Aeronautics Study - Safety Threats Term Paper

For an additional 14 occurrences, the outcome could not be determined. A a) Figures are rounded to nearest percentage.

Errors

Perceptual error

Example: After being on duty for 18 hr on a long overtime shift, the worker was carrying out a general inspection on an engine at around 22:00. He missed obvious damage to the internals of the cold stream duct area. The damage was found later, when another defect was being investigated.

Memory lapse

Example: Just prior to the departure of the aircraft, I remembered I had left a blanking plug within the engine inlet area. I advised the pilot that I needed to check that area again and retrieved the blank.

Slip

Example: Without thinking, I moved to wipe oil with a rag. The rag was ingested in the engine intake causing FOD [Foreign Object Damage].

Rule-based error

Example: A mechanic did not check the position of the flap lever before he pushed in a cockpit circuit breaker that provided electrical power to a hydraulic pump. When the pump started, the flaps began to retract automatically. This could have caused damage to the aircraft or injured other workers.

Violation

Example: At the end of a shift we realized that an engine hadn't been run to check for oil leaks when the aircraft was to be placed online. Under pressure to avoid a delay due to this oversight,...

...

I was unfamiliar with the aircraft, so I asked an airframe tradesman who was working on the aircraft and he pointed to a red rocker switch. I queried him and he said that must be it. I pushed the switch and the right engine turned over, with the propeller narrowly missing a tradesman who was inspecting the engine. There is no radio master in this aircraft. I immediately marked the "start" and some other switches and learned a valuable lesson.
Mischance

Example: A service procedure was carried out in accordance with the aircraft maintenance manual. The manual however, contained an error, which resulted in an aircraft system failing to operate correctly during a functional test at the end of the maintenance procedure.

Factor n or Fatigue 1-0.2

Pressure 8-1.9

Coordination 6-1.4

Training 1-0.2

Supervision 5-1.9

Procedure 16 9.0 **

Equipment 1-0.3 deviation 4-4.3 *

Environment 1-0.8 chi square](9, N = 805) 46.68

Wald test significant at p

Sources Used in Documents:

References

Bruggink, Gerard M. (2000, August). "Remembering Tenerife." Retrieved November 23, 2007, at http://cf.alpa.org/internet/alp/2000/aug00p18.htm

Dismukes, Key, Berman, Benjamin a. And Loukopoulos, Loukia D. (2007). The Limits of Expertise: Rethinking Pilot Error and the Causes of Airline.... Ashgate Publishing, Ltd. Retrieved November 23, 2007, at http://books.google.com/books?id=mMxaYxhu0l0C&dq=runway+excrusions+causes

Fadden, S., Ververs, P.M., & Wickens, C.D. (2001). Pathway HUDs: Are They Viable?. Human Factors, 43(2), 173. Retrieved November 19, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5001043570

Hobbs, a., & Williamson, a. (2003). Associations between Errors and Contributing Factors in Aircraft Maintenance. Human Factors, 45(2), 186+. Retrieved November 23, 2007, from: Questia database: http://www.questia.com/PM.qst?a=o&d=5002089765
Jentsch, F., Barnett, J., Bowers, C.A., & Salas, E. (1999). Who Is Flying This Plane Anyway? What Mishaps Tell Us about Crew Member Role Assignment and Air Crew Situation Awareness. Human Factors, 41(1), 1. Retrieved November 20, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5001307301
Johnson, Chris W. And Palanque, Philippe. (2004). Human Error, Safety and Systems Development. Springer. Retrieved November 23, 2007, at http://books.google.com/books?id=wjo5s3zCxiEC&dq=runway+incursion
Kirwan, Barry, Rodgers, Mark and Sch fer, Dirk. (2005). Human Factors Impacts in Air Traffic Management. Retrieved November, 22, 2007, at http://books.google.com/books?id=sot7a1TMhqAC&pg=PA44&dq=runway+incursion&sig=0f1FX6IqZOOdThA2mekD48NMGdk www.questia.com/PM.qst?a=o&d=5009564197
Krieger, J.L. (2005). Shared Mindfulness in Cockpit Crisis Situations: An Exploratory Analysis. The Journal of Business Communication, 42(2), 135+. Retrieved November 23, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5009564197 www.questia.com/PM.qst?a=o&d=5001910855
Mcfadden, K.L. (2002). DWI Convictions Linked to a Higher Risk of Alcohol-Related Aircraft Accidents. Human Factors, 44(4), 522+. Retrieved November 23, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5001910855
NTSB Warns of Runway Collision Risk; Encouraged by Potential for Technology to Improve Road Safety. (2007, November 8, 2007). NTSB News. Retrieved November 22, 2007, at http://www.ntsb.gov/Pressrel/2007/071108.htm
Olson, W.A., & Sarter, N.B. (2001). Management by Consent in Human-Machine Systems: When and Why it Breaks Down. Human Factors, 43(2), 255. Retrieved November 19, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5001043608
Runway Safety. (2007, October 10). Federal Aviation Administration. Retrieved November 23, 2007, at http://www.faa.gov/runwaysafety/
Runway Safety Data and Statistics. (2007, July 11). Retrieved November 23, 2007, at http://www.faa.gov/runwaysafety/data/ri_tot.cfm?fy1=2007&fy2=2006
Runway Safety the Human Element. (2007). Retrieved November 23, 2007, at http://www.faa.gov/runwaysafety/human.cfm
Scarborough, M.P.H., Pounds, Ph.D., and Bailey, Ph.D. (N.d). "Human Factors Classification of Runway Incursions Associated with Vehicle and Pedestrian Deviations." FAA Civil Aeromedical Institute. Retrieved November 22, 2007, at http://uk.geocities.com//HF_Runway_Incursions.pdf


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