Human Factors in Aviation Safety Case Study

Excerpt from Case Study :

The mechanic must have adequate knowledge, training, data for assigned task, tools and equipment, be mentally and physically prepared, take safety precautions, have adequate resources, and have researched FAR, Federal Aviation Regulations, to ensure compliance. The task must be performed with a committed attitude, in accordance with appropriate data and acceptable methods, techniques, and practices that are industry acceptable. The mechanic must perform without pressures, stresses, and distractions, re-inspect work, properly record work performed, and perform operational checks. The mechanic must also be willing to sign for work performed and be willing to fly in the aircraft upon approval for return to service.


In spite of having measures in place to mitigate human error in aviation, there is still a major amount of incidents that involve human error. A Quantas plane flew from Darwin to Brisbane with a rag over a power generator, left on the generator during a maintenance inspection (Airline worker killed at N.C. airport, Aug, 9, 2007). The rag on the generator had set off fire alarms while the plane was still on the ground. The APU was investigated on the outside, but not on the inside, and returned to service when nothing was found. Further investigation found the rag on the inside of the APU. In Brazil, pilots were told the runway was wet and slippery, but they did not use spoilers and no braking equipment was activated on touchdown. The plane runoff the runway and impacted a hangar, killing 199 people. Investigation showed that in spite of pilots trying to slow the craft, landing was not aborted. Further investigation showed the right thrust reverser was inoperative at the time of the incident.

In Dublin, Ireland, a cargo door seal was installed incorrectly indicating a number one engine bleed problem with no reference to a pressurization problem. In flight the cabin pressurization kept climbing. After investigation, it was found the incorrect installation of the cargo door seal resulted in a pressurization leak through the unsealed door. In Lexington, Kentucky, non-pertinent conversations during a critical phase led an aircraft down an incorrect runway causing a crash. The conversations were prohibited by federal "sterile cockpit" regulations and Comair guidelines. The runway was unlit and dark, killing 49 people. The air controller had only two hours of sleep in the 24 preceding hours.

American Airlines was cited with $231,000 in fines for 22 significant safety violation, including six repeat violations and a 'willful' infraction, where the employer knew the safety problem existed, it could kill or seriously injure, but didn't correct it, during an OSHA inspection. The 'willful' infraction concerned proper fall protection during heater inspections from unprotected catwalks 80 feet above ground and inspections atop jet bridges and de-icing trucks. A Northwest airlines plane had mistakenly crossed and active runway during a downpour and was undetected by a malfunctioning radar. Airbus pilots missed procedures and visual cues causing the plane to land with the parking break set and blowing all four mains. In Ludville, Georgia, an incident killed a famed aviator who failed to ask for weather updates and the directives. Safety errors are also being caused by cutting corners to cut costs.


In spite of measures being taken to mitigate human error in aviation safety, there are still a major amount of incidents that involve human error. Human errors are being caused by fatigue, engaging in general conversations that divert attention from safety issues that could arise, noncompliance with FAA directives and standards, being in a hurry, cutting corners to save costs, and inadequate training. All Federal Aviation Administration directives must be followed to ensure compliance and safety measures are being taken to prevent and mitigate human error in accidents. This includes continual training to enable situational awareness and full awareness of safety issues that could arise in the course of job performance.


Administration, F.A. (2009). Aircraft Inspection and Repair: Acceptable Methods, Techniques, and Practices. New York, NY: Skyhorse Publishing, Inc.

Airline worker killed at N.C. airport. (Aug, 9, 2007). Aviation Human Factors Industry News, Vol III Issue 28, Retrieved from

Aviation operators cut corners at espense of safety. (Oct. 9, 2007). Aviation Human Factors Industry News, Retrieved from

Higgins, C. & . (n.d.). Human factors in improving aviation safety. Retrieved from Boeing:

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