Tillögur í öryggisátt Síða 10

Lög um RNSA, 35. gr.

TQL operation under failed engine condition

Flug
Nr. máls: M-01313/AIG-09
Staða máls: Lokuð
23.03.2016

Tillaga í öryggisátt

Clarify the AFM procedures to require both TQLs to be operated in cases where a failed engine has not been identified and secured.

Afgreiðsla

SCAC clarify that the AFM approved by lAC AR and EASA for RRJ-95 aircraft contains all the instructions related to the engine thrust setting and also to the activation of the go-around function in accordance with the Certification Basis (CB) para. 25.125; 15.121 and 25.119 requirements. Both TQL's go-around position setting instructions are in the part of the Standard Operational Procedures (SOP) which are described in the Flight Crew Operating Manual (FCOM).

Activation of emergency plan

Flug
Nr. máls: M01313/AIG-09
Staða máls: Lokuð
23.03.2016

Tillaga í öryggisátt

Take the necessary steps to ensure that Keflavik Airport’s emergency plan is activated without a delay, following an accident occurrence

Afgreiðsla

Isavia:

  • Í því skyni að styðja við tímanlega boðun voru búnar til æfingar og æfingaáætlun þar sem ætlast er til að stutt boðunar-æfing fari fram a.m.k. vikulega (SR15005,SR19018).
  • Í skýrslu RHA (Rannsóknarhópur atvika) um atvikið kom fram að boðunarlisti var ekki á þeim stað sem viðkomandi flugumferðarstjóri gerði ráð fyrir. Í dag er virkt, daglegt, eftirlit til að tryggja að gátlista-mappa sé á réttum stað og að innihald hennar sé eins og það á að vera (SR15005,SR19018).
  • Neyðargátlistar flugturnsins í Keflavík voru uppfærðir og samræmdir við gátlista annarra flugturna.
  • Sérstök áhersla var lögð á boðun í síþjálfun ársins 2014 og neyðarviðbrögð eru árlega á dagskrá síþjálfunar.

Adhere to AIP

Flug
Nr. máls: M-01313/AIP-09
Staða máls: Lokuð
23.03.2016

Tillaga í öryggisátt

Take the necessary steps to ensure that the AIP is adhered to

Afgreiðsla

Isavia:

  • Til staðar er sérregla SR19006 Noise abatement procedures, þar er starfsmönnum bent á þær reglur sem auglýstar eru í AIP.
  • Í framhaldi af útkomu skýrslunnar var eftirfarandi texti settur inn á vaktaskiptablað í flugturninum í Keflavík
    • „Allt árið um kring: Hvorki snertilendingar né lág aðflug verða samþykkt fyrir braut 11/29 milli 22:00 og 07:00“.
  • Skýrslan kynnt á varðstjórafundi og umræða tekinn um mikilvægi þess að fara eftir þeim tilmælum sem að ofan er getið.

Airport procedure regarding flight testing

Flug
Nr. máls: M-01313/AIG-09
Staða máls: Lokuð
23.03.2016

Tillaga í öryggisátt

Set up formal procedures for Flight Certification / Flight Testing at the BIKF airport, based on the work of the in-house task group

Afgreiðsla

Isavia hefur gefið út sérstakt verklag VR700 10-4 Prófunarflug á Keflavíkurflugvelli.

Procedure for flight certification/testing in Iceland

Flug
Nr. máls: M-01313/AIG-09
Staða máls: Lokuð
23.03.2016

Tillaga í öryggisátt

Set up a procedure for approval of Flight Certification / Flight Testing that are performed at Icelandic airports and in Icelandic airspace. The procedure should ensure that the airport/ATC service provider (Isavia) is
informed/consulted as applicable

Afgreiðsla

Samgöngustofa hefur brugðist við tilmælunum á þann hátt að verkferill hefur verið útbúin og tryggir hann að ávallt verði haft samráð við rekstraraðila flugvalla og flugleiðsögu áður en heimild til flugvottanna og/eða flugprófanna er gefin út af Samgöngustofu.

Independent auditing role of flight certification officers

Flug
Nr. máls: M-01313/AIG-09
Staða máls: Opin
23.03.2016

Tillaga í öryggisátt

Ensure that on-site flight certification officers maintain an independent auditing role from the flight crew of the manufacturer

Afgreiðsla

Not actioned by the Russian Ministry of Industry and Trade.

Change to emergency slide system

Flug
Nr. máls: M-01313/AIG-09
Staða máls: Lokuð
23.03.2016

Tillaga í öryggisátt

In conjunction with the manufacturer, ensure that necessary changes are made to the emergency escape slide design of RRJ-95B aircraft EASA certified under type certificate EASA.IM.A.176 to meet the maximum wind requirements of EASA CS-25.810(iv)

Afgreiðsla

EASA has contacted the manufacturer and the Interstate Aviation Committee-AR in order to review the compliance of the slides with the certification requirements.

Verklag við lendingar á jöklum og í snjó

Flug
Nr. máls: M-00414/AIG-02
Staða máls: Lokuð
10.08.2017

Tillaga í öryggisátt

RNSA beinir því til Norðurflugs að setja í handbækur sínar verklagsreglur varðandi lendingar á jöklum og á snjó, þegar hætta er á að flugmenn geti misst viðmið á jörðu.

Afgreiðsla

Norðurflug hefur innleitt tillöguna á eftirfarandi hátt:

  • Hluti í handbók 8.1.2.2
  • Hluti af OPC formi
  • Hluti af þjálfun fyrir þyrlu skíðun þar sem einkum reynir á þetta og í kennsluefni er ítarlega farið yfir „whiteout“
  • Hluti af áhættumati sem gert er vegna nýrrar reglugerðar Ferðamálastofu

Tvíþátta mæling eldsneytis við fyrirflugsskoðun

Flug
Nr. máls: M-01214/AIG-09
Staða máls: Lokuð
10.08.2017

Tillaga í öryggisátt

RNSA beinir því til flugskólans Keilis að hann endurskoði handbók flugnema í þeim tilgangi að tryggja tvíþátta mælingu og samanburð á eldsneyti við fyrirflugsskoðun.

Afgreiðsla

Flugakademía Íslands hefur samið nýja eldsneytishandbók og hafa tveir starfsmenn verið þjálfaðir af Olíudreyfingu í meðhöndlun eldsneytissins og aðstoðuðu þeir okkur líka við skrif á handbókinni. 

Að auki hefur flugvélahandbók (OM) hefur verið endurskoðuð:

Aircraft type specific,
􀁸 information and data for fuel consumption;
􀁸 detailed instruction on how to use the provided data;
􀁸 unit of fuel measurement;
are to be found in the manual provided by the manufacturer. Refer to the List of aircraft used for training.
For the applicable fuel calculation form, refer appropriate form in Flight Logger
Both, the instructor/examiner and the student/applicant are familiar with the fuel calculation and the actual fuel data of the aircraft used.
As part of the pre-flight planning, the pilot in command/student shall make a careful calculation of the amount of fuel required specific to the intended flight session. In addition, the following shall be taken into consideration:
􀁸 the correct and consistent application of the fuel consumption data including associated unit of measurement as applicable for the concerned aircraft;
􀁸 the actual and forecast meteorological conditions;
􀁸 the planning of an alternative course of action to provide for the eventuality that the flight cannot be completed as planned;
􀁸 possible traffic delays for the anticipated ATC routings and aerodromes;
􀁸 any other condition that may delay (e.g. temporary operating restriction or closing of runway / and/or aerodrome, required re-routing) the landing of the aircraft;
􀁸 procedures specific to the type of aircraft, such as failure of one engine while en-route, loss of pressurisation etc. or any other condition that may increase the fuel and oil consumption.
As part of the briefing, the instructor shall evaluate the student’s fuel calculation prior to commencing the flight.

Re-evaluation of CRM training

Flug
Nr. máls: M-01513/AIG-11
Staða máls: Lokuð
12.06.2017

Tillaga í öryggisátt

It is recommended to the operator to re-evaluate its CRM training.

Afgreiðsla

Since the time of the Accident the company taken a number of measures to analyse, identify risks and mitigate. Effort has been made to keep ICETRA and RNSA abreast of all findings and changes resulting thereof. A number of changes include reconsideration of CRM/Human Factors elements in traininig and the operation as a whole. Changes include, but are not limited to:

  • Company’s Emergency Response plan has been revised and published.
  • A new, yonger model aircraft was purchased, financed and registered. TF-MYA. A factor in the descision was the superior avionics package, including traffic advisory system and terrain awareness functions.
  • The company discarted the practice of conducting every other recurrent training in actual aircraft and in stead opted to conduct all recurrent training in full flight simulators.
  • Normal operating procedures where completely rewritten and operational philosophy redefined to include industry best practices. Outside consultation was sought and used in this process to ensure a broader perspective.
  • Normal checklist system revised based on new operational philosophy and new checklists published.
  • Stricter emphasis placed on procedural adherence and standardization in all training. This effort is ongoing.
  • Effort launched to reiterate that individuality in procedural adherence is not acceptable by management. This effort is ongoing.
  • Training has and will continue to include material aimed at enforcing the relationship between flight standardization, professionalism and safety.
  • IFR/VFR policy has been rewritten and published to make clear under what conditions visual flying is allowed. New policy reviewed in training.