After studying the Aloha aircraft accident in 1933, our group is interested in the investigation in Human performances factors in maintenance and inspection. We have divided the investigation into 5 aspects:
Investigation:
1. The lack of inattention of the mechanics in practical procedures and policies planning.
Aloha Airline operated inter-island flight in Hawaii, therefore, Aloha 243 was operating in salt water environment. During each flight, there was a risk that the air saturated with salt and water vapour would enter the crevice when the aluminium sheets are failed to be bonded to the fuselage by epoxy adhesive, also corrosion of metal is stimulated.
After the accident, a full-scale investigation was launched by the United States National Transportation Safety Board (NTSB). It concluded that the accident was caused by metal fatigue exacerbated by crevice corrosion, the corrosion is exacerbated by the salt water and the age of the aircraft was already 19 years old as the plane operated in a salt water environment.
During the pre-flight inspection, there were no damages or abnormal conditions on Aloha 243 were found. Furthermore, In 1988, when the accident of Aloha 243 happened, Federal Aviation Administration did not have requirement that forced airline operators to carry out inspection between each flight. We can say that the crevice was exacerbated by the salty and moistly air, if inspection was carried out after each flight, this problem must be able to be aware and prevented.
As all the operators and mechanics are trained properly and qualified through adequate testes and examinations, they would be capable to consider about the risk that corrosion will be caused by salt water. Besides, following the authority regulations, they should also carry out any extra inspections specifically required according to the status of aircraft (eg: age, structural and functional properties etc) ensure the aging aircraft was not in risk or damages were made to the aircraft during the flight. (In this case, if inspection is carried out after each flight, accident will be prevented.)
Inspection between each flight besides avoiding accidents, it also helps engineers to understand what problems that would be aroused by operation environment. Pre-flight inspection of Aloha 243 was only carried out before the first flight each day which is inadequate. Besides, all inspection records at each inspection should be kept; it records all the status of the parts and help engineers to understand how the aircraft structures would be affected after each operation.
Titanic and the SS Maheno. The well know ship “The Titanic” now lies 3,800 m under water off the shore of Newfoundland where it sunk back in 1912 after colliding with an iceberg, the ship is now rapidly rusting and disintegrating. The SS Maheno is a major tourist attraction that lies on the east coast of Fraser Island, Australia. It was a trading ship between New Zealand and Australia from years 1905 to 1935, and also participated in World War I for the New Zealand Naval Force. The wreck was left there to disintegrate after the owners refused to pay to move it. Corrosion is ‘a chemical process by which a metal is oxidised. ’ (corrosionist.com). Iron is the only metal that rusts and occurs out of the chemical processes, oxidation and reduction. In most cases, corrosion of iron occurs when the metal is losing its electrons, this is oxidising. Another cause behind the occurrence of rusting is ‘rust eating bacteria’ at deep enough levels of the ocean. And finally, abiotic factors such as salinity, pH and oxygen levels have an impact on the rusting or shipwrecks. The last cause to be discussed is environmental effects such as salinity, pH and oxygen levels.
In all the National Transportation Safety Board concluded there were twenty-three findings that directly contributed to this airplane accident. I will address the ones I feel carried the most impact where if the instance was removed the accident would have be...
for the workers of the company. All the blame is not due to poor design and construction flaws, but to the oil companies for not teaching the employees about the system. This disaster could have been prevented if the engineers and oil companies were not blinded by their ignorant beliefs that the Ocean Ranger was unsinkable. Citations 1. http://www.canadianheritage.org/reproductions/21050.htm.
According to “A Human Error Approach to Aviation Accident Analysis…”, both authors stated that HFACS was developed based off from the Swiss Cheese model to provide a tool to assist in the investigation process to identify the probable human cause (Wiegmann and Shappell, 2003). Moreover, the HFACS is broken down into four categories to identify the failure occur. In other words, leading up to adverse events the HFACS will identify the type error occur.
MAINTENANCE: Keep our station and boats running and looking great. Preventative maintenance, material condition, and house-keeping are the responsibilities of everyone.
Rodney Rocha is a NASA engineer and co-chair of Debris Assessment Team (DTS). When possibility of wing damage appeared he requested an additional imagery to obtain more information in order to evaluate the damage. This demonstrates that he actually tried to resolve the issue. However, due to absence of clear organizational responsibilities in NASA those images were never received. Since foam issue was there for years and risk for the flights was estimated as low management decided not to proceed with this request. After learning of management decision Rocha wrote an e-mail there he stated that foam damage could carry grave hazard and have to be addressed. At the same time this e-mail was not send to the management team. Organizational culture at NASA could be described as highly bureaucratic with operations under standard procedures only. Low-end employees like Rocha are afraid to bring any safety-related issues to the management due to delay of the mission. They can be punished for bringing “bad news”. This type of relationship makes it impossible for two-way communication between engineers and managers, which are crucial for decision-making in complex env...
In conclusion, many contribution factors led to the Crossair flight 3597 crash but is mainly triggered by Crossair’s incapability of assessment, pilot error and lastly the air traffic controller. Analysis of a flight crash is important so that we will know the causes, thus being able tackle it, making sure that there are no other flight crashes like Crossair flight 3597.
Furthermore, investigators discovered that faulty switch attributed electrical actuation for the door to open. This means that the cargo door had a design flawed, which allow the door open during flight. Despite the nine fatalities, United Airlines flight 811 had landed Honolulu with 328 passengers. With that in mind, the survivals of Flight 811 was grateful for the flight crew landed safely with their cripple plane.
After the collision, six watertight compartments began filling with water. Soon, water spilled over the tops. Scientists have concluded that the watertight compartments contributed to the disaster by keeping the flood waters in the bow of the ship [Gannon, 1995].
The National Transportation Safety Board determines that the probable cause of this accident was the failure of the flightcrew to monitor the flight instrument during the final 4 minutes of flight, and to detect an unexpected descent soon enough to prevent impact with the ground. Preoccupation with a malfunction of the nose landing gear position indicating system distracted the crew's attention from the instruments and allowed the descent to go unnoticed.
...irplane that the inspector can navigate through via voice commands to mark a region of the airplane that is in need of service. Once identified, the application tags the area for transmission to the maintenance database and initiates the proper form for the inspector to fill out. The form is completed and then transmitted to the same maintenance database. When the inspector has identified all of the problems with a particular region, voice navigation is used to continue to other areas of the aircraft. The inspector is not required to take any information about the aircraft, previous defect records, clipboards, paper, etc. with them, everything required to perform the inspection is on-line and displayed in a manageable fashion in real time during the inspection. When the inspector completes the inspection, no further input is required. The inspector is not required to take notes and then pass them off to someone else to decipher and input to the system. The information is already in the maintenance database and ready for verification, planning, and scheduling.
Potapczuk, M. (n.d.). Aircraft Icing. Retrieved February 18, 2005, from Research Associateship Program website: http://www4.nationalacademies.org/PGA/rap.nsf/ByTitle/44.54.44.B1317?OpenDocument
Throughout the history of aviation, accidents have and will continue to occur. With the introduction of larger and more complex aircraft, the number of humans required to operate these complex machines has increased as well as, some say, the probability of human error. There are studies upon studies of aircraft accidents and incidents resulting from breakdowns in crew coordination and, more specifically, crew communication. These topics are the driving force behind crew resource management. This paper will attempt to present the concept of crew resource management (CRM) and its impact on aviation safety in modern commercial and military aviation. The concept is not a new one, but is continually evolving and can even include non-human elements such as computer-controlled limitations on aircraft maneuvers and the conflicts that result in the airline industry.
Aircrafts undergo a variety of stresses, strains, vibrations, and detrimental environments. It is important to inspect the aircraft regularly in order to keep the aircraft operable, which inspections of the aircraft is a big part of proper maintenance. There are many types of inspection; the most common one is pre-flight inspection and post-flight inspection. Under the Canadian Aviation Regulations (CARs), a pre-flight inspection is mandatory for Pilot Proficiency Check. During a pre-flight inspection, the pilot should use the pre-flight checklist to perform an inspection on the exterior and interior of the aircraft. It is a chance for the pilot to check any defects on the aircraft that may cause a problem, and the readability of the radio signals.