DEPARTMENT OF THE AIR FORCE HEADQUARTERS AIR FORCE SAFETY CENTER

Transcription

1 DEPARTMENT OF THE AIR FORCE HEADQUARTERS AIR FORCE SAFETY CENTER MEMORANDUM FOR DISTRIBUTION C MAJCOMs/FOAs/DRUs AFMAN91-222_AFGM June 2018 FROM: AF/SE 1400 Air Force Pentagon Washington DC SUBJECT: Air Force Guidance Memorandum to AFMAN , Space Safety Investigations and Reports By Order of the Secretary of the Air Force, this AF Guidance Memorandum immediately implements changes to AFMAN , Space Safety Investigations and Reports. Compliance with this Memorandum is mandatory. To the extent its directions are inconsistent with other Air Force publications, the information herein prevails, in accordance with AFI , Publications and Forms Management. This Memorandum becomes void after one year has elapsed from the date of this Memorandum, or upon publication of an Interim Change or rewrite of the affected publication, whichever is earlier. 1 Attachment: 1. Guidance Changes JOHN T. RAUCH Major General, USAF Chief of Safety

2 Attachment 1 Guidance Changes The below changes to AFMAN , dated 22 Dec 2016, are effective immediately Deleted Investigate and report damage or injury to Air Force space resources or personnel as a Space mishap. This includes, but is not limited to, the following specific situations: Investigate and report damage or injury involving Air Force space resources or personnel as a space mishap. This includes, but is not limited to, the following specific situations: Operational Systems. For operational systems (or systems transitioned to operations), classify space events prior to the end of design life based on the impact on mission capability (MC). A program s Capability Development Document (CDD) or other Operational Capability Requirements Document defines the MC. The document should define the primary, secondary, and tertiary MCs. Space systems may have more than one primary, secondary, or tertiary MC Classify loss of operational capability of a system (ground or on orbit) as determined by the MAJCOM owner, at least as a Hazard. Update event classification, as appropriate during anomaly resolution following guidance in Section Non-Operational Systems. Reference AFI91-204, paragraph 1.9, Exceptions to mandatory reporting requirements for this AFI, to determine reporting criteria for non-operational systems. AF/SE or MAJCOM/SE has the discretion to conduct an investigation, depending on the non-operational event Hazards. Space Safety staffs will classify any space event deemed important to investigate/report for mishap prevention, and which does not meet other reportable space mishap classification criteria and does not result in injury or damage, as a Hazard. Hazard reports provide an expeditious way to disseminate valuable mishap prevention information. As a minimum, report the following in AFSAS: Incidents. Space Safety staffs will classify any space event deemed important to investigate and/ or report for mishap prevention, which includes injury and/or damage but that does not meet Class A-E Mishap reporting criteria (Ex: injury and/or damage to commercial assets, whereby no injury and/or damage occurred to AF assets, but the AF can benefit from lessons learned.) Identify and notify organizations that will incur investigation responsibility should a mishap occur At a minimum, an ISB will stand up after a declaration of a Class A or B Mishap or at the direction of the MAJCOM or HQ AFSEC/SES General Information. The CA determines the depth of investigative effort required for each mishap. Conduct the investigations IAW AFI and the space-specific guidance contained in this chapter. Conduct safety investigations using a SIB or SIO. Briefing slide templates, suggested resources, and checklists are available through the AFSEC SIB SUPPORT page on the AF Portal (also see AFSAS Pubs & Refs tab). If necessary and directed by the CA, conduct Air Force safety investigations concurrently with other applicable investigations.

3 All timeline milestones begin at Event declaration. This is normally the same time that the Event occurs. For some space Events, there may be a delay between the occurrence and declaration of an Event Notify the CA safety office of any unresolved orbital anomaly that extends past 72 hours. The clock begins at the onset of an anomaly. If subsequent anomalies occur, the clock will not be reset for each new anomaly. Track anomalies as hazards. Once notified, the CA safety office shall observe the anomaly resolution process and transition to a safety investigation when / if enough information exists to classify the anomaly as a mishap (Class A-E). The CA may delegate to another safety office for initial anomaly status reporting. (T-2) At any point during the anomaly process when it has been determined an anomaly meets the definition of a space mishap, declare a space mishap and start a safety investigation Complete SIB/SIO investigations within 90 days for Class A and B mishaps and 45 days for all other Events. Refer to AFI for reporting and routing requirements The CA can support investigation and reporting of Class E Mishaps using a program/operation anomaly resolution process for analyzing technical data and other fact-based information. Follow guidance in AFI for the handling of any privileged information.

4 BY ORDER OF THE SECRETARY OF THE AIR FORCE AIR FORCE MANUAL DECEMBER 2016 Safety SPACE SAFETY INVESTIGATIONS AND REPORTS COMPLIANCE WITH THIS PUBLICATION IS MANDATORY ACCESSIBILITY: Publications and forms are available on the e-publishing website at for downloading or ordering. RELEASABILITY: There are no releasability restrictions on this publication. OPR: HQ AFSEC/SES Supersedes: AFMAN , 9 AUGUST 2005 Certified by: AF/SE (Maj Gen Andrew M. Mueller) Pages: 30 This manual provides additional guidance for investigating and reporting space mishaps to support Air Force Instruction (AFI) , Safety Investigations and Reports. This manual applies to all Regular Air Force (RegAF), Air Force Reserve, and Air National Guard (ANG) units that design, develop, modify, evaluate, test and/or operate existing and future Air Force space systems (operational, test, and experimental), Air Force space support systems, or use or operate Air Force launch facilities or ranges. Request waivers to this manual as Tier-1 and coordination through the Major Command (MAJCOM)/SE to Air Force Chief of Safety (AF/SE), unless otherwise specified in this manual. See AFI , Publications and Forms Management, for a description of the authorities associated with Tier numbers. Maintain all records created pertaining to processes prescribed in this publication in accordance with (IAW) Air Force Manual (AFMAN) , Management of Records, and dispose of IAW Air Force Records Information Management System (AFRIMS) Records Disposition Schedule (RDS). Any level organization may supplement this publication. Coordinate any supplements to this publication with MAJCOM/SE before submitting to Headquarters (HQ) Air Force Safety Center, Space Safety Division (AFSEC/SES) for review, coordination, and approval prior to publication. Refer recommended changes and questions about this publication to the OPR using the Air Force Form 847, Recommendation for Change of Publication; route Air Force Forms 847 from the field through the appropriate functional chain of command to Headquarters Air Force Safety Center / Space Safety Division (HQ AFSEC/SES), 9700 G Avenue, SE, Building 24499, Kirtland AFB NM or AFSEC.SES@us.af.mil.

5 2 AFMAN DECEMBER 2016 No Technical Order (TO), Instruction or Operating Instruction (OI) can address every hazard or potential hazard that may arise from a specific task or combination of tasks. When situations arise not covered by existing directives, use the Risk Management (RM) process to assess risk associated with those situations and determine adequate safeguards or procedures to manage the risk. Refer to AFPAM , Risk Management (RM) Guidelines, and Tools, for guidance on using the RM process. Note 1: do not use the RM process in a manner that violates laws, directives, and/or other regulatory guidance. Follow normal waiver and/or variance procedures in all cases (refer to this instruction). Outside of Air Force guidance, the Air Force does not have authority to grant exemptions and/or waivers for statutory and/or regulatory requirements that have risk-related exposure elements or standards. Process all other waivers, variances, and/or change requests through appropriate agencies for approval. SUMMARY OF CHANGES Due to substantial revisions, completely review this document. This revision provides detailed guidance on Space Mishap and Event Classifications, and the use of the Air Force Safety Automated System (AFSAS) for reporting. Chapter 1 GENERAL INFORMATION Purpose of Safety Investigations and Reports Space Mishaps and Events that Require Safety Investigations and Reports Space Mishaps and Event Classifications Space Mishap Costs Chapter 2 RESPONSIBILITIES General Information HQ AFSEC/SES MAJCOM Commanders The Convening Authority (CA) Commanders of Air Force launch and/or range operations Unit Commanders Interim Safety Board (ISB) President Joint/DoD/Non-DoD Space Safety Guidelines Chapter 3 PRIVILEGED SAFETY INFORMATION General Information

6 AFMAN DECEMBER Releasing Recommendations Chapter 4 DETERMINING INVESTIGATIVE RESPONSIBILITY General Information Determining AF Space Mishap Ownership Determining Commercial Space Mishap Ownership Chapter 5 SAFETY INVESTIGATIONS General Information Investigation Timelines Investigation Funding Investigation Options Obtaining and Using Technical Assistance and Laboratory Analysis Chapter 6 REPORTS AND BRIEFINGS General Information Marking Messages, Reports, Documents, and Other Safety Materials Guidance for Space Mishap Formal Reports Chapter 7 FOLLOW-UP ACTIONS General Information Review Process Memorandum of Final Evaluation (MOFE) Tracking Recommendations Attachment 1 GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION 20 Attachment 2 WORKING WITH ACCIDENT INVESTIGATION BOARD (AIB) AND THE ENGINEERING ANALYSIS GROUP (EAG) 29

7 4 AFMAN DECEMBER 2016 Chapter 1 GENERAL INFORMATION 1.1. Purpose of Safety Investigations and Reports. The sole purpose of safety investigations is to prevent future mishaps. This manual, in conjunction with AFI , Safety Investigations and Reports, and the Air Force Safety Automated System (AFSAS), directs procedures and provides guidance specific to the investigation and reporting of United States Air Force (USAF) space mishaps and events in support of the Air Force Chief of Staff (CSAF) Safety Program. Follow this manual to determine space mishap severity classification and expected safety investigation and safety reporting requirements This manual does not cover investigations to gather evidence for claims, litigation, disciplinary, adverse administrative actions, or for purposes other than mishap prevention Request waivers to this instruction through the Major Command (MAJCOM)/SE to Air Force Chief of Safety (AF/SE). Unless otherwise specified in this instruction, consider all waivers Tier 1. Note: for the purposes of this instruction, the term "MAJCOM" includes Air National Guard (ANG), Direct Reporting Units (DRUs), and Field Operating Agencies (FOAs) Space Mishaps and Events that Require Safety Investigations and Reports A mishap or event is an unplanned occurrence, or series of occurrences, resulting in damage or injury. Report any unplanned occurrence or series of occurrences meeting the definition of a space mishap or event IAW AFI Classify hazardous situations that could lead to a future mishap or unplanned operations as events Investigate and report damage or injury to Air Force space resources or personnel as a space mishap or event. This includes, but is not limited to, the following specific situations: The loss or damage of a space system over which the Air Force has development and/or procurement responsibility Injury, illness, and/or damage to Air Force space resources that results from government and/or contractor operations The loss or damage of Air Force space systems during pre-launch or launch on commercially procured launch systems or services Injury, illness, and/or abnormal physiological episodes resulting from space system operations or space system processing Damage or loss of space systems caused by natural phenomena within system design parameters. Do not report the damage or loss if it is the result of unexpected and unavoidable natural phenomena Damage or loss of space vehicle in space when caused by inadvertent commanding, regardless of design life.

8 AFMAN DECEMBER Damage or loss of space vehicle in space when caused by collision, regardless of design life The loss or damage of a space system over which the Air Force has satellite control authority Unplanned occurrence, or series of occurrences, that result in damage to a ground based space system Fly-back of a system that results in damage, injury or does not execute its flyback maneuver as intended Investigate and report damage involving Air Force space resources or personnel as a space mishap or event. This includes, but is not limited to, the following specific situations: When Air Force personnel or equipment is suspected or known to have contributed to a non-dod Launch mishap or event (does not include normal authorized destruct) The failure of Air Force launch and/or range operations, procedures, or processes to adequately protect the public or DoD operations from damage or injury (e.g., loading fuel, testing high-pressure equipment) Any unauthorized creation of debris larger than 5mm Failure to passivate a space vehicle Inadvertent system actuation that results in damage, injury or creates potentially hazardous conditions Re-entry of a system that results in damage, injury or does not execute its reentry maneuver as intended For mishaps involving radioactive material, follow AFI If the radioactive material has a permit from the US Air Force Radioisotope Committee or a Nuclear Regulatory Committee (NRC) license, also follow AFI , and Title 10, Code of Federal Regulations, Department of Energy. (T-0) Comply with relevant additional guidance in Department of Defense Directive (DoDD) , DoD Response to Nuclear and Radiological Incidents. Send Operational Reporting (OPREPs) and attach the appropriate flag word to all mishap messages (see AFI , Operational Reporting, and CSAF OPREP-3 Reports Matrix) Ensure that the investigation and report addresses any radiological mishap Exception to mandatory reporting requirements. Do not report normal residual damage as the result of a space launch Space Mishaps and Event Classifications. Classify mishaps IAW AFI , by total direct mishap cost and the severity of injury/occupational illness, except as specified in the definitions below.

9 6 AFMAN DECEMBER Operational and Non-Operational Systems. Non-operational systems include research and development satellites, test systems, and other missions that involve deliberative risk acceptance during the acquisition development process Classify any failure to complete passivation and/or disposal (per AFI , Space Safety and Mishap Prevention Program) as a Class C mishap Classify any unauthorized creation of orbital debris, 5mm or larger, that involves an Air Force space system as a Class C mishap Operational Systems. For operational systems (or systems transitioned to operations), classify mishaps or event prior to the end of design life based on the impact on mission capability (MC). A program s Capability Development Document (CDD) or other Operational Capability Requirements Document defines the MC. The document should define the primary, secondary, and tertiary MCs. Space systems may have more than one primary, secondary, or tertiary MC Classify permanent loss of primary mission capability as a Class A mishap Classify permanent degradation of primary or secondary mission capability or the permanent loss of secondary mission capability as a Class B mishap Classify permanent loss or degradation of tertiary mission capability as a Class C mishap Classify loss of operational capability of a system (ground or on orbit) as determined by the MAJCOM owner, as at least a Class E event. Update mishap or event classification, as appropriate during anomaly resolution following guidance in Section Non-Operational Systems. For non-operational systems, classify mishaps as a Class E event. Depending on the event, a non-operational system s mishap category maybe upgraded by AF/SE at their discretion Use the mission success criteria, experiment plan or other document (i.e. Operational Requirements Document (ORD), CDD) to identify impact to mission capability The document should define which aspects of the system are experimental or high-risk, and distinguish them from high-reliability systems not expected to fail Class E Events. Space Safety staffs will classify any space event deemed important to investigate/report for mishap prevention, and which does not meet other reportable space mishap classification criteria, as a Class E event. Class E reports provide an expeditious way to disseminate valuable mishap prevention information. As a minimum, report the following in AFSAS: A collision avoidance maneuver conducted by an on-orbit Air Force spacecraft outside of its normal collision avoidance process. Include the miss distance and time until predicted collision at the point when performing the maneuver Any loss or degradation to an on-orbit asset due to human error, even if occurring after the component / payload / spacecraft design life Any hazardous event that could potentially lead to a mishap.

10 AFMAN DECEMBER Space Mishap Costs. It is DoD policy to determine the total direct mishap cost in order to provide a factual basis for the allocation of resources in support of DoD mishap prevention programs. Determine mishap costs IAW AFI For destroyed, lost assets, or partial mission capable (PMC) assets with no item to exchange, use the cost from the program (DD Form 250).

11 8 AFMAN DECEMBER 2016 Chapter 2 RESPONSIBILITIES 2.1. General Information. Follow guidance listed in AFI , with the following spacespecific additions: 2.2. HQ AFSEC/SES. For non-dod launches from Air Force launch facilities and/or ranges, HQ AFSEC/SES will ensure investigation and reporting agreements allow the Air Force to participate at least as an observer on FAA, NASA, and/or NTSB-led investigation boards. This participation includes gathering information to put into AFSAS for future mishap prevention purposes MAJCOM Commanders. Commanders will establish a process to enable timely identification and assignment of safety investigation board (SIB) presidents and single investigating officers (SIO) for Space Safety investigations The Convening Authority (CA). The CA will forward to HQ AFSEC/SES as quickly as is practical, all critical safety information discovered by a SIB related to any relevant civil space vehicle and commercial space equipment. HQ AFSEC/SES will forward all such non-privileged information contributing to the promotion of Space Safety to the Federal Aviation Administration (FAA), National Aeronautics and Space Administration (NASA), and National Transportation Safety Board (NTSB) for appropriate action Commanders of Air Force launch and/or range operations Prior to each operation (e.g., launch, fly-back, re-entry), commanders of Air Force launch facilities, and/or ranges will: Identify and notify organizations that will incur investigation responsibility should a mishap or event occur Establish an Interim Safety Board (ISB) President Launch Facility and/or Range Commanders will notify the FAA Office of Commercial Space Transportation when a mishap and/or event occurs involving a licensed commercial space system at Air Force launch facilities and/or ranges. During launch of a commercial space vehicle from an Air Force launch facility and/or range, the on-site FAA representative, if/when present, will fulfill this notification requirement and up-channel as required Unit Commanders The commander of the first Air Force organization to become aware of a space mishap and/or event will notify the organization with control authority over the affected space system For high-risk activities with significant mishap potential, the Unit Commander identifies an ISB President prior to conducting the activity Interim Safety Board (ISB) President The ISB President, under certain circumstances, may have to interface with non-air Force organizations (e.g., Lockheed Martin (LM) Company, Northrop Grumman (NG), National Reconnaissance Office (NRO), FAA, NASA, NTSB, commercial vendors).

12 AFMAN DECEMBER The ISB President will follow existing agreements, when applicable, with respect to wreckage and evidence owned by non-air Force organizations For mishaps in which the FAA, NASA, or NTSB is the CA or lead investigating agency, per AFI and AFI (I), ISB members shall refrain from interviewing witnesses until the CA or lead investigating agency representatives arrive, unless there is a compelling reason to take the witness' statement(s) immediately (i.e., transient witnesses or perishable evidence). (T-2) Provide a hand-off briefing to SIB or SIO that marks the end of the ISB's involvement in the investigation. Hand-off briefing will review ISB actions accomplished to date and updated site hazard information At a minimum, an ISB will stand up after a declaration of a Class E or at the direction of the MAJCOM or HQ AFSEC/SES The ISB is not responsible for determining mishap cause(s). The sole purpose of the ISB is to gather, preserve and protect evidence. The ISB investigation is normally limited to determining what evidence exists. The ISB only analyzes evidence when it will perish prior to arrival of the permanent SIB and with CA or SIB BP permission. The ISB is responsible for: Notifying the owning installation of the need to collect personnel records. (T-1) Impounding all equipment and/or data, which may relate to the mishap. The items of interest to impound are typically in the installation s Mishap Response Plan (MRP). Refer to AFI for further guidance. (T-1) Collecting perishable fluids and photographing the mishap site. (T-1) Preserving integrity of the evidence, ensure only ISB members have access to the evidence pending transfer over to the SIB. (T-1) Identifying possible witnesses and gathering preliminary statements as appropriate. (T-1) 2.8. Joint/DoD/Non-DoD Space Safety Guidelines. All participating organizations within a mission partnership should establish Memorandums of Agreement (MOAs) or Memorandums of Understanding (MOUs) outlining each organization s responsibilities and requirements with regard to Space Safety Investigations and Reports. This includes organizations operating in a joint environment or with non-department of Defense (DoD) agencies. It is the participating organizations responsibilities to determine the lead agency and proper approval authorities. Refer to AFI (I), Participation in a Military or Civil Aircraft Accident Safety Investigation, for joint investigation guidance.

13 10 AFMAN DECEMBER 2016 Chapter 3 PRIVILEGED SAFETY INFORMATION 3.1. General Information. For privileged safety information, follow the guidance in AFI and the following space-specific additions: Investigations involving or affecting multiple agencies require special attention to the handling of safety information, privileged or not. SIB Presidents/SIOs will release information collected by safety investigators to outside AF safety channels only IAW this manual and AFI , carefully observing guidance regarding privileged information In all cases, contact the Headquarters Air Force Safety Center, Staff Judge Advocate (HQ AFSEC/JA) for approval to release. In certain cases, the Air Force may exchange privileged safety information with other DoD agencies solely for mishap prevention purposes. In addition, the Air Force shares certain mishap prevention information with other entities in the interests of the general safety community. Commonality of launch vehicles, launch vehicle systems, components, and launch range safety systems exists for launches conducted under launch licenses issued by the FAA and launches conducted by and for the Air Force. The FAA and the Air Force therefore require timely knowledge of the facts and circumstances of commercial space launch accidents. Reference 14 Code of Federal Regulations (CFR), Part An Air Force safety investigator discovering a critical safety concern applicable to commercial spaceflight will provide that information to HQ AFSEC/SES for consideration of release to other organizations IAW AFI Send all Freedom of Information Act (FOIA) requests, subpoenas, or other requests involving safety information protected by the military safety privilege to HQ AFSEC/JA, IAW AFI When the Air Force participates in an investigation led by the NTSB, FAA or NASA, the Air Force will protect all investigation data, information, documents, or other material as prescribed by the investigating agency. The Air Force will not disclose this information in any manner without the written consent of the Investigator-in-Charge. In addition, the Air Force will refer any FOIA request, subpoena, or other request for such information to the NTSB, FAA or NASA for resolution Releasing Recommendations. Only HQ AF may release an AF investigative board s conclusion attributing cause to another agency or recommendation of corrective action by another agency, IAW AFI For the release of safety information to the FAA, NASA or the NTSB for space mishaps, use AFI as a guide.

14 AFMAN DECEMBER Chapter 4 DETERMINING INVESTIGATIVE RESPONSIBILITY 4.1. General Information. The Air Force generally assigns investigative responsibilities to the MAJCOM experiencing operational loss of an assigned/owned asset (personnel or property). Unless otherwise stated, the mishap owner (as determined IAW AFI ) has investigative responsibility for the mishap The CA is the individual who has the authority to order a safety investigation The MAJCOM/CC of the organization that owns the asset is the CA unless: AF/SE assumes investigative responsibility, another MAJCOM/CC assumes investigative responsibility (with the concurrence of the owning organization and AF/SE), or investigative responsibility is delegated to a lower level of command Determining AF Space Mishap Ownership. The mishap owner is that unit which has permanent possession and mishap reporting accountability for the affected asset and/or personnel involved in the mishap. Assign ownership of the space mishap to the MAJCOM responsible for the space system at the time of the mishap For satellites, assign mishap ownership to the MAJCOM with satellite control authority Satellite control authority for an on-orbit space system, or the debris associated with it, does not end until: re-entry and touchdown on Earth; transfer of responsibility to another agency; or injection into an Earth-escape trajectory as part of the end-of-life process (e.g., satellite control authority does not end for space systems in a nonoperational orbit) For non-operational satellites, the last organization with SCA maintains SCA for the purposes of mishap reporting For launch vehicles, including upper stages, assign ownership of the mishap to the MAJCOM acquiring the launch vehicle unless an agreement is in place specifying transfer of ownership to another agency Aerospace Vehicle Contractor Mishaps Involving Air Force Indemnification. For operations involving unusually hazardous safety risks that the Air Force indemnified, such as contractor provided launch services for Air Force or National Security Space payloads, the MAJCOM that acquired the operational service is the CA for the mishap If the Air Force leads a safety investigation, HQ AFSEC/SES will consider providing the FAA, NASA, or the NTSB the opportunity to participate in the investigation according to each agency s respective role or interest Determining Commercial Space Mishap Ownership Depending on the circumstances, commercial space asset mishaps within US jurisdiction may be investigated by the FAA, NASA, NTSB, and/or the commercial vendor. If the FAA/NTSB leads such an investigation, it is implicit the FAA/NTSB will retain

15 12 AFMAN DECEMBER 2016 custody of evidence for the duration of the investigation whether referring to physical or intellectual (i.e. witness accounts) Reference existing MOAs/MOUs to determine the correct mishap investigation agency for commercial space mishaps.

16 AFMAN DECEMBER Chapter 5 SAFETY INVESTIGATIONS 5.1. General Information. The CA determines the depth of investigative effort required for each mishap/event. Conduct the investigations IAW AFI and the space-specific guidance contained in this chapter. Conduct safety investigations using a SIB or SIO. Briefing slide templates, suggested resources, and checklists are available through the AFSEC SIB SUPPORT page on the AF Portal (also see AFSAS Pubs & Refs tab). If necessary and directed by the CA, conduct Air Force safety investigations concurrently with other applicable investigations Investigation Timelines All timeline milestones begin at mishap declaration. This is normally the same time that the mishap occurs. For some space mishaps/events, there may be a delay between the occurrence and declaration of mishap/event Notify the CA safety office within 72 hours of any unresolved anomaly. The CA safety office shall observe the anomaly resolution process and transition to a safety investigation when / if enough information exists to classify the anomaly as mishap/event. The CA may delegate to another safety office for initial anomaly status reporting. (T-2) At any point during the anomaly process when it has been determined an anomaly meets the definition of a space mishap/event, declare a space mishap/event and start a safety investigation Complete SIB/SIO investigations within 90 days for Class A and B mishaps and 45 days for all other mishaps/events. Refer to AFI for reporting and routing requirements Due to the complexity of the data recovery and engineering analysis process, space mishaps might require longer timeframes. If circumstances prevent meeting a timeline, the board president/sio may request an extension from the CA. The SIB/SIO annotates the extension and approval by the CA in each status message. AF/SE has the authority to reject any extension request in order to ensure the timely completion of a safety investigation Investigation Funding Follow the funding guidance in AFI Observers to an Air Force SIB fund their own TDY Additional Funding Guidance for Mishaps Involving Civil and Commercial Space Assets. If the Air Force is the CA or the mishap owner for a mishap involving civil or commercial space mishaps, use the following funding guidance: In general, if the space mishap occurs at a facility not located on an Air Force installation, then the home base of the investigating organization acts as the host installation for the investigation and is responsible for providing and funding local support.

17 14 AFMAN DECEMBER To properly investigate space mishaps, there may be a need for multiple host installations. The closest Air Force base to the mishap site, to an investigation location (contractor/civil/government), and to the investigation organization s home location will fund and provide in-house support at the request of the board president See AFI for expenses that exceed the resources of the host installation Investigation Options The CA determines the size and membership of the safety investigation based on the category and complexity of the mishap. Investigations can utilize multiple members (SIB) or SIO As a minimum, AF safety investigations must have an SIO appointed. A space mishap SIO should be a space professional and graduate of formal Air Force safety training and mishap investigation courses The CA can support investigation and reporting of Class E events using a program/operation anomaly resolution process for analyzing technical data and other fact-based information. Follow guidance in AFI for the handling of any privileged information At least one SIB member must be at least equal in grade to the senior person directly involved in the mishap. Normally, the SIB president is the senior SIB member. The Board President should be the senior person on a SIB. The CA may tailor the following personnel requirements, limitations, and restrictions for Primary and Non-Primary SIB Members as appropriate for space mishaps: Safety Investigation Board President, a space professional and graduate of formal Air Force safety training and mishap investigation courses Air Force Safety Center Representative. HQ AFSEC/SES has the option to provide a representative or advisor to the SIB for on-duty Class A mishaps, unusual high interest off-duty Class A mishaps, and complex Class B mishaps, as determined by AFSEC/SES and CA. AFSEC will fund the representative. AFSEC/SES will offer telephonic support for all Class A mishaps. A HQ AFSEC/SES representative assigned to the SIB is a primary member and acts as the investigation process expert to guide SIB procedures. A HQ AFSEC/SES advisor supports the SIB as a non-primary member. The HQ AFSEC/SES representative or advisor is the single point of contact with AFSEC for the duration of the investigation Space Operations Officer, qualified or previously qualified, in the operational use of the space system involved in the mishap Space Materiel Officer or Acquisition Officer, qualified in the maintenance, engineering, or manufacturing of the space system involved in the mishap Weather Officer or Space Environmental Expert, if weather, weather service, or space environment is suspect or a known factor in the mishap For mishaps involving potential human error, the medical member must be a flight surgeon graduated from the USAF School of Aerospace Medicine mishap investigation course.

18 AFMAN DECEMBER Any appropriate expert when mishaps involve areas not specified in (e.g., appropriate human factor professional, medical officer, environmental scientist) Non-primary SIB Members The CA may select non-primary SIB members at his/her discretion Representatives to serve as liaisons, advisors, or consultants. This may include the FAA, NASA, NTSB, or joint service observers. Refer to applicable MOAs/MOUs for specific requirements Use of Non-Air Force Investigations. While the Air Force is always responsible for determining the cause of Air Force mishaps, in certain situations the Air Force may accept the results of a non-air Force investigation to satisfy Air Force mishap prevention requirements as directed by the CA. The FAA, NASA, NTSB, or the space system owner will usually investigate commercial space mishaps. When possible, the Air Force should make use of these investigations and limit duplicative investigations. However, the Air Force always retains the right to conduct a separate Air Force safety investigation The Air Force will observe all investigations related to the mishap IAW this document, the applicable MOAs/MOUs, and AFI Air Force observers will contact the appropriate MAJCOM Safety office or AFSEC/SES for guidance on current agreements with the FAA, NASA, NTSB, and the responsible commercial entity The Air Force observer reports to the CA on the adequacy of the investigation, the validity of the conclusions, and advises on whether the conclusions satisfy Air Force s mishap prevention needs Based on the Air Force observer s assessment on the adequacy of the non-air Force investigation report, the Air Force CA may accept it with a cover letter from the Air Force observer stating acceptance of findings and submit as the Air Force final report. The Air Force observer will ensure the prepared report and cover letter contain non-privileged information. Alternately, the CA may appoint another SIO to evaluate the report and deliver an Air Force mishap report. In this case, the Air Force report shall include the non-air Force report. (T-1) If the Air Force CA determines that the investigation will not satisfy the Air Force s mishap prevention needs, the Air Force will conduct its own investigation within the terms of applicable contracts and agreements Air Force Participation in non-air Force Investigations. When the Air Force participates in another service s or government agency's investigation, AFSEC will contact the MAJCOM(s) that can best meet the requirement. The MAJCOM/SE will coordinate the selection of the participant with AFSEC/SES. Once AF/SE approves the nominee, AFSEC/SES will provide a fund site to the MAJCOM and establish direct communication with the individual. Air Force representatives to Joint Safety Investigations should be graduates of formal Air Force safety training courses Use of Air Force Observers on Non-Air Force Investigations. Outside agencies such as the FAA, NASA, or the NTSB may allow Air Force personnel to participate as official observers to investigations led by these agencies. Air Force observers will adhere to the

19 16 AFMAN DECEMBER 2016 applicable MOAs/MOUs, AFI , and the provisions of Title 49 CFR, Part 831, as applicable Observers are not formal Air Force safety investigators and cannot offer promises of confidentiality per AFI Air Force observers may participate but may not interfere with the observed investigation. Air Force observers will refrain from making judgment calls, providing opinions, or analysis, or writing any part of the report unless specifically requested to do so by the lead investigating agency Air Force observers may not observe multiple investigations simultaneously nor may they participate in any other investigations while still acting in an observer status. Observers may transition from an Air Force observer to an Air Force SIB to provide the SIB with continuity; however, once transferred, may no longer serve as an Air Force observer or transfer back to observer status Personnel observing or participating in an investigation will be under the control and direction of the lead agency's chief investigator (e.g., NTSB "Investigator-In-Charge," or FAA "Investigator-In-Charge"). All such personnel will follow the lead agency's rules regarding the handling and/or release of information, or other evidence collected during an investigation Obtaining and Using Technical Assistance and Laboratory Analysis. The contractor and the system program office, in coordination with the SIB and Accident Investigation Board (AIB) presidents, may establish an Engineering Analysis Group (EAG) or similar to assist in analyzing the technical data from a mishap. Refer to Attachment 2, AFI and the launch or space system contract For space mishaps, the EAG conducts a technical examination of mishap data. It provides important fact-based (non- privileged) analysis to the SIB and the AIB and assures the release of this fact-based information as soon as possible to the Commercial Space Industry The SIB and the AIB will pass fact-based mishap data to the EAG. The EAG will pass the results of its engineering analysis to both the SIB and the AIB as soon as it is available The EAG s engineering analysis is non-privileged information If the EAG s engineering analysis is classified, the information owner must clearly mark and control appropriately If the engineering analysis contains proprietary information, the information owner must clearly mark and control appropriately The EAG will provide updates, as directed by the SIB president or SIO, to SIB or ISB members on the status of the engineering analysis. SIB members may monitor the EAG but will not direct or provide input to the EAG.

20 AFMAN DECEMBER Chapter 6 REPORTS AND BRIEFINGS 6.1. General Information. Safety reports include messages (preliminary, 10-day, status, final, and final supplemental), formal reports, injury and occupational illness forms, and logs. Safety reporting will be via the AFSAS. Use the following URL for AFSAS: If AFSAS is not available, contact HQ AFSEC/SES for transmission alternatives at AFSEC.SES@us.af.mil. Once the SIB/SIO completes the investigation, finalizes the formal report, and the final message, the SIB/SIO will normally provide a briefing to the CA. Space mishaps involving fatalities, or other mishaps when requested, require a briefing to the CSAF and Secretary of the Air Force (SECAF). AF/SEI will be the focal point for scheduling all briefings to the CSAF and SECAF and will coordinate with HQ AFSEC/SES Report space mishaps in accordance with AFI When a non-air Force organization s report exists that fulfills the requirements of an Air Force final report, the CA may use it as the official final investigation report. Complete a report in AFSAS and include the non-air Force organization s report Marking Messages, Reports, Documents, and Other Safety Materials Space mishap messages and safety reports are subject to limited distribution, and control therein appropriately Make every effort to keep investigative reports and briefings unclassified to ensure the widest dissemination possible. Report the unclassified portion of the report (i.e., one-liner, date, time, location, Investigating Officer, and objects) using AFSAS. Do not input DoD Unclassified Controlled Nuclear Information (DCNI) into AFSAS Report classified mishaps IAW the template in AFI The SIO or SIB President will place the final report on a mission owning unit-shared drive IAW the Security Classification Guide (SCG) of the system with copies provided to the MAJCOM and AFSEC safety work centers, as security guidance permits. (T-2) Mark classified pages in messages, reports, or other safety documents with the proper security classification marking from the appropriate SCG and AFI , Air Force Information Security Program For materials containing privileged information, follow the guidance in AFI Place the Privilege Warning statement IAW AFI , at the foot of each page that contains privileged information. Do not place the Privilege Warning on unclassified, nonprivileged pages, on preliminary messages, or on other fact-based only material For each page that contains proprietary information, as identified by a contractor, include an appropriate proprietary information warning. This warning must identify the extent of the protection required (e.g., Government Only, Air Force Only) Guidance for Space Mishap Formal Reports. Formal safety reports present detailed information, both fact-based and analytical, about mishaps. Prepare them IAW AFI and the following guidance:

21 18 AFMAN DECEMBER Distributing the Formal Report. The CA will ensure the upload of all non-waivered formal reports into AFSAS. All Air Force agencies with a need to know can access the tabs or request tab access via AFSAS. If the report references a document, attach a copy of the document to the AFSAS report Do not provide copies or extracts to agencies outside the Air Force. If an agency outside the Air Force requires a copy of the formal report for mishap prevention, corrective actions, or other purpose, notify HQ AFSEC/JA. Distribute formal reports IAW AFI

22 AFMAN DECEMBER Chapter 7 FOLLOW-UP ACTIONS 7.1. General Information. Reviewing authorities, CAs, and HQ AFSEC/SES will conduct follow-up actions to ensure program compliance, hazard mitigation, and trending validity. These three areas are core safety functions required at every level. Follow guidance in AFI Review Process. CA safety staffs will review messages and formal reports prior to release in AFSAS for AFI compliance, completeness, and accuracy. Although SIBs/SIOs retain authority for all substantive report changes, the report must comply with this AFMAN and AFI Memorandum of Final Evaluation (MOFE). HQ AFSEC/SES prepares a MOFE for each Class A and Class B mishap. Refer to AFI , Chapter 7, for more details on this process Tracking Recommendations. Manage corrective actions, with or without a MOFE, IAW with AFI , Chapter 7. ANDREW M. MUELLER, Major General, USAF Chief of Safety

23 20 AFMAN DECEMBER 2016 References Attachment 1 GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION DoDD , DoD Response to Nuclear and Radiological Incidents, 20 January 2010 DoDM V4, DoD Information Security Program: Controlled Unclassified Information (CUI), 24 February 2012 DoD R_AFMAN33-302, Freedom Of Information Act Program, 21 October 2010 (Incorporating Through Change 2, 22 January 2015) DoDI , Operation of the Defense Acquisition System, 7 January 2015 DoDI , Mishap Notification, Investigation, Reporting, and Record Keeping, 6 June 2011 DoD R, DoD Health Information Privacy Regulation, 24 January 2003 AFI , Operational Reporting, 11 June 2014 AFI , Operational Capability Requirement Development, 6 November 2013 AFI , Air Force Information Security Program, 29 May 2015 AFI , Records Management Program, 4 June 2012 (Incorporating Change 1, 18 December 2014) AFI , Publications and Forms Management, 25 September 2013 AFI , Space Professional Development Program, 20 May 2010 AFI , Radioactive Materials (RAM) Management, 17 September 2014 AFI , Aerospace and Ground Accident Investigations, 15 April 2015 AFI63-101/20-101, Integrated Life Cycle Management (ILCM), 07 MARCH 2013 AFI , Nuclear Safety Review and Launch Approval for Space or Missile Use of Radioactive Material and Nuclear Systems, 13 January 2015 AFI , The US Air Force Mishap Prevention Program, 24 June 2015 AFI , Safety Investigations and Reports, 12 February 2014 (corrective actions applied on 14 April 2014) AFI , Participation in a Military or Civil Aircraft Accident Safety Investigation, 8 July 2004 AFI , Space Safety and Mishap Prevention Program, 11 April 2014 AFMAN , Management of Records, 1 March 2008, (Incorporating Change 1, 28 January 2015) AFMAN , Weapons Safety Investigations and Reports, 21 August 2015 AFMAN , Aviation Safety Investigations and Reports, 16 May 2013 AFPAM , Risk Management (RM) Guidelines, and Tools, 11 February 2013

24 AFMAN DECEMBER Military Standard (MIL-STD) 882E, Department of Defense Standard Practice System Safety, 11 May 2012 TO 00-35D-54, USAF Deficiency Reporting and Investigating System TO , Repair and Disposal of Aerospace Vehicles DOD-HDBK-343 (USAF) Design, Construction, and Testing Requirements for One of a Kind Space Equipment, 1 February 1986 Abbreviations and Acronyms AF Air Force AF/SE Air Force Chief of Safety AFI Air Force Instruction AFMAN Air Force Manual AFRIMS Air Force Records Information Management System AFSAS Air Force Safety Automated System AFSCN Air Force Satellite Control Network HQ AFSEC/SES Headquarters Air Force Safety Center, Space Safety Division HQ AFSEC/JA Headquarters Air Force Safety Center, Staff Judge Advocate AIB Accident Investigation Board ANG Air National Guard C2 CIF Command and Control Controller Information File CA Convening Authority CAC Common Access Card CDD Capability Development Document CFR Code of Federal Regulations CJCS Chairman of the Joint Chiefs of Staff CP Command Post CPI Critical Program Information CPD Capability Production Document CSAF Chief of Staff, United States Air Force DCNI DoD Unclassified Controlled Nuclear Information DCR DOTMLPF P Change Recommendation DoD Department of Defense DoDD Department of Defense Directive DoDM Department of Defense Manual

25 22 AFMAN DECEMBER 2016 DRU Direct Reporting Unit EAG Engineering Analysis Group FAA Federal Aviation Administration FOA Field Operating Agency FOIA Freedom of Information Act FOUO For Official Use Only HQ Headquarters IAW In Accordance With ICBM Intercontinental Ballistic Missile ICD Initial Capabilities Document ILCM Integrated Life Cycle Management ISB Interim Safety Board JA Judge Advocate JCIDS Joint Capabilities Integration and Development System LSO Launch Safety Officer MAJCOM Major Command MC Mission Capability MOA Memorandum of Agreement MOU Memorandum of Understanding NASA National Aeronautics and Space Administration NRC Nuclear Regulatory Committee NRO National Reconnaissance Office NTSB National Transportation Safety Board MRP Mishap Response Plan OCA Original Classification Authorities OI Operating Instruction OPR Office of Primary Responsibility OPREP Operational Reporting ORD Operational Requirements Document PMC Partial Mission Capable RDS Records Disposition Schedule RegAF Regular Air Force