International Civil Aviation Organization Safety Occurrence Reporting and Analysis ICAO EUR/NAT 15 February 2011 OUTLINE Safety related occurrences Primary reporting schemes ICAO Annex 13 framework Mandatory incident reporting system Voluntary incident reporting system Aircraft accident/incidentdatabase database ECCAIRS training provided by ICAO Analysis of safety related occurrences Some results from ICAO USOAP audits 2 1
Safety related occurrences Accidents Serious Incidents* ICAO ADREP System (Annex 13) Reportable incidents (other than serious incidents) Other safety related occurrences/hazards *An incident involving circumstances indicating that there was a high probability of an accident 3 Primary reporting schemes Accidents: asap to AIB ICAO ADREP System (Annex 13) Serious Incidents: asap to AIB Reportable incidents (other than serious incidents) MOR to CAA Other safety related occurrences/hazards VOR to the State s designated authority + SMS within the operator/service provider 4 2
ICAO Annex 13 framework Investigation of accidents/ serious incidents and prevention (incidentreporting reporting, storage and analysis) Amendment 13 Rights and obligations of States (State of Occurrence and Registry, and others) and organisations involved Chapter 8: Accident Prevention Measures Guidance material, incl. Safety Management Manual 5 Mandatory incident reporting system Annex 13 requires States to establish a mandatory incident reporting system. Guidance on this system is contained in the Safety Management Manual. Underthe State s mandatoryincident reporting system, individuals and organizations are required to notify incidents within an established time frame to the State s designated/competent authority (usually: the CAA). There is no standard established by ICAO for an appropriate time frame, but typically it is between 24 and 72 hours. The State should: clarify in the regulations the list of incidents to be notified within the mandatory scheme; make available the necessary reporting forms; and issue guidance material to the industry regarding their obligations with respect to occurrence reporting. Furthermore, the designated authority should clearly designate the sections and individuals within the organization which will be in charge of processing these incident reports. 6 3
Voluntary incident reporting system In addition to the mandatory incident reporting system, the State shall also establish a voluntary incident reporting system in order to: facilitate thecollection of safety information that may nototherwiseotherwise be captured by the established mandatory incident reporting system; and enable the identification of hazards and unsafe conditions that have not yet caused an incident. This system shall be non punitive and afford protection to the sources of information legal and procedural framework needed. It complements the voluntary reporting systems established by the industry as part of their Safety Management Systems (SMS). The designated authority for the management of this system should also issue guidance to the industry, and clarify which occurrences cannot be submitted through the voluntary reporting system. 7 Aircraft accident/incident database The State is required to establish such a database to facilitate the analysis of information on actual or potential safety concerns. The State s database should use a taxonomy compatible with the ICAO ADREP taxonomy and the ECCAIRS system (European Co ordination centre for Accident and Incident Reporting Systems). This compatibility aims at facilitating the exchange of data between the State and international organizations. 8 4
ECCAIRS training provided by ICAO 9 Analysis of safety related occurrences Single occurrence investigation/analysis Trend analysis and general statistical analysis Safety studies on specific operations or safety concerns Sharing of the analysis results with the aviation community 10 5
Some results from ICAO USOAP audits LEI: Lack of effective implementation Number Question LEI 6.501Has the State established a mandatory incident reporting system? 44.67% 6.503Has the State established a voluntary incident reporting system? 71.14% 6.505 Legislation and procedures for non punitive system and information source protection? 64.96% 6.507Has the State established an accident and incident database? 58.67% 6.509Database created in a standardized format to facilitate data exchange? 64.96% 6.511Does the State analyze the information in its accident/ incident reports and the database? 59.33% 11 International Civil Aviation Organization THANK YOU Q&As 6