT58/7 - Power Turbine Wheel - CANCELLED Bombardier (Canadair) CL-600 (Challenger) Series Aeroplanes AD/CT58/8 – De-tuner Hose Assembly CANCELLED CF-2010-34 - Horizontal Stabilizer Trim Actuator Rubber Bull Gear Wheel Material Hardness out of Specification AD/CT58/9 - Anti-icing Valve - CANCELLED CF-2010-36 - Main Landing Gear Door - Fairing Seal Interference British Aerospace BAe 146 Series Aeroplanes 2010-0202R1 - Landing Gear - Nose Landing Gear Main Fitting British Aerospace BAe 3100 (Jetstream) Series Aeroplanes AD/JETSTREAM/11 Amdt 2 - Nose Equipment Bay Spine Member AD/JETSTREAM/107 Amdt 1 - Nosewheel Steering Selector Valve AD/CT58/10 - Accessory Drive Gearbox - Pinion Gear Bolt Torque - CANCELLED Pratt and Whitney Turbine Engines JT8D Series 2010-21-17 - First Stage Fan Blades Turbomeca Turbine Engines - Arriel Series AD/ARRIEL/35 - HP/LP Pump Metering Unit - Low Pressure Fuel Pump Impeller Drive - CANCELLED 2010-0215 - Engine Fuel & Control - High Pressure (HP)/Low Pressure (LP) Pump Metering Unit - Low Pressure Fuel Pump Impeller Drive - Inspection/ Replacement Embraer ERJ-170 Series Aeroplanes 22 October–4 November 2010 2010-10-01 - Airworthiness Limitation Section (ALS) - Changes Rotorcraft Agusta A109 Series Helicopters Fokker F100 (F28 Mk 100) Series Aeroplanes 2010-0222-E - Tail Rotor Drive - Tail Rotor Special Hub Plug - Inspection 2010-0139 - Fuel - Fuelling Control Panel Cam Inspection / Replacement / Functional Check (Fuel Tank Safety) Eurocopter BO 105 Series Helicopters AD/A320/184 - Inboard Flap Trunnion - CANCELLED 2010-0091R1 - Stabilizers - Elevators - Inspection General Electric Turbine Engines CT58 Series Learjet 45 Series Aeroplanes 2010-21-19 - Fire Protection Turbine Engines CFM International Turbine Engines CFM56 Series 2010-0212 - Engine - Fan Blade - Replacement General Electric Turbine Engines CF6 Series AD/CF6/78 - State of Design Airworthiness Directives 2010-0192 Correction - Flight Controls - Trimmable Horizontal stabiliser Actuator Screw/Nut Assembly - Inspection / Lubrication AD/CF6/79 - Low Pressure Turbine 2010-0205 - Landing Gear - Main Landing Gear Retraction Bracket AD/CF6/81 - Low Pressure Turbine (LPT) Nozzle Lock Assembly Studs AD/CF6/80 - High Pressure Compressor Air Ducts AD/CF6/82 - High Pressure Compressor Disk Lock Slots 2010-0216-E (Correction) - Main Rotor - Main Rotor Blade Erosion Protective Shell - Inspection / Replacement 2010-0223 - Main Rotor Drive - Main Gearbox Inspection Eurocopter EC 135 Series Helicopters AD/EC 135/19 - Tail Rotor Control Rod CANCELLED 2010-0227 - Rotor Flight Controls - Tail Rotor Control Rod and Ball Pivot - Inspection / Replacement Kawasaki BK 117 Series Helicopters TCD-7733-2010 - Flight Manual Supplements for Optional Equipments and Special Operations for which Category A Operations (VTOL) are not approved 41 AIRWORTHINESS 2010-21-18 - Wing Overload Failure - Due to installation of Aviation Enterprises Supplemental Type Certificates (STCs) that are now or have ever been installed AD/B747/132 - Fuselage - Upper Lobe Skin Panel Joints - CANCELLED PULL-OUT SECTION Eurocopter BK 117 Series Helicopters Boeing 747 Series Aeroplanes APPROVED AIRWORTHINESS DIRECTIVES ... CONT Below 5700kg Pacific Aerospace Corporation Cresco Series Aeroplanes AD/CRESCO/5 Amdt 1 - Aileron Control Cables CANCELLED PULL-OUT SECTION Rotorcraft Bell Helicopter Textron 212 Series Helicopters 2010-0230 - Flight Controls - Rudder Pulley Bracket Inspection / Replacement AD/F406/12 - Rudder Pulley Bracket - CANCELLED Robin Aviation Series Aeroplanes Eurocopter AS 332 (Super Puma) Series Helicopters AD/ROBIN/7 Amdt 3 - Nose Landing Gear Bracket - CANCELLED Above 5700kg Airbus Industrie A319, A320 and A321 Series Aeroplanes 2010-0234 - Time Limits/Maintenance Checks - Airworthiness Limitations - Amendment / Implementation AD/ROBIN/40 Amdt 1 - Nose Landing Gear Bracket 2010-0210 (Correction) - Equipment / Furnishings Off-wing Escape Slide Enclosure - Modification Eurocopter EC 135 Series Helicopters Airbus Industrie A330 Series Aeroplanes AD/A330/76 Amdt 4 - Electrical Power/APU Generator Inspection - CANCELLED 2010-0218 - Wings - Inner Leading Edge Droop Nose 1 Sidestay Bracket - Inspection / Replacement 2008-0173R1 - Electrical Power / Airborne Auxiliary Power - Auxiliary Power Unit (APU) Generator Inspection / Modification Bombardier (Canadair) CL-600 (Challenger) Series Aeroplanes CF-2010-35 - Hydraulic Accumulators - Screw Cap/ End Cap Failure CF-2010-37 - Air Data Computer - Erroneous Airspeed and Altitude Indications British Aerospace BAe 3100 (Jetstream) Series Aeroplanes AD/JETSTREAM/108 - Flap Torque Shaft Assembly Fokker F28 Series Aeroplanes 2010-0217 - Fuel - Fuel Quantity Indication System Inspection / Modification (Fuel Tank Safety) 2010-0234 - Time Limits/Maintenance Checks - Airworthiness Limitations - Amendment / Implementation Kawasaki BK 117 Series Helicopters TCD-7745-2010 - Unintentional Turning of the Baro Rotary Knobs TCD-7723-2010 - Bell Crank Bearing Inspection Below 5700kg Diamond DA40 Series Aeroplanes AD/SUPP/18 Amdt 1 - SIREN Load Release Units CANCELLED 2010-0231 - Nose Landing Gear - Support Plate Of Oleo Outer Cylinder - Inspection/Repair Above 5700kg Boeing 767 Series Aeroplanes 2010-23-03 - Incorrect Indication of Improper Fuel System Configuration Fokker F100 (F28 Mk 100) Series Aeroplanes 2010-0158R1 - Fuel - Crossfeed Valve System and Fire Shut-off Valve System - Modification Turbine Engines Rolls Royce Turbine Engines - RB211 Series 2010-0236-E - Engine - High Pressure / Intermediate Perssure (HP/IP) Structure Inspection Equipment Electrical Equipment 2010-0235 - Doors - Rear Passenger Door Retaining Bracket - Replacement 2010-0237 - Spectrolab Nightsun XP Searchlight Diamond DA42 Series Aeroplanes 2010-0196R1 - Propellers - Propeller Hub Inspection / Replacement 2010-0235 - Doors - Rear Passenger Door Retaining Bracket - Replacement Embraer EMB-500 (Phenom 100) Series Aeroplanes 2009-02-04 - Flap System 2009-09-01 - Elevator Mass Balance Fasteners 2009-10-01R2 - ADS Sensors Equipment Supplementary Equipment 2009-0122R1 - Equipment / Furnishings - Load Release Units - Inspection 2010-0227 (Correction) - Rotor Flight Controls Tail Rotor Control Rod and Ball Pivot - Inspection / Replacement Eurocopter EC 225 Series Helicopters Airbus Industrie A380 Series Aeroplanes Airbus Industrie A330 Series Aeroplanes FSA JAN-FEB 2011 Reims Aviation F406 Series Aeroplanes 2010-24-51 - Main Rotor Hub Strap Fitting DCA/CRESCO/15A - Aileron Control Cables Modification, Replacement and Inspection 42 5–18 November 2010 Propellers - Variable Pitch - Dowty Rotol Propellers - Variable Pitch - McCauley 2010-23-06 - Propeller Hub Inspection Radio Communication and Navigation Equipment 2010-0204 - Navigation Systems - Mode-S Transponder - Modification / Replacement. 2010-07-01 - Wings - Drain Holes in Control Surfaces 2010-08-01 - Cabin Pressurization 2010-09-02 - Harness W101 I[hl_Y[:_\ÓYkbjoH[fehji TO REPORT URGENT DEFECTS 97BB0')'-+-<7N0&(,('-'/(& or contact your local CASA Airworthiness Inspector [freepost] Service Difficulty Reports, Reply Paid 2005, CASA, Canberra, ACT 2601 Online: www. casa.gov.au/airworth/sdr OnTrack TRY BEFORE YOU FLY! OnTrack is the industry’s newest interactive flight planning tool available on the CASA website. Using video, audio, pop-up alerts and text, OnTrack helps brief pilots on how to operate in and around controlled airspace and avoid dreaded airspace infringements. OnTrack features interactive maps with added visual terminal chart (VTC) information, plus video guides on how to fly inbound and outbound tracks into newly-designated Class D aerodromes. You will be able to navigate around airspace boundaries, VFR routes, VFR/Class D reporting points and military control zones – and do so safely before you take off to fly for real. CAIRNS REMEMBER to plan your route thoroughly, and carry current charts and documents. Always check ERSA, NOTAMs and the weather BEFORE you fly. coming soon 43 For more information please visit our website www.casa.gov.au/ontrack Applications are invited for the 2011 scholarship, established to promote aviation management excellence. One scholarship will be awarded. This will cover tuition fees at Griffith University for either the Bachelor of Aviation Management, the Graduate Certificate in Aviation Management or the Master of Aviation Management. 2011 Aviation Management Scholarship For further details and an application form, email [email protected] Applications close 28 January 2011. CLOSE CALL? $500 ever had a Write to us about an aviation incident or accident that you’ve been involved in. If we publish your story, you will receive Write about a real-life incident that you’ve been involved in, and send it to us via email: [email protected]. Clearly mark your submission in the subject field as ‘CLOSE CALL’. Articles should be between 450 and 1,400 words. If preferred, your identity will be kept confidential. Please do not submit articles regarding events that are the subject of a current official investigation. Submissions may be edited for clarity, length and reader focus. ADVERTISMENT The Guild of Air Pilots & Air Navigators (GAPAN) Griffith University That was the year that was Th most worrying trend in aviation in 2010 was the lack of a strong overall The trend. Airliners remain among the safest forms of transport ever devised, tr but the trend towards ever-lower accident rates appears to be slowing. There were some encouraging elements in the big picture. In a change to the historical order, turboprop airliners saw worldwide safety improvements compared to the performance of jetliners, with 15 major accidents involving airline turboprops, versus 17 involving airline jets. This compares to 21 turboprop and 17 major airline jet accidents in 2009. 2010 was a mediocre to below average year for commercial jets; and a good year for business jets and commercial turboprops. James ames Burin Burin, director 44 technical programs gra with the FSA JAN-FEB 2011 Flight Safety Foundation (FSF), gave his annual state of the industry address at the International Aviation Safety Seminar held in Milan in November last year. The fleet 2010 Type Western built Eastern built Total Turbojets 20,239 1,390 21,629 Turboprops 4,766 1,351 6,117 Business jets 16,638 Source: Ascend However, Jim Burin explained, there was no room for complacency, because, after more than three decades of substantial and steady declines in global accident statistics, the FSF found that there had been a levelling off in the overall commercial aircraft accident rate. 'While commercial jets have an outstanding accident record, we have stopped improving,' Burin explained. For the decade of the nineties, Burin quoted an accident rate of 1.18 per million departures, which for the following decade had dropped to .57 per million departures (see opposite). Noting that there were still two months to go in the first decade of the century, Burin highlighted the high-risk areas, especially the approach and landing phases. Recognising this, in 2010 the Foundation continued their series of approach and landing accident reduction (ALAR) workshops, holding sessions in Manila, Singapore and Bangkok, and releasing an updated ALAR tool kit (version 5.0) on CD. 'The rolling rate of controlled flight into terrain (CFIT) accidents is getting better,' Burin said, showing that 'TAWS (terrain alert warning system) is still working', with aircraft involved in CFIT generally being turboprops not fitted with TAWS. However, 'loss of control (LOC) accidents are widening their lead,' he said. 'From 1998-2009, no one year has had zero accidents, and the number of fatalities is big.' Describing such accidents as a situation where the 'aircraft is unintentionally flown into a position where the crew is unable to recover', Burin identified several common factors with these accidents. Often in LOC accidents there were (see graph below): 'Aviation is an industry where the risk is never going to be zero', so the industry has to emulate successful high-risk organisations which: no good visual references - IMC, night, over water or featureless terrain mistakes involving the autopilot (confusion as to whether it was on or off), and have well-developed and current procedures (manuals and standard operating procedures) the initial movement was imperceptible (2 degrees/sec) investigate high-risk management failures, and the initial correction was often in the wrong direction. share information. Accordingly, in 2011, Flight Safety Australia will look at the factors behind loss of control accidents, continue our focus on the human-machine interface and the role of automation in aviation, and examine some more case studies of stick-shaker accidents. Perhaps the most disturbing factor or trend in these loss of control accidents, Burin stated, was the fact that 'one of the crew has good or better situational awareness [than the pilot flying], but waits too long to correct the situation.' So, the safety challenge, he explained is to manage the risk to modify the probability or the severity. We also plan more articles on maintenance, as one of the other critical factors in aviation safety, as well as further articles on ground safety, cabin crew and the rapidly-growing sport aviation and unmanned aircraft sectors. Major Accidents Worldwide Commercial Jets 2000-2010 45 40 1.20 20 17 19 17 16 13 13 17 19 17 11 13 0.60 0.40 10 Major Accident Rate* 0.80 0.20 2000 01 02 03 04 05 06 07 08 09 2010 *Reliable worldwide departure/rate data not available for Eastern-Built Aircraft Loss of Control Major Accidents Commercial Jets 1998-2009 Number of Accidents Major Accidents 1.00 30 Aviation is an industry where the risk is never going to be zero 3 5 4 4 2 4 2 3 3 5 6 3 ‘98 ’99 ‘00 ’01 ‘02 ’03 ‘04 ’05 ‘06 ’07 ‘08 ’09 Source: Ascend, Boeing THE YEAR THAT WAS Hull losses Western Major Accident Rate* 46 The old man was right FSA JAN-FEB 2011 Name withheld by request Now older himself, this pilot rues the combination of inexperience and confidence that almost got him killed. This happened some years ago, but now it's time to come clean because my father no longer reads Flight Safety, so he won't know, and the hapless passengers along with the wife (a pilot) of one of them have also probably forgotten. But I haven't. Dad had been an instructor in World War II, so I should have listened more attentively to his clear and concise instructions when he phoned me that eventful afternoon some years ago. It was late on a warm summer's afternoon in the wheatbelt of Western Australia and his words had been simple and clear: fly out to his friend's farm, pick up a couple of guys, do a couple of circuits, drop them back at the farm and return home about an hour for everything. He'd also said: ‘Just watch for the power lines ... land parallel to them on the big paddock ... on some slightly rising ground. ‘Ye-e-e-e-s, Dad.’ I grabbed the plane keys and the car keys and powered out to the strip in the big V8 and parked near Dad's pride and joy - a gleaming red and white Cessna 172, tethered to the dry windswept earth. After a cursory pre-flight check, I lifted off the strip and settled back into the luxurious brocade and leather seat while the docile 172 virtually flew itself in a light sou'westerly in VFR conditions. I had the onerous navigational duties of following a couple of the roads that led to the farm. I had never been to the farm by air or road, but I knew where it was so I sat back and relaxed - ‘just take it easy old son!’ As a rather inexperienced pilot in command (and one who was loafing on the job), I was simply unprepared, inexperienced, and just not ‘with it’ - how could I possibly cope with the events of the next hour, on my first, real, out-of-field landing? Suddenly the farm was there – ‘yes, that's it: house, sheds, windmill, and powerlines running north/ south across the top paddock. No problem.’ At least that’s what this PIC thought. I managed to land Dad's pride and joy as per instructions, taxied over the stubble and dried earth to the farmhouse, picked up the two guys and took off from the same area. Still no problem. A couple of OK circuits - with my mind just slightly more engaged in what I was doing - but then foolishly, I decided to land at right angles to the power lines (no, the lines were not my undoing!). I was planning to land a little more into wind and closer to the farm. Now, really alert, and suddenly with it, I checked the shaken passengers - they were OK - and, more importantly, the pride and joy - it, too, was OK. Thank God for sturdy undercarriages!! ’Sorry, guys, about the rough landing - must have been a glitch in the Autoland 3 system!’ My shaken passengers retired to the sidelines to recuperate with a couple of tinnies and sit back and watch this comic attempt a take-off. Incredibly, again, another stupid decision - take off in the same direction after taxiing under the power lines. Stupid? Yes, because I didn't notice a number of one to one and a half metre shallow depressions or ‘crab holes’ along with a couple of rabbit warrens which flashed past me during the take off! To this day I don't know how I didn't wreck Dad's pride and joy, oh, and also kill two passengers and myself! Apart from those minor details, how on earth did I make so many mistakes and wrong decisions? Pilot in command You're the boss, the driver man, so keep your mind focused on the job. React Make sure that you are capable of reacting quickly. Anticipate Think ahead and be mentally prepared with a plan of action. Prepare Even for a joy ride - we don't know how many rabbit holes might be on the strip so get someone to check! And listen to your ‘old man’ (instructor, senior pilot, etc, because they have a wealth of advice.) 47 Windshear Watch out for it – 'cause it's a washout! Learn to know where it lurks and be ready to firewall the throttle. ... with one helluva THUMP, we landed, or arrived, or something, with the SHORTEST LANDING ROLL in the history of powered flight and right at the back door of the farm! CLOSE CALLS Full flaps, like barn doors, not much on the ASI or tacho, everything fairly steady, windmill sliding under the left wing, house under the right, and suddenly, with one helluva thump, we landed, or arrived, or something, with the shortest landing roll in the history of powered flight - and right at the back door of the farm! So, a few words of wisdom ... Andrew Spong almost learned the hard way about the fine line between initiative and foolishness. FSA JAN-FEB 2011 48 Learning to fly can be thrilling, though eventually comes the temptation to push the limits beyond what you’ve been taught. In the early 1980s, I learned to fly ultralights at a farm in rural Victoria. In those days learning to fly ultralights wasn’t governed in nearly the same way it is today. Eager students often resorted to backyard flight schools; lessons were often not as well structured as they could have been. And having a height restriction of 500ft was very much a factor in this incident. Early morning lessons meant getting up in the dark to be out at the farm soon after dawn. Owing to the need to train in low wind conditions, the lessons usually began as early as possible. They were conducted in a twoseater followed by solo practice in a single-seater. I must have done two circuits before deciding to have a go at a stall. I reasoned that the process looked so simple it should be a breeze. Observing the instructor from overhead, he appeared to be preparing another student and they had not joined the circuit yet, so I decided it was safe to take my shot while I was still alone in the circuit. Both aircraft were skeletal framed pushers, with the only covering being the material on the wings and tail. That meant the view was largely unobstructed, and looking between your knees afforded a great view of the ground. I often thought of them affectionately as motorcycles of the air. Soon after turning downwind I pulled the throttle back to idle and began pulling back on the joystick. The nose rose as the airspeed fell away. Then as if hitting an invisible speed hump, the nose bumped, then pitched forward. I followed by pushing the joystick forward. It was my first stall and couldn’t have been more perfectly executed. I had already gone solo when the instructor decided to show me some of the other things I would be learning. Up in the air he went through a handful of manoeuvres, including something that looked terribly easy, the stall. He demonstrated a basic stall, showing how simple and uneventful it was. After we landed, he put me into the single seater saying, ‘just go out and do a few circuits’. Now for the recovery, I told myself. The nose was pointing downward and I was keen to get it back up quickly. So I brought the throttle up to near full and pulled hard back on the stick. You may be wondering at this point how the hell I’m still alive to write about it. ... looking between your knees afforded a great view of the ground. I often thought of them affectionately as motorcycles of the air. The nose rose so quickly and my reactions were slowed by the shock of it. I looked between my legs and saw blue sky. I must have been nearly vertical. I was adjacent those on the ground and maybe 300ft above them. The instructor apparently looked up and said, ‘*#@^*, look at Andrew.’ At that height, most of the possible outcomes were not very pleasant. After what seemed like an eternity just hanging there, the plane finally yawed to starboard and gently rolled back level. I was now turned ninety degrees to the downwind leg, stalled again and needing very much to get back on top of things. Forcing myself to take it slowly, I eased the throttle back up and followed with judicious backpressure on the joystick. This time the recovery was good. Still facing away from the downwind leg, the first instinct was to return to the ground as soon as possible. Knowing my mental state and also that there may now be others in the circuit, I decided to continue on my current heading and collect my thoughts. Ten minutes later, having regained my sanity, I landed back on the farm, much to everyone’s relief. Needless to say, I learnt a valuable lesson that day. Don’t get ahead of yourself, and don’t try anything you haven’t been properly instructed and tested on. It’s so easy to think that just because you know the theory, just because you’ve seen it done, and just because it seems straightforward, that there wouldn’t be any harm in trying something. But as I discovered, one or two seemingly minor details can mean the difference between life and the death. A few years later I did my first solo in a Piper at busy Moorabbin airport. I’ll never forget the joy as my instructor climbed out and told me to go do a circuit on my own. As I taxied for take-off, I tempered my excitement with the memory of that incident, glad to be alive. CLOSE CALLS The nose rose so quickly and my reactions were slowed by the shock of it. I looked between my legs and saw blue sky. I must have been nearly vertical. What happened next was a gut reaction, but I remember thinking at this point that the plane itself knows more about flying than I do so I pulled the throttle back to idle and let go of the joystick. 49 Karratha Coral Bay Monkey Mia Mullewa M ullewa 50 Geraldton FSA JAN-FEB 2011 Perth Freemantle Esperance Augusta A SIMPLE ELECTRICAL FAULT ALMOST HAD DISASTROUS CONSEQUENCES FOR GLENN CROCKENBERG, AND ANOTHER AEROPLANE THAT DID NOT NOTICE HIM … See and avoid My hangar is at Jandakot, but my home airstrip at the time was the newly refurbished strip in the isolated coastal crayfishing town of Jurien Bay, which would see only a few aircraft per week. Servicing the local wind turbines and having another wind farm nearby in Geraldton, I would often take the other wind farm service technicians up for an aerial view in my 1964 Piper Cherokee. The views from the air of the swooshing blades against the red dirt are spectacular. On this particular clear, sunny, summer Sunday morning, I planned a trip for a work colleague visiting from Denmark and my partner over the two farms and then over the nearby Abrolhos Islands, with a stop for fuel and lunch at the Greenough/Geraldton airport. The three of us took off from Jurien and headed over the local wind farm so my Danish colleague could snap some photos, and then headed back west to the coast and north to Walkaway for some additional aerial photography. At about 20nm outside of the Greenough/Geraldton airport, while conducting the usual ten-minute checks, I noticed the fuel gauges were reading zero. This sent alarm bells because I had planned for enough fuel to get to Geraldton, with an 80-minute reserve. I went to speak to the passengers and noticed the headphones were not working. After a quick scan of the instrument panel, I noticed all electrically operated gauges and communications were also not working. My training kicked in, and I tuned the transponder to 7600 in the hope that it would work, so that any other transponder-equipped aircraft would be alerted that there was an aircraft in the area without communications. Geraldton Greenough Walkaway This was my first emergency situation in my newly purchased Piper Cherokee and I wasn’t fully conversant with the electrical system. From my training, I knew that one check for alternator failure is to recycle the alternator switch. However, this Cherokee was not fitted with an alternator switch, only a master switch. Because the engine was still running, it seemed most sensible not to recycle the master switch for fear of the engine stopping. At that point, I briefed the passengers over the roar of the 235 horses telling them we had a total electrical failure. I said not to worry as the engine was still running, but that they should keep a vigilant lookout for any aircraft nearby. After determining the wind direction from the windsock, I made a normal circuit and had an uneventful landing. We then taxied to the fuel area and shut down the aircraft. The passengers, only mildly complaining how loud the last bit of the trip was, went in to the airport lounge while I refuelled. After refuelling, I turned the master switch back on and all electrically operated instruments and communications were back on line. I suspected that the recycling of the master switch on shut down had rectified the electrical fault. Just to be sure, I asked the refueller about a local LAME in the hope that he might be able to come down and have a look. Unfortunately, he was out fishing, so I rang my LAME at Jandakot who said that perhaps there had been an overload on it, but without actually seeing the aircraft it was difficult to assess the problem. As the electrics now seemed to be fine, I made the decision to abort the plan to go to the Abrolhos Islands and head the 90nm back to Jurien Bay. With passengers back on board, I went to start the aircraft - the battery didn’t have enough power to turn it over. I suspected that because of the electrical failure it just needed a charge and once running the alternator would charge the battery sufficiently. Jurien Bay The flight back down to Jurien was beautiful; lots of swell in the Indian Ocean with waves breaking over reefs leaving their trails of white water - and all electrical operations were normal. The passengers were chatting and taking photos. After 45nm the same electrical problem reared its ugly head. I was pretty sure the engine would be fine as it had been on the previous leg. I tuned the transponder to 7600 again and I told the passengers to enjoy the flight, but to keep a good lookout for other aircraft. Unsurprisingly, no one saw any other aircraft out there in the West Australian outback. Upon approaching Jurien airstrip, I entered into a normal circuit broadcasting normally even though the comms were not working. My Danish colleague happily snapped photos of the marina and islands off Jurien Bay, and just as I was entering finals he remarked that he was taking a photo of an aircraft flying below us. Below us! I hadn’t seen it and he apparently didn’t think it was a problem, so didn’t alert me to it until the last minute. I swiftly aborted the landing and conducted a go-around, keeping a very vigilant lookout this time. Thankfully, I had an uneventful landing. At the airstrip, I tried to catch up to the other pilot to explain that I had lost my comms, but he had left by the time I had landed. I still don’t know to this day whether he realised how close we were to him. The flight back down to Jurien was beautiful; ... After 45nm the same electrical problem reared its ugly head. The culprit was a broken alternator wire - something that could potentially happen at any time. In hindsight, it would have been more prudent to leave the aircraft at Greenough/ Geraldton so that the LAME could have looked into it. From this incident, I realise how important it is to know the electrical system of my Piper Cherokee. And, by the way, if I had recycled the master switch, the engine would have still run, because the key on a separate circuit controls the mags. Finally, regardless of how much air traffic you perceive in a particular area, procedures and communications are imperative for aircraft separation. CLOSE CALLS The refueller found a car battery and some jumper leads. After determining whether the Cherokee was positively or negatively earthed, we hooked up the batteries. Within moments, the prop was spinning and I was doing the run-ups for our flight back to Jurien, passengers waving thanks to the refueller. 51 The Australian Chief Commissioner’s message In November last year, the ATSB launched its new-look website. The function and design of the new site is based on the findings from the market research we recently conducted with stakeholders. You asked and we responded. Besides the contemporary look and feel, the new website helps us better communicate key safety i i d messages from our transport safety investigations and research reports. It also improves overall accessibility and usability for our users. 52 You will notice that we’ve added some new features to FSA JAN-FEB 2011 enhance your overall experience with the site. These include: s ASCROLLINGNEWSITEMSSECTIONONTHEHOMEPAGETHAT gives you quick updates on ATSB investigations and activities s ANIMPROVEDINVESTIGATIONSHUBTHATPROVIDESBETTER access to all relevant data and information on our active and completed investigations Risk of aviation oxygen cylinder rupture extremely remote he rupture of an oxygen cylinder on board a Qantas Boeing 747 was a unique event and highly unlikely to happen again, according to an ATSB investigation. T On 25 July 2008, an oxygen cylinder ruptured in the plane’s forward cargo hold about an hour into a flight from Hong Kong to Melbourne. Part of the ruptured cylinder punctured the fuselage wall and damaged the cabin, causing the plane to depressurise rapidly. The plane then made an emergency descent and landed at the nearest suitable airport in Manila, Philippines. None of the 369 passengers and crew on board were injured. s APROGRESSBARTHATPROVIDESAVISUALONTHESTATUSOF ATSB investigations ATSB Chief Commissioner, Mr Martin Dolan, said investigators conducted a comprehensive investigation to determine the cause of the rupture, despite missing the key piece of evidence. s ALATESTREPORTSSECTIONONTHEHOMEPAGETHATLETSYOU scroll and access recent investigation and research reports ‘This was an unusual and challenging investigation as the key piece of evidence, the ruptured cylinder, was ejected from the plane and is at the bottom of the South China Sea,’ Mr Dolan said. s ANEASIERWAYTOSUBMITANACCIDENTINCIDENTNOTIlCATION through improved secure online forms. The new-look website forms part of our commitment to improving the way we communicate key safety messages and updates to industry and the community. The new site was particularly useful during the early stages of our investigation into the uncontained engine failure of Qantas Flight QF32. Through the news item section on the home page, we provided daily updates for several weeks following the occurrence. I am pleased to say that this was well received by industry. Be sure to bookmark our website (www.atsb.gov.au) and try our free online subscription service to receive ATSB updates and reports via email. If you have any feedback about the new website, you can email us on our website feedback form. Martin Dolan Chief Commissioner ‘Since we didn’t have the ruptured cylinder, we exhaustively tested and evaluated identical cylinders, including cylinders from the same manufacturing batch. Through these tests we did not identify any aspect of the cylinder design or manufacture that could pose a threat. ‘As well, the published maintenance procedures were found to be valid and thorough, and inspection regimes appropriate. The investigation also found no record of any other related instances of aviation oxygen cylinder rupture. ‘Given the widespread and long-term use of this type of cylinder, it was clear that this occurrence was a unique event. ‘In light of the investigation’s findings, it is our view that the risk of a similar rupture and consequent aircraft damage remains extremely remote.’ The ATSB investigation report also provides safety advice for operators and organisations involved with aviation oxygen cylinders and operators of pressurised passenger transport aircraft. This advice included improving aircraft passenger briefings to ensure passengers are able to readily use emergency oxygen supply when required. This has already been addressed by Qantas. Q ATSB investigation report AO-2008-053 Aviation Safety Investigator QF30–how the investigation unfolded eville Blyth is the ATSB’s technical analysis manager. His involvement with the investigation into the explosive decompression onboard Qantas Flight QF30 began on 25 July 2008. Neville was called out of a meeting to be told that a Boeing 747 aircraft had been diverted to Manila with a two-metre hole in its fuselage. The aircraft was still in flight, but the ATSB was already mobilising a response. N When the ATSB investigation team arrived they discovered the ruptured cylinder was ejected from the aircraft over the South China Sea. As a result, the team didn’t have the key piece of evidence to examine. Neville explains this lack of evidence meant it was not going to be a conventional investigation. “Without the ruptured cylinder we basically had to draw generalised conclusions from the limited evidence we had. In other words we had to examine a number of hypotheses—using inductive reasoning to get to the bottom of the cause.” Neville says. The approach taken by Neville and the team involved developing hypothetical scenarios based on the available also looked at the batch of cylinders to see if they had an inherent flaw or weakness,’ Neville says. ‘The investigation process began with the close, forensic examination of the remaining physical evidence such as damage around the door and cabin along with witness statements.’ Neville says. The team worked for many months testing the hypothetical scenarios on the identical cylinders. They undertook oxygen gas analysis, endoscopic examination, magnetic particle inspection, temperature and impact tests, flattening tests, stress analysis, hydrostatic pressure tests and an artificially flawed cylinder test. No stone was left unturned. 53 Despite the extensive testing regime, the team was unable to identify any particular factor that could be associated with the ruptured cylinder on QF30. ‘We then identified five key hypothetical scenarios or possibilities on how the cylinder could have been damaged. These included: the cylinder having a manufacturing flaw; the cylinder being damaged before the last overhaul; the cylinder being damaged during the last overhaul; the cylinder being damaged after the last overhaul; the cylinder having been damaged during the accident flight.’ Neville explains that the investigators thoroughly explored each of these scenarios in-depth using identical cylinders, some of which were from the same manufacturing batch. ‘We wanted to determine whether there was any aspect of the cylinder design, including materials and manufacture methods, which could lead to a fault. We ‘We basically eliminated all of our five scenarios following exhaustive testing, examination and analysis of the identical oxygen cylinders,’ Neville explains. ‘In other words, the cause of the cylinder rupture on QF30 remains unknown.’ While the outcome was inconclusive, the investigation did confirm that the cylinder type did not pose a threat to the safety or airworthiness of the design. ‘As a result of our rigorous and comprehensive approach to the investigation we can confidently say that this was a unique event and is highly unlikely to happen again.’ The ATSB investigation report into this incident, which details the ATSB’s approach to the investigation along with the findings, is available on the ATSB website: www.atsb.gov.au. Q ATSB investigation report AO-2008-053 ATSB It soon became evident that an oxygen cylinder had ruptured in the forward cargo hold of the aircraft. Part of the ruptured cylinder punctured the fuselage wall, causing the plane to rapidly depressurise while another part of the cylinder damaged the passenger cabin. The aircraft then made an emergency descent and landed in Manila, Philippines. evidence and systematically trialling and eliminating these hypotheses over the course of the investigation. Investigation briefs The importance of being aware ATSB investigation AO-2007-065 The fatal collision between two aircraft at Latrobe Valley Aerodrome, Victoria highlights the importance of pilots being aware of other aircraft traffic in the area while flying. On 1 December 2007, a Cessna 172 aircraft and an Avid Flyer collided in midair while conducting circuit operations at the aerodrome. The Cessna was being flown by a student pilot who was conducting a series of solo circuits and the Avid was being flown by an experienced pilot. FSA JAN-FEB 2011 54 The Cessna collided with the Avid from above and behind after both aircraft had turned onto the final leg of the circuit. The Avid then descended uncontrolled and crashed into the ground, killing the pilot. The Avid was equipped with a ballistic parachute recovery system but it had not been armed before the flight. Although the Cessna sustained damage from the collision, the student pilot was able to land the aircraft. The ATSB investigation (AO-2007-065) reveals the student pilot was probably unaware of the Avid’s presence before turning onto the final leg. This is despite the fact that both aircraft had been in the circuit for some time before colliding. There was no evidence that the aerodrome’s common traffic advisory frequency procedures were a factor in the occurrence. However, a radio overtransmission that was made before the collision possibly contributed to the student becoming unaware of the Avid’s position. The ATSB recently released ‘A pilot’s guide to staying safe at non-towered aerodromes’. See the article entitled ‘Safety at aerodromes without control towers’ Q Boeing issues recommendations to identify axle failures Misaligned take-off risk ATSB investigation AO-2009-047 Airservices Australia has issued a safety bulletin encouraging increased vigilance in avoiding misaligned take-offs at Melbourne Airport. Boeing has issued advice to Boeing 737 operators and maintenance providers detailing enhanced inspection recommendations to assist in identifying grinding damage that could lead to possible axle failures. ATSB investigation AR-2009-033 The Bulletin, which has been distributed to all domestic and international operators, coincides with pavement and lighting construction work at Melbourne Airport which is set to continue until July 2011. Melbourne Airport is undertaking an asphalt overlay on Runway 16/34 and Runway 09/27 and plans to realign the existing airfield ground lighting on Runway 09/27 and Runway 16/34, and replace cracked concrete pavement on Runway 09/27 and Taxiway Papa. Boeing’s recommendations come as a result of an ATSB investigation into a 25 July 2009 occurrence where a Boeing 737 lost a nose wheel tyre while taxiing towards the runway at Melbourne Airport. The right wheel detached from the nose landing gear due to an axle fracture. The investigation found the nose wheel had separated as a result of a fatigue crack through the right, inboard bearing journal. The crack formed due to residual stresses in the steel surface associated with grinding damage during manufacture. The ATSB investigation prompted the aircraft operator to conduct an immediate, fleet-wide inspection of axles with similar service history. Boeing also audited the landing gear supplier’s processes and production records to determine the extent of the grinding problem. Q Works will frequently occur at night. During some stages of the work there will be displaced thresholds for Runway 16, and no centreline lighting. In releasing the Bulletin, Airservices Australia drew attention to a recent ATSB research report on ‘Factors Influencing Misaligned Take-off Occurrences at Night’. This report examined occurrences where pilots have misjudged their position on the runway due to darkness and a combination of runway, weather and task conditions. The bulletin identifies eight common factors that increased the risk of a misaligned take-off or landing occurrence. The factors included: distraction or divided attention of the flight crew; confusing runway layout; displaced threshold or intersection departure; poor visibility or weather; air traffic control clearance/s issued during runway entry; no runway centreline lighting; flight crew fatigue; and recessed runway edge lighting. The Airservices Australia Safety Bulletin is available from the Airservices Australia website www.airservicesaustralia.com.au Q QF32 investigation prompts early safety actions n a preliminary investigation report, the ATSB outlines safety actions that have already been taken in response to an uncontained engine failure on board a Qantas A380 aircraft over Batam Island, Indonesia on 4 November 2010. Airbus A380 aircraft. The problem relates to a possible manufacturing issue with the high pressure/ intermediate pressure (HP/IP) bearing structure oil pipes of some engines, which could lead to fatigue cracking, oil leakage and potential engine failure from an oil fire within the HP/IP bearing buffer space. I ‘The investigation highlights Australian and international cooperation in the interests of aviation safety,’ said the ATSB’s Chief Commissioner, Martin Dolan. ‘The ATSB is the lead investigator, but many others are involved and their cooperation has been essential’. ‘We’re still in the early stages of investigation,’ Mr Dolan added, ‘but significant action has already been taken to minimise the risk of a recurrence’. The report identifies an overspeedrelated failure in the intermediate pressure turbine disc in the aircraft’s No 2 engine. Sections of the fractured disc and other engine components penetrated the aircraft’s left wing and a number of other areas on the aircraft, resulting in significant structural and systems damage to the aircraft. As a result of the investigation, the ATSB has issued a safety recommendation about potential engine problems in some 747 engine failure and air turn-back 55 In Australia, Qantas is carrying out the necessary inspections in coordination with the Civil Aviation Safety Authority. ‘We stress that this is a preliminary report,’ Mr Dolan said. ‘It is intended to set out the sequence of events as we understand it so far and to highlight the safety issue we have identified. A comprehensive report will be completed within a year of the occurrence.’ The report also describes the flight crew’s actions in dealing with the consequences of engine failure and in landing the aircraft safely in Singapore without injury to any of the 469 crew and passengers on board. The ATSB’s preliminary factual report outlines a number of areas for further investigation. They include additional examination of the turbine disc and other engine components, onboard recorded information, damage to the aircraft and its systems, and of the response by flight, cabin and emergency services crews. A copy of the preliminary factual report is available on the ATSB website www.atsb.gov.au Q ATSB investigation report AO-2010-089 ATSB The preliminary report into an accident involving an Australian operated Boeing 747 aircraft, which occurred not long after leaving San Francisco on 30 August 2010, has revealed the number-4 (right most) engine sustained an internal mechanical failure in the turbine area, rupturing the casing and ejecting debris that punctured a hole in the cowling. The plane’s flaps and wing skin also incurred minor damage. ATSB investigators inspected the engine and aircraft in San Francisco, and attended the subsequent detailed disassembly and technical examination in Hong Kong. Representatives from the engine manufacturer, aircraft operator and airframe manufacturer also observed the examination. During the examination, it was evident that the internal turbo-machinery had been significantly disrupted, with extensive damage sustained by the intermediate pressure (IP) and low pressure (LP) turbine rotors. All of the turbine blades had separated from the IP turbine disk; blades from the three LP turbine stages were either fractured through the airfoil section or separated from the disk; the LP stage 1 nozzle guide vanes were destroyed and the remaining LP nozzle stages were substantially damaged. While ‘uncontained’ engine failures are relatively uncommon, the circumstances must be examined thoroughly and any significant safety lessons are learnt from the incident. The investigation is continuing and will include: t

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GBJMVSF The final report is not expected to be published until August 2011. In response to the recommendation Rolls-Royce, affected airlines and safety regulators have taken action to ensure the continued safe operation of A380 aircraft. The action involves the close inspection of affected engines and the removal from service of any engine which displays the suspected problem. In addition, the European Aviation Safety Agency has approved a modification to the engine control software to reduce the risk of an overspeed-related turbine disc failure. Safety at aerodromes without control towers ecause Australia’s population is spread so widely, most aerodromes are located in uncontrolled airspace. Consequently, they do not have an air traffic control presence. Instead, pilots are responsible for making themselves aware of other nearby aircraft and for maintaining separation. A booklet released by the ATSB reminds pilots of their responsibilities and the precautions they need to observe around aerodromes which do not have air traffic control towers. B FSA JAN-FEB 2011 56 ‘Generally, operations at non-towered aerodromes can be considered to be safe,’ said Martin Dolan, the Chief Commissioner of the ATSB. ‘Continued safety relies on all pilots maintaining awareness of their surroundings and of other aircraft, and on their flying in compliance with procedures, while being observant, courteous and cooperative.’ Between 2003 and 2008, the ATSB was notified of 709 airspace-related safety occurrences at, or in the vicinity of nontowered aerodromes. Of these, 60 were considered serious incidents (mostly near mid-air collisions) and six constituted accidents (four mid-air and two ground collisions). The booklet, A Pilot’s Guide to staying safe in the vicinity of non-towered aerodromes, provides advice to pilots on how to avoid the risks. It provides strategies for alerting other aircraft to one’s presence and maintaining awareness of other aircraft. Non-towered aerodromes can have a mix of passenger-carrying aircraft, instrument or visual flight rules aircraft, smaller general aviation aircraft or amateur-built aircraft, agricultural or military aircraft, helicopters, balloons, and gliders all operating at any one time. In addition, the traffic density can vary greatly. For example, Broome (WA), Kununurra (WA), Wagga Wagga (NSW), Wollongong (NSW), Toowoomba (Qld), Horn Island (Qld), Bathurst (NSW), Geraldton (WA), and Port Macquarie (NSW) aerodromes all have over 20,000 movements per year. At some of these (and many other) non-towered aerodromes, there are a significant number of passenger transport flights utilising large jet and turboprop aircraft, as well as recreational and general aviation aircraft. This dynamic environment can present a challenge for even experienced pilots. The reports of accidents and incidents at non-towered aerodromes received by the ATSB have raised a number of concerns relating to aircraft separation, situational awareness, adherence to circuit and approach procedures and airmanship. Pilots need to remember that there may be a variety of aircraft with different sizes, flight rules and performance levels all operating at the same time in the same airspace. One of the most important strategies for ensuring safety at non-towered aerodromes is maintaining good communications. Pilots operating at non-towered aerodromes are expected to make a series of standard broadcasts on the Common Traffic Advisory Frequency (CTAF), regarding their position and intentions. Broadcasting on the CTAF effectively helps to reduce the risk of a mid-air collision or reduced separation by supporting pilots’ visual lookout for traffic and situational awareness, and assisting them to mutually separate their aircraft. This is known as radioalerted ‘see-and-avoid’. However, maintaining a total reliance on the radio is dangerous. The report also documents many cases where standard radio calls were not made and/ or not heard due to a variety of reasons, resulting in pilots being unaware of other traffic. Whether you fly into non-towered or towered aerodromes, maintaining a vigilant lookout at all times is also important. You can find the booklet ‘A pilot’s guide to staying safe in the vicinity of non-towered aerodromes’ on the ATSB website, at www.atsb.gov.au. The guide has been released in association with a larger and more detailed report into non-towered aerodrome operations. The Civil Aviation Safety Authority has also released two important Civil Aviation Advisory Publications to support recent changes to Civil Aviation Regulation 166 and to reinforce safe flying practices in the vicinity of nontowered aerodromes. Q ATSB investigation report AO-2008-044(2) REPCON briefs Australia’s voluntary confidential aviation reporting scheme REPCON allows any one who has an aviation safety concern to report it to the ATSB confidentially. Unless permission is provided by the person that personal information is about (either the reporter or any person referred to in the report) that information will remain confidential. REPCON would like to hear from you if you have experienced a ‘close call’ and think others may benefit from the lessons you have learnt. These reports can serve as a powerful reminder that, despite the best of intentions, well-trained and well-meaning people are still capable of making mistakes. The stories arising from these reports may serve to reinforce the message that we must remain vigilant to ensure the ongoing safety of ourselves and others. If you wish to obtain advice or further information, please contact REPCON on 1800 020 505. Unsafe practices at an aerodrome Report narrative: Action taken by REPCON: REPCON supplied CASA with the de-identified report CASA advised that it was aware of increased activity at the aerodrome as a result of aircraft operating from the Aerodrome. CASA has recently conducted surveillance activity on operations in the vicinity of the aerodrome and is satisfied that aircraft operators are meeting their safety obligations in accordance with the applicable civil aviation legislation. Further surveillance activity is planned. Without more specific information, CASA is unable to action or comment further on the issues raised in the REPCON. Safety of cabin crew in turbulence Report narrative: The reporter expressed safety concerns about cabin crew not being seated with The reporter believes that CAO (Civil Aviation Order) 20.16.3 requires all passengers and crew to occupy a seat during turbulent conditions. On other airlines the reporter has flown with, whenever the seat belt sign is illuminated due to turbulence, both passengers and crew are instructed to be seated and fasten seatbelts. Action taken by REPCON: REPCON supplied the operator with the de-identified report and the operator advised that CAO 20.16.3 states: 3.1 Each crew member and each passenger shall occupy a seat of an approved type: a) during take-off and landing; and b) during an instrument approach; and c) when the aircraft is flying at a height less than 1000 feet above the terrain; and d) in turbulent conditions. NOTE: Crew should be seated immediately if they feel their safety is in jeopardy at any stage. The operator also noted that CAO 20.16.3 and Civil Aviation Regulations (1988) 251 lists duties for cabin crew that require certain actions if turbulence is encountered. The operator believes that assumes cabin crew are to perform functions other than immediately resume their seat in all cases of turbulence encounters. The operator therefore, in keeping with the drafting of the relevant CAO, published procedures detailing duties of cabin crew in turbulence as long as the overriding embodied intent is to ensure the safety of both passengers and crew. REPCON supplied CASA with the deidentified report and a version of the operator’s response. CASA provided the following response: CASA has reviewed the report and will request that the operator review their turbulence procedures in accordance with Civil Aviation Regulation 251 s1(d). The operator has subsequently advised they are in the process of revising their turbulence procedures. Q How can I report to REPCON? /NLINEWWWATSBGOVAUVOLUNTARYASPX Telephone: 1800 020 505 Email: [email protected] Facsimile: 02 6274 6461 Mail: Freepost 600, PO Box 600, Civic Square ACT 2608 57 ATSB The reporter expressed safety concerns that incidents/accidents are increasing and operating procedures appear to be deteriorating at a named aerodrome. Occurrences and deteriorating operating procedures include not restraining aircraft when unattended, collisions with other aircraft and structures, dangerous hand starting procedures, unconventional circuits being flown and non standard radio calls. seatbelts secured during turbulence while passengers are seated with seatbelts secured and the seat belt sign illuminated. The reporter estimated that over the last seven years flying with the operator, with an estimated 300 to 400 sectors, that only once were cabin crew observed to resume their seats in turbulence. This occurred when the turbulence was so severe that crew found it extremely difficult to stand. During the flights where the crew did not resume their seats in turbulence the food service was continued and cabin crew moved through the cabin with hot liquids and food. The operator advised that the CAO does not define the level of severity of the turbulence at which crew and passengers must be seated. The operator ensures that passengers are seated at a lesser level of turbulence than for cabin crew this is stated in their procedure manual. Contained therein are procedures for dealing with the levels of severity of turbulence and also included is the following note: Corroded to death FSA JAN-FEB 2011 58 About a minute after lifting off from a seaplane base in Miami, Florida, USA, on 19 December 2005, the starboard wing of a Grumman Turbo Mallard amphibian failed and the flying boat plunged into a shipping channel. All 20 on board were killed, writes Macarthur Job. Operated by Chalk’s Ocean Airways, the aircraft had arrived at the seaplane base an hour before from nearby Fort Lauderdale. It was departing on a scheduled afternoon flight to the Bahamas with a crew of two pilots and 18 passengers, three of whom were infants. The modifications were done in accordance with an FAAapproved supplemental type certificate. The aircraft’s take-off weight at the time of the accident was just less than the maximum permitted, and its centre of gravity within its permitted range. Eyewitnesses reported seeing the aircraft’s starboard wing suddenly break off with a cloud of smoke and fire. Some also heard an explosion as the wing failed. Lifeguards patrolling a nearby beach were the first to respond to the crash on jet skis, and a Coast Guard rescue helicopter took off for the site minutes afterwards. The captain and another first officer had flown the aircraft two days before on 10 passenger trip segments. That first officer said it had flown normally throughout the day. Because it had undergone maintenance immediately before those trips, he and the captain had conducted a 20-minute check flight before beginning the day’s services. The captain commented it had come out of maintenance ‘in good shape’. The aircraft The aeroplane was more than 58 years old, and had accumulated no less than 31,226 flying hours over 39,743 cycles. Manufactured by the Grumman Corporation in May 1947 as a G-73 Mallard amphibian powered by two nine-cylinder Pratt & Whitney radial engines, it was originally certificated for two pilots and 10 passengers. Chalk’s Ocean Airways acquired it in 1980, modifying it a year later to a G-73T Mallard by replacing its piston engines with PT6A-34 turboprops. The cabin was modified to a 17-seat configuration and the avionics were upgraded. Operational environment The long-established seaplane base in Miami is on Watson Island, about 3km east of the city itself. It provides a water runway 4572m long and 180m wide, oriented northwestsoutheast. At the time of the accident, the wind was from 340 degrees at 7kt, there was four miles visibility, overcast cloud at 1200 feet, a temperature of 23º C and a QNH of 1020mb. The crew Wreckage The captain, 37, had joined Chalk Ocean Airways in March 2003 and had accumulated 2820 hours flying, including 1630 hours in the G-73T, of which 430 hours were in command. On the day of the accident, she was scheduled to fly seven flight segments for a total of 4.1 hours of flying. Her first flight, to leave Fort Lauderdale at 0815, was delayed by fog. The company’s chief pilot, also waiting there for the fog to lift, said she seemed ‘upbeat, friendly and alert’. In addition to her flying duties, the captain was the company’s director of safety, spending about two days a month attending meetings, conducting safety audits and reporting safety concerns to the general manager. The captain’s husband told accident investigators she had voiced concerns about the company’s maintenance of its aeroplanes. The wreckage was located on the seabed, in about 10m of water. The first officer, 34, joined Chalk’s Ocean Airways earlier in the year, and had accumulated 1420 hours flying and 71 hours as co-pilot on the Turbo Mallard. A company maintenance manager at Fort Lauderdale saw him making a pre-flight inspection of the aircraft on the morning of the accident. He looked ‘normal and energetic’. The flight on which the accident occurred was his first with this captain. The main wreckage was scattered within a field about 60m long. The separated starboard wing with the engine still attached lay about 50m north-west. The wing box structure had fractured where the wing intersects the fuselage at WS 34, breaching the starboard fuel tank. There was fire damage on the separated wing, but the port wing showed no evidence of fire. The aircraft was equipped with a Fairchild solid-state cockpit voice recorder. Although it sustained no damage other than immersion, its recording was unintelligible. Tests revealed an electronic circuit had failed, probably sometime before the accident. The aircraft was not equipped with a flight data recorder. The FAA did not require one for this class of aircraft registered before October 1991. The wing structure, certificated in accordance with Civil Air Regulation current in March 1944, required only a static strength analysis, using loads having a constant magnitude, such as in steady one-G flight. No requirements for a fatigue analysis existed at the time. Three days after the crash the NTSB issued a news release with photos showing fatigue cracks in the recovered wreckage. Investigators identified the front and rear spars, upper and lower stringers and skins from about right WS 60 to left WS 60, and used them to ‘reconstruct’ the centre wing box. The fractures showed areas of fatigue in several places. Camera evidence Segments of the flight were captured on video and still cameras. An image taken from a vehicle travelling over a nearby causeway showed the aircraft taking off. A second image, taken from the same causeway, showed the aircraft above the main channel just after lift-off. A video, recorded from a beach north of the accident site, did not show the wing separating, but captured the aircraft in a nose-down attitude of between 35 degrees and 45 degrees after the wing failed. Stringers Skin Ribs Rear spar Web Front spar Wing station 34 It showed no smoke or debris coming from the aircraft but, in the upper right corner of the view, there was a small cloud of fire and black smoke. Rear spar p lower spar cap Wing station 125 Figure 1 G-73/G-73T Wing box components Diagram adapted with permission from the National Transportation Safety Board. 59 CORRODED TO DEATH Flight recorders The Mallard’s wing structure includes a centre wing box spanning the centre of the wing-to-wing stations WS 125, just outboard of the engines on either side. The fuselage sides intersect the wing box at wing stations WS 34. Portions of the wing box serve as fuel tanks. The structure of the wing box comprises the front and rear spars, stringers, ribs, and upper and lower skin. (See figure 1). There was no evidence from the performance or appearance of the aircraft to warn of the wing’s imminent failure. The upper part of Figure 2 shows an overall view of WS 34, including the locations of the rear spar lower spar cap, rear Z-stringer, the chordwise fracture in the lower skin, the crack (parallel to and outboard of the chordwise lower skin fracture) in the lower skin, and the external and internal doublers. The lower part of figure 2 shows a view with the doublers detached. Fatigue fracturing was found in the rear spar lower cap, rear Z-stringer and skin. Lower skin panel with internal and external doublers View of lower skin panel with internal and external doublers detached Outboard Forward Internal doubler er Z stringer Zstrin Skin fracture Skin ccrack Green n seal sealant Slosh hole Fuel sump drain hole Rear spar lower spar cap External doubler er 60 FSA JAN-FEB 2011 Fatigue in the rear spar lower cap initiated from a doubledrilled hole (one in which a portion of the hole from the first drilling remains after the second is drilled) for a threaded fastener in the horizontal flange of the spar cap 25mm inboard of WS 34. Multiple fatigue origins were found along the double-drilled hole through the thickness of the horizontal flange. Crack growth extended from fatigue areas forward and aft of the hole. The portion of the crack aft of the hole had propagated from 1.77 to 112mm in about 11 increments of rapid crack growth. Figure 2 view of doublers detached Diagram adapted with permission from the National Transportation Safety Board. The external doubler adjacent to WS 34 was removed from the lower skin for examination. The lower skin crack in the area covered by this external doubler was about 40 cm long. The aft end of the crack extended from the skin trailing edge to a point near the aft side of the middle Z-stringer lower flange. The skin crack under the doublers at WS 34 intersected three unfilled machined holes in the skin, undoubtedly stop drill holes, made as an attempt to prevent the crack from growing. These were about 18, 23, and 41cm forward of the skin trailing edge. Several fasteners at the inboard end of the doubler had been inserted through hard green sealant around the fuel sump drain. Examination at WS 34 showed that fatigue in the rear Z-stringer initiated from a slosh hole about 40mm outboard of WS 34. The skin crack under the doublers at WS 34 had evidence of fatigue originating from an area of corrosion around the fuel sump drain and from a fastener hole adjacent to the rear Z-stringer fracture. The lower skin chordwise fracture (inboard of the skin crack) at the separated area intersected the fastener holes at the inboard edge of the doublers. Regions of fatigue extended from several of the fastener holes. Examination of the port wing revealed indications of fatigue fractures in the rear and middle Z-stringers, front spar lower spar cap, and lower skin near WS 34. One external and two internal doublers were attached to the lower skin on the aft side of the wing box at WS 34. The lower surface of the external doubler showed evidence of corrosion around the fuel sump drain. The port wing front spar lower cap had a transverse fracture about 13cm outboard of WS 34. Areas of fatigue emanated from a hole for a threaded fastener that attached a wing panel to the spar cap’s horizontal flange. There was evidence of a rapidly progressing overstress fracture. Maintenance records Investigators reviewed the flight logs for the aircraft from January 1995 to December 1999, and from February 2001 to the day before the accident. During July 2005, there were three entries for fuel leaks in the starboard wing root area. Also, during September 2005, three entries noted ‘fuel leak from dry bay.’ (The dry bay is inside the centre wing box, adjacent to the fuel tanks.) The leaks were corrected by replacing the fuel tank sealant. Work cards for the aircraft’s C checks from 2001 to 2005 revealed eight references to fuel leaks in the starboard wing. FAA records showed that a major repair to the rear spar upper cap at WS 34 was made on 13 April 1992 because of structural corrosion under the skin and popped rivets found during an inspection. When the skin was removed, light to moderate corrosion was also found on the top aft spar. Another major repair to the rear Z-stringer at WS 50 was made on 6 July 2000. Investigators found that rivets used in the repair were not installed correctly. There was also evidence of a major repair to the lower wing skin where the wing separated from the fuselage, but there was no record of this repair, which consisted of one external and three internal doublers in the area of a long chordwise skin The company’s maintenance program was ineffective in correcting longstanding structural problems. crack just outboard of WS 34. Maintenance records also showed that, on 6 May 1992, the lower skin of the port wing underwent a similar major repair. Examination of both repairs showed their rivet installations were not in accordance with specifications. Analysis There was no evidence from the performance or appearance of the aircraft to warn of the wing’s imminent failure. Analysis showed that the starboard rear Z-stringer had probably fractured first, and been fractured for some time. Fatigue at the slosh hole in the web of the Z-stringer just outboard of WS 34 was the result of the number of load cycles on the stringer exceeding its fatigue life. Multiple fatigue damage was found on the skin fracture surface inboard of the stop-drilled crack. Some time before the accident, several of these sites linked up to form a fracture through the skin at the rear Z-stringer and several inches forward and aft of the Z-stringer. After the skin fractured, fatigue cracks began in the rear spar lower spar cap. The development of these fatigue cracks probably occurred late in the sequence because the fracture features indicated rapid growth under high stresses. Fatigue in the rear spar lower cap began at a doubledrilled hole in the horizontal flange of the spar cap for a threaded fastener attaching the wing to the fuselage. Although a double-drilled hole could be considered an initiating defect, fatigue in this case developed at multiple sites through the thickness of the horizontal flange, indicating stresses in the spar cap were high enough to initiate fatigue from any fastener hole in the area in relatively few load cycles. This fatigue in the rear spar progressed rapidly from a small, slow growth region before more than half the rear spar lower cap fractured in overstress. The small size of The fatigue analyses of the wing structure showed that when the fatigue cracks grew to a critical length, the remaining wing structure could no longer sustain the applied loads. The reduced strength of the wing resulted in its failure during normal flight. The company’s maintenance program was ineffective in correcting longstanding structural problems. These occurred over months and years, and maintenance staff had multiple opportunities to identify and correct the damaged components. Other maintenance problems existed in the aircraft. Corrosion was found in many places throughout its structure, some areas showing significant pitting and thinning. Metallurgical examination also showed fatigue cracks in the port wing, including one crack that had begun to progress fairly rapidly. Had the Mallard not experienced a catastrophic failure of its starboard wing, this crack in the port wing would probably have led to such a failure. Maintenance problems also existed on at least one another Turbo Mallard in the company’s fleet. Five months before the accident, fuel was found to be leaking from this aircraft’s starboard wing-to-fuselage fairing. When the fairing was removed, a 56cm crack was found in the wing lower skin which reduced the load-carrying capacity of the wing box by about 50 per cent. All the wing’s stringers were corroded and cracked and there were many old repairs on the rest of the wing. Repairs involved replacing all the stringers and lower skin from the centreline to the engine nacelle. The company’s failure to identify fatigue cracks in the aircraft’s wing structure and its numerous other maintenance problems, as well as in another company aircraft, demonstrated that the company’s maintenance practices were grossly deficient. These deficiencies led to the fatal accident. A similar accident in a second Mallard owned by the company was averted only because of the need to correct a fuel leak. Chalk’s Ocean Airways changed its name to Chalk’s International Airlines, but the US Department of Transport withdrew its permission to fly in September 2007. Further reading: National Transportation Safety Board accident report: NTSB/AAR-07/04 PB2007-910405 at www.ntsb.gov 61 CORRODED TO DEATH After the Z-stringer fractured, the lower skin developed a fatigue crack. The crack, 40cm in length, initiated from two areas, propagating both forward and aft. This crack also developed over months or years. Stop drill holes in the crack path showed it was detected on at least three occasions, and that crack extension beyond the previous stop drill hole was detected at least twice. The external and internal doublers found were probably applied after the third stop drill hole was drilled and after the skin crack propagated forward to the middle Z-stringer. the slow growth region and the limited overall size of the fatigue region indicated that stresses on the rear spar lower spar cap were high as the crack propagated under normal flight loads. AGAIN FSA JAN-FEB 2011 62 What more can you say about Valujet 592 than ‘never again’? Flight Safety Australia’s SeptemberOctober 2010 issue describes how I was horrified during a routine audit in an operator’s freight shed, to discover loose-packed chemical oxygen generators – the very thing that brought down Valujet 592 into the Florida Everglades in May 1996. They were awaiting collection by the owner, having been transported across Australia. A quick recap:Oxygen for emergency breathing at high altitude in aircraft can be supplied in two ways: by high-pressure storage or by chemical generation. Generating oxygen, rather than storing it in tanks has the advantage of being lighter, more compact, having a longer service life and requiring less frequent inspection. Aircraft oxygen generators use a mixture of sodium chlorate and potassium perchlorate to generate oxygen, as well as barium peroxide or calcium hydroxide to absorb the small amount of chlorine created as a by-product. The oxygen generator is started by a small charge in a percussion cap. ... it’s fair to say freight forwarders are less likely to question material coming from their own stores ... but …the message is: ‘never assume’. The percussion cap generates just enough heat to start the sodium chlorate reaction; then the heat of the reaction sustains itself. The sodium chlorate does not burn – it does not react with the air – its chemical decomposition gives off heat and oxygen, enough for about 15 minutes’ supply. Oxygen generators get hot. The surface of the canister can reach about 260 degrees Celsius, hot enough to melt or combust nearby materials, particularly if the atmosphere, as happened in the Valujet hold, is enriched with generated oxygen. We recommended an accelerated amendment process, which ICAO’s Air Navigation Council has approved. The technical instructions now contain these words: ‘The generator, without its packaging, must be capable of withstanding a 1.8m drop test onto a rigid, non-resilient, flat and horizontal surface, in the position most likely to cause actuation, without loss of its contents and without actuation - as follows: The US National Transportation Safety Board investigation of Valujet 592 found the probable cause of the accident was a fire in the aircraft’s class D cargo compartment initiated by the actuation of one or more oxygen generators being improperly carried as cargo. The oxygen generators had been removed from company aircraft and were being transported by air to central storage for disposal. All 110 people on board the McDonnell Douglas DC-9 died. CASA’s team of dangerous goods inspectors has taken steps to make it less likely that it will happen in 2011. Last year, at the International Civil Aviation Organization’s (ICAO) dangerous goods panel meeting in Abu Dhabi, we submitted a paper which better clarifies two methods of avoiding activation of chemical oxygen generators. The amendment recognised that the current packaging instruction might not give enough guidance for a person dispatching such articles using packing instruction 523 of the 2009-2010 edition of the technical instructions (packing instruction 565 in the 2011/2012 edition) as to what constituted 'two positive means of preventing unintentional actuation' and should be clarified. ii) one pin and one retaining ring, each installed so that each is independently capable of preventing the actuator from striking the primer; or iii) a cover securely installed over the primer and a pin installed so as to prevent the actuator from striking the primer and cover. 2 electrically actuated devices: The electrical leads must be mechanically shorted and the mechanical short must be shielded in metal foil. 3 For personal breathing equipment (PBE): i) a pin so as to prevent the actuator from striking the primer; and ii) placed in protective packaging such as a vacuumsealed bag. This amendment makes the instructions much clearer about how to make chemical oxygen generators safe. The gist of it is that here must be two independent barriers to activation at all times. An amendment to packing instruction 565 removes the words ‘passenger aircraft’ from the document. Chemical oxygen generators are only to be carried as freight on cargo aircraft. The dangerous goods team has been working with the operator and the ground handling agent, focusing on safety management and the ethos of a ‘just culture’, to come up with robust and enduring fixes. The operator was cooperative and took the initiative to propose and implement solutions. These are measures already in use by Australia’s major airlines and charter operators using oxygen generators on their aircraft fleet. 63 DANGEROUS GOODS 2 How quickly memory fades. Fourteen years later here was a chemical oxygen generator, removed from a company aircraft, and being sent by air to the central storage for disposal. There was a hard-working, conscientious storeman–but could the confusion that brought down Flight 592 recur in Australia, in 2010? 1 mechanically actuated devices: i) two pins, installed so that each is independently capable of preventing the actuator from striking the primer; The operator has implemented the following: 1. Oxygen generators removed from an aircraft are to be transported only by road, rail or sea. New generators may only be transported by air when they are in the sealed original manufacturer’s packaging. 2. Oxygen generators are to be held in a quarantined part of a ground handling and storage area. This is to be away from other flammable material and clearly placarded with up-to-date procedures for handling and storage of oxygen generators. 3. Training courses will be delivered by two providers, to ensure a thorough coverage of knowledge and deeper understanding by covering the subject matter from a variety of approaches. 64 FSA JAN-FEB 2011 4. Procedures for identification, installation and removal of oxygen generators are now documented at a national and local level. 5. An organisation-wide bulletin flagged the issue and raised awareness in ports & stores across the country. Looking back, it’s clear that it took many things to go wrong for this incident to occur. The message is: ‘Stay vigilant, don’t assume. If you have doubts – then there are no doubts.’ Partly, it was the engineers, who removed the component, and reused the packaging from the replacement item. But … they were just doing it the way they had always, and they didn’t know it was going by air. Partly, it was the stores people, who were diligent in their reading of the regulations, and determined it could travel by air. But … they assumed that the engineers, as experienced, trained and intelligent people, had re-packed the item correctly. Partly, it was the ground-handling agent, who, from an external examination of the package, concluded that it passed muster, and could travel by air. Finally, there was the operator’s ramp staff, who loaded the dangerous goods into the aircraft, and ensured it was correctly stowed. Does it matter if it rattles? After all, it had been properly accepted for travel by air, and DG training in such areas usually focuses on leakages and spills. I cannot single any of these people out for criticism because I would suspect that many others would operate in the same way under the same circumstances. The message for stores: Are you sending company material that has contained, or may contain dangerous goods? (DG) It’s largely because I have years of experience that I smelled a rat. When I saw it was going to a repair facility, alarm bells started to go off. When I shook it, it rattled. Yet here shouldn’t have been any noise, because it should have been securely packed. If so – who prepared it and gave it to you? Are they trained in DG? As was the case with Valujet, the dangerous material was internal to the company. I think it’s fair to say ground handling agents are less likely to question material being sent between their contracting operator’s own stores than they would material coming from a commercial customer. That’s another significant point, because one of the highrisk descriptors in the ICAO technical instructions is ‘company material’. Nor do I blame shed and acceptance staff - given the tonnes of freight handled, and the time frame they have to do it in, it’s not easy, but …the message is: ‘Stay vigilant, don’t assume. If you have doubts – then there are no doubts.’ You’re the one signing the shipper’s declaration. In an ideal world, the two manufacturers would have correlated procedures, but meanwhile it’s important for aircraft engineers to be aware of the difference between the two ways of operating, and securing the variety of oxygen generators. The message for engineers: Are you using the tools that are supposed to be used? Are you doing the job how you’ve always done it? Or Are you doing it how the operator/manufacturer says it should be done? The message for forwarders and ground handlers: If it is a declared DG consignment; and it feels loose or rattles; then it needs to be investigated. ‘AOG’ and ‘company material’ are indicators of higher risk. Don’t hold them up unnecessarily – just pay them more attention. Don’t look for any excuse to reject the shipment; look for valid, safety-related concerns. Just because the shipper’s declaration is missing full stops in certain parts of the proper shipping name, or the state of consignment or destination is not spelled out (e.g. ‘NSW’), are not well-founded reasons to reject the item for carriage. The message for operators: Do your QA and SMS processes look at the employees and their role in a process – or do you look at the systems, and interactions between those systems, from beginning to end, i.e. do you audit the ‘experience of the DG consignment’? Do your employees do the tasks in the same way they were shown how to—how they’ve done it for the past 20 years? The training ‘law of primacy’ suggests they are. Does ‘that’s how we’ve always done it’ match with your procedures or the manufacturer’s instructions? Flight Safety Australia will continue to focus on dangerous goods with an investigation of the safety issues relating to lithium batteries (and other battery types) this year, as well as broader ground safety issues. 65 DANGEROUS GOODS 2 Some issues remain unresolved. Boeing and Airbus still have divergent procedures for dealing with chemical oxygen generators. The procedures for one are reversed when it comes to the other. It’s a classic human factors issues in terms of an engineer working on one type on one day, and another the next. If you’re still unsure – speak with your line management, company DG compliance officer; your DG instructor; or if you are getting nowhere - CASA 1. When transiting VFR through Avalon, Victoria (YMAV) E airspace when the tower is active, the requirements include 5. (a) squawk 1200 mode C, and request a clearance on Melbourne Radar. (a) the added fuel to adequately mix with the existing fuel in the tanks to achieve a uniform octane rating. (b) squawk 1200 mode C, maintain a listening watch on Avalon Approach and remain 1000ft vertically from cloud. FSA JAN-FEB 2011 (b) the added fuel to adequately mix with the existing fuel in the tanks to achieve a uniform temperature and density. (c) squawk 3000 mode C, maintain a listening watch on Avalon Approach, remain clear of cloud and in sight of the ground or water. 66 (c) suspended water particles in the fuel, which are not readily detected other than by chemical means, to accumulate on the tank surface to the point where they may be drained and detected visually. (d) squawk 3000 mode C, broadcast your intentions and request a clearance from Melbourne Radar or Avalon Tower and remain 100ft vertically from cloud. 2. (d) suspended water particles in turbine fuel, which are not readily detected other than by chemical means, to accumulate on the tank surface to the point where they may be detected visually. Settling time is only applicable to turbine fuel. When operating an aeroplane below 10,000ft VFR within G airspace with the intention of entering E airspace (a) it may not be possible to proceed because E airspace does not permit the ‘clear of cloud’ requirement that is allowable in G. 6. (b) it may not be possible to proceed because the E airspace requires 8km of visibility whereas G airspace requires only 5km. (b) transfer from the high tank to the low tank, then overflow overboard from the vents, but only if the fuel selection is inadvertently left on. (d) it will be possible to proceed ‘clear of cloud’ provided the aircraft has a serviceable mode C transponder. (d) accumulate in the vent line and cause uneven fuel flow. 7. A radar based on-request service to VFR pilots in E and G airspace is called (b) with a visibility of 800m, but only between 700 and 1000ft AGL. (a) a RIS (radar information service). (c) with a visibility of 800m at any height below 5000ft, provided the forward speed is appropriate for the avoidance of traffic or obstacles. (c) a RAS (radar advisory service). (d) with a visibility of 800m provided it is below 700ft AGL. 4. (c) accumulate in the lower vent line and pressurise the tank when the ambient temperature increases. In addition to the additional radio requirements, a helicopter may operate to VFR by day over land (a) only provided that the same visibility and cloud clearance requirements as an aeroplane are observed. A risk of parking an aircraft overnight on sloping ground with full tanks is that fuel may (a) transfer from the high tank to the low tank, then overflow overboard from the vents even if the fuel is switched off. (c) it will be possible to proceed in all circumstances because the VFR are the same in both types of airspace. 3. When sampling fuel from aircraft tanks to check for contamination after refuelling, ‘settling time’ is the time required for An aircraft rolls in the (a) longitudinal plane about the lateral axis, and one method of achieving roll stability is by differential ailerons. (b) a SIS (surveillance information service). (d) a RIM (radar information service). 8. The conditional status of a restricted area through which pilots may plan and, on request, will be granted a clearance when the area is active (unless a NOTAM indicates otherwise) is termed (a) RA1. (b) lateral plane about the lateral axis, and one method of achieving roll stability is by differential ailerons. (b) RA2. (c) lateral plane about the longitudinal axis, and one method of achieving roll stability is dihedral. (d) RA4. (d) lateral plane about the lateral axis, and one method of achieving roll stability is by dihedral. (c) RA3. 9. A forecast that also indicates the weather trend is called (a) a trend type forecast and is abbreviated TTF. (b) a trend forecast and is abbreviated TTF. (c) a trend forecast and is abbreviated TF. (d) METAR Speci. 10. When departing from a non-towered aerodrome a departure report (a) is not required. (b) is not mandatory, but is recommended. (c) is required, and the minimum information required is departure location, tracking details and intended level. (d) is required, and the minimum information required is departure location, tracking details, intended level, ETA at first reporting point. 1. 2. On a three-spool jet engine, the intermediate power turbine (IPT) drives 6. (a) the fan. (a) provide the maximum heat dissipation. (b) the booster. (b) minimise insulation abrasion. (c) the high pressure compressor (HPT). (c) minimise cross-talk where the wires are carrying data. (d) the first axial compressor behind the fan. (d) minimise the diameter of the bundle. ‘Bird-caging’ refers to 7. (b) a fault with an outer Bowden cable where it expands locally due to excessive bending. (b) hydraulic pressure is applied to one side of the piston against spring pressure on the other side. (c) the rigging of numerous external bracing wires. (c) the cylinder, and not the piston, is attached to the part that is moved hydraulically. (d) the piston shaft emerges from the cylinder at both ends. 8. (a) has a stable form at rest, but becomes fluid when agitated. (a) a higher stress on the insulation of the primary winding, and an increased tendency to jump the safety gap. (b) has a stable form at rest, but becomes thicker when agitated. (b) a higher stress on the insulation of the primary winding, and a reduced effectiveness of the safety gap. (c) shows very little change in viscosity with increase in temperature. (c) a higher stress on the insulation of the secondary winding, and an increased tendency to jump the safety gap. (d) remains at basically the same viscosity down to very low temperatures. 4. (d) a higher stress on the insulation of the secondary winding, and a reduced tendency to jump the safety gap. The weight and balance datum on an aircraft is (a) the furthermost forward point on an aeroplane. (b) the position of the centre of gravity. (c) an imaginary lateral plane from which all of the moment arms are measured. (d) a point at which each load area may be considered to act. 5. Erosion of the stationary segments in a magneto distributor results in Part number MS21919 refers to (a) a castellated nut. (b) a cable clamp. (c) a 45º elbow fitting. (d) a toggle switch. 9. The stator vanes on an axial compressor (a) form divergent ducts in which the air velocity decreases and the pressure increases. (b) form divergent ducts in which the air velocity and the pressure increase. (c) form convergent ducts in which the air velocity decreases and the pressure increases. (d) form convergent ducts in which the air velocity and the pressure increase. QUIZ (a) hydraulic pressure may be applied to either side of the piston to control the direction of movement. The term ‘thixotropic’ when applied to a grease means that the grease 67 A double-acting hydraulic cylinder is one in which (a) a fault with an inner Bowden cable where it expands locally due to compressive loading and eventually jams. (d) a condition in which there is insufficient tension on the external bracing wires. 3. Individual wires in a wire bundle or loom are best laid parallel in order to 10. Tetraethyl lead is added to piston engine fuel in order to (a) raise the octane number, and ethylene dibromide is used to scavenge the lead deposits that form at low power settings. (b) raise the octane number, and ethylene dibromide is used to scavenge the lead deposits that form at high power settings. (c) raise the calorific value of the fuel. (d) lower the calorific value of the fuel. Here are extracts from both Airservices (DAP) and Jeppesen versions of the Sydney (Kingsford Smith) Runway 07 ILS-Z or LOC 07-Z approach plate. (a) (b) c) FSA JAN-FEB 2011 68 (d) (e) (f) (g) (i) (j) (h) (k) (l) (m) (n) (p) (q) (o) FOR FILING AS ALTERNA L ATE Special Other A B C 1189’18 4.4 km 7 700’2.5 km 1479’ 4 -6.0 km k 1479’ 7 -7.0 km D Not applicable to all LOC/DME & VOR/DME procedures except LOC/DME Rwys 34L & 34R and VOR Rwy 34L. (r) (s) For each of the opposite items, select the extract above that represents how DAP and Jeppesen show this information. 8. 1. 9. What is the transition level and transition altitude? DAP ______________ Jeppesen _________________ What are the minimum safe altitudes for both 25 nm and 10 nm Sydney? DAP ______________ Jeppesen _________________ What are the alternate and special alternate minima for Category B aircraft? DAP ______________ Jeppesen _________________ 2. Is DME required to fly this approach? DAP ______________ Jeppesen _________________ 10. What is the missed approach procedure? DAP ______________ Jeppesen _________________ 3. Is there a time and DME limit on the holding pattern at Glenfield (GFD)? DAP ______________ Jeppesen _________________ 4. Where is the initial final approach fix? DAP ______________ Jeppesen _________________ 5. Where is the final approach point? DAP ______________ Jeppesen _________________ 6. 69 How are altitude restriction details for the localiser approach shown? DAP ______________ Jeppesen _________________ 7. What is the M.D.A. and visibility for circling for a Category B aircraft? What is the maximum speed for circling for this Category B aircraft? DAP ______________ Jeppesen _________________ QUIZ Invest wisely in your CIR training with Peter BINI ADVANCED FLIGHT TRAINING When it comes time for you to invest in your Command Instrument Rating, you need to know your investment is spent wisely. Peter Bini Advanced Flight Training has been teaching and successfully producing quality pilots for over 30 years. With over ,000 hours of Àying e[perience, C)I 6teve 3earce and his team of instructors not only teach what is required, but also ensure you bene¿t from their practical knowledge. Invest in pearls of wisdom, not just the basics. Call us for a tour of our facilities, aircraft, and meet our friendly staff. Phone    (mail info#biniÀighttraining.com.au CALENDAR 2011 FSA JAN-FEB 2011 70 S M T W T F 2 9 16 23 30 3 4 5 6 7 10 11 12 13 14 17 18 19 20 21 24 25 26 27 28 31 S M S 1 8 15 22 29 T W T F S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 S M 6 7 13 14 20 21 27 28 T W T F S 1 2 3 4 5 8 9 10 11 12 15 16 17 18 19 22 23 24 25 26 29 30 31 january 7-10 10-14 10-21 z Benalla Club and Sports Class Nationals 12 „ AvSafety seminar 20 „ AvSafety seminar february 1 8-9 9 14 16 16 17 19 24 27 M T W T 3 4 5 6 7 10 11 12 13 14 17 18 19 20 21 24 25 26 27 28 F S 1 2 8 9 15 16 22 23 29 30 „ AvSafety seminar z Tackling Kidnapping, Hostage-taking and Hijacking conference „ AvSafety seminar z 1st Business Aviation Safety Conference „ AvSafety seminar „ AvSafety seminar „ AvSafety seminar „ AvSafety seminar „ AvSafety seminar z Wings Over Illawarra 2011 Evans Head, NSW Southern California Safety Institute San Pedro, California Benalla, Vic Yarrawonga, Vic Warrnambool, Vic www.greateasternflyin.com www.scsi-inc.com www.gfa.org.au www.casa.gov.au www.casa.gov.au Nowra, NSW Houston, Texas, US www.casa.gov.au www.quaynote.com Perth, WA Munich, Germany Port Lincoln, SA Hervey Bay, Qld Rockhampton, Qld Richmond, NSW Hay, NSW Illawarra Regional Airport www.casa.gov.au www.basc.eu www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au Phil Ayrton, 0417 210 731 march 1-3 1-6 8 9 9 10 10 16 17 19-20 19-26 21-22 21-24 22 23 23 23 29-30 S z Great Eastern Fly-in z Safety Management Systems Complete Course z 23rd European Aviation Safety Seminar Conrad Istanbul Hotel, Istanbul Turkey Avalon zAustralian International Airshow Albury, NSW „ AvSafety seminar Toowoomba, Qld „ AvSafety seminar Echuca, Vic „ AvSafety seminar Warwick, Qld „ AvSafety seminar Busselton, WA „ AvSafety seminar Naracoorte, Vic „ AvSafety seminar Mt Gambier, SA „ AvSafety seminar Deniliquin z Disabled Pilots' fly-in z Australian Qualifying Sailplane Grand Prix Boonah, QLD Maitland NSW z RFACA Flying Training Conference Fremantle, WA z 8th International conference on managing fatigue in transportation, resources and health Moree, NSW „ AvSafety seminar Goondiwindi, Qld „ AvSafety seminar Tyabb, Vic „ AvSafety seminar Darwin, NT „ AvSafety seminar Hotel Realm, Canberra z Asia-Pacific AVSEC 2011 aviation security conference april 5 5 6 6 7 10 11 12 13 14 19 22-24 27 28 „ „ „ „ „ „ „ „ „ „ „ z „ „ AvSafety seminar AvSafety seminar AvSafety seminar AvSafety seminar AvSafety seminar AvSafety seminar AvSafety seminar AvSafety seminar AvSafety seminar AvSafety seminar AvSafety seminar Natfly AvSafety seminar AvSafety seminar Merimbula, NSW Coolangatta, Qld Ballina, NSW Morouya, NSW Coffs Harbour, NSW Bindoon, WA Devonport, Tas Launceston, tas Mildura, Vic Hobart, Tas Wagga Wagga, NSW Temora, NSW Moorabbin, Vic Essendon, Vic KEY: „CASA events www.flightsafety.org www.airshow.net.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au David McPherson 03 5881 3991 www.gfa.org.au rfaca.com.au www.fatigueconference2011.com.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.informa.com.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.casa.gov.au www.ra-aus.asn.au www.casa.gov.au www.casa.gov.au z Other organisations' events $23$1DWLRQDO$LUÀHOG 'LUHFWRU\ 1RZDYDLODEOH H 7KH$23$1DWLRQDO$LU¿HOG'LUHFWRU\ LVQRZLQVWRFN 0/11 )LUVWSXEOLVKHG\HDUVDJRWKH1DWLRQDO$LU¿HOG'LUHFWRU\LV WKHRQO\FRPSUHKHQVLYHFROODWLRQRISODFHVWRODQGDQDLUFUDIW DFURVV$XVWUDOLDEHLW\RXU%HHFKFUDIWRU\RXU%RHLQJ,W JLYHVYLWDOLQIRUPDWLRQWRDLGVDIHHI¿FLHQWÀLJKWSODQQLQJE\ DYLDWRUVWUDYHUVLQJWKHFRQWLQHQW Log on to www.aopa.com.au DnG KHDG to tKH µ,nIoUPDtLon &HntUH¶ to GoZnOoDG \oXU oUGHU IoUP DnG VHnG Lt Ln to tKH oI¿FH E\ SoVt HPDLO oU ID[ to VHFXUH \oXU FoS\ National $iU¿HlG 'iUHFtoU\ 201 Aircraft O RRP $6 wners and Pi 5 lots 71 Associ ation of Austra lia Ph: 02 9791 9099 Email: [email protected] u Web: W Web eb:: www.aopa.com.au www ww w.ao aopa pa.com com.au au QUIZ ANSWERS QUIZ ANSWERS Flying Ops IFR Operations Maintenance 1. (b) AIP SUP H83/10 introduces Avalon Approach. 2. (a) AIP ENR 1.2 par. 2.3 – 2.5. 3. (d) AIP ENR 1.2 par. 2.5. 4. (c) 5. (c) 6. (a) 7. (b) ENR 1.1. & GEN 2.2 -22. The name was changed on 18 November. 8. (a) ENR 5.3.2.1 & .2. 9. (b) GEN 2.2 Page 43 & GEN 3.5 page 4 - ‘Type’ has been deleted. 10. (d) GEN 3.4 5.14.8. 1. 2. 3. 4. 5. 6. 7. 1. (d) 2. (a) Damage from a previous event may ultimately cause a seizure of the control. 3. (a) 4. (c) 5. (b) 6. (b) 7. (a) 8. (c) 9. (a) 10. (a) DAP: Not shown Jeppesen: (D) DAP: (A) Jeppesen: (F) DAP: (L) Jeppesen: (I) DAP: (B) Jeppesen: (E) DAP: (G) Jeppesen: (C) DAP: (P) Jeppesen: (M) DAP: (R) Jeppesen: (N) Note: circling speed not shown. 8. DAP: (J) Jeppesen: (O) 9. DAP: (S) Jeppesen: (Q) Note: alternate minima are on separate aerodrome details page 10. DAP: (H) Jeppesen: (K) FSA JAN-FEB 2011 72 flightsafety … essential aviation reading INSIDE MAR-APR 2011 Strike special: Strike one – birds and other animals Strike two – wires and unseen obstacles AvMed – a heads-up on head colds And … more close calls CASA at 2011 AUSTRALIAN INTERNATIONAL AIRSHOW AND AEROSPACE & DEFENCE EXPOSITION te’ es deba ökull canofrofir Eyjafjallaj ‘Volfall out m The on’ onthsgra m m 12 ‘AOD g the AOD pro A review of the state of play ‘Train in vain?’ Continuing discussion on making a pilot Reviewin t 2010 Sept-Oc Issue 76 work r in the i Spanne k of tools Keeping ‘15 years of aviation safety’ Nov-Dec 2010 Issue 77 s trac this i Hear noi Cockpi t se and pilots’ ear s calls i Closemore And ... 15th Anni While you are at our stand: „ Try OnTrack – our interactive online flight planning tool, „ update your details and subscribe to Flight Safety Australia, and „ find CASA products, safety information and giveaways. www.casa.gov.au 131 757 ue versar y iss ;OLYLOHZUL]LYILLUHIL[[LY[PTL [VIL^P[ONVVKWLVWSL *RRGSHRSOHWREHZLWK 8),0UZ\YHUJL(\Z[YHSPH3PTP[LK()5! 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