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ASSASS
Mr. Bob Hahn
Associate Director, School of Aviation Safety
Naval Aviation Schools Command
NAS Pensacola
MISHAP PREVENTION EDUCATION
IN
NAVAL AVIATION
ASSASS SIGNAL CHARLIESIGNAL CHARLIE
Dallas TX 29-30 Mar 2011Dallas TX 29-30 Mar 2011
ASSASS It’s a big outfit
• We have a lot (over 300) Squadrons
• We have a lot of people – staff, maintainers, pilots, aircrew
• We have a broad span of operations
• How to daily make the right decisions at all levels, and operate the airline company safely …
ASSASS It’s a big outfit
• … that’s the mission of the USN/USMC School of Aviation Safety and the Naval Safety Center
Navy/Marine Corps Navy/Marine Corps ChallengeChallenge
““I challenge I challenge all of you to all of you to reduce reduce mishaps . . . mishaps . . . at least 75% at least 75% by FY 12.”by FY 12.”
--Secretary of Defense--Secretary of Defense
ASSASS Purpose of the ASO CoursePurpose of the ASO Course
• Prepare officers in the policy, philosophy, and techniques of Prepare officers in the policy, philosophy, and techniques of managing and effective command aviation safety programmanaging and effective command aviation safety program
• Teach mishap investigation and preparation of investigation Teach mishap investigation and preparation of investigation reportsreports
• Educate officers in aeronautical topics to add to the Educate officers in aeronautical topics to add to the professional knowledge base in fleet squadrons in order to professional knowledge base in fleet squadrons in order to cultivate critical thinking skills which in turn contribute to cultivate critical thinking skills which in turn contribute to safety in the dynamic environment of naval aviation.safety in the dynamic environment of naval aviation.
ASSASS
• Enhance Combat Readiness!
• Operational Risk Management
• Training and Education
• Accountability
• Leverage New Technologies
• Proactive vs Reactive
• Mishaps vs Accidents
NAVAL SAFETY STRATEGY
Naval Aviation Safety Programs (SMS)
SAFETY EDUCATION
• Aviation Safety Command Course 6 Days
Commanding Officers
• Aviation Safety Officer Course Aviation Safety Officers
4+ Weeks Intensive Instruction
• Crew Resource Management Course 5 Days
Train the Trainer
SAFETY EDUCATIONSAFETY EDUCATION
Its more than just education, its about Its more than just education, its about leveraging the Navy-Marine Corps culture leveraging the Navy-Marine Corps culture and inspiring our students to create a and inspiring our students to create a climate within the command that influences climate within the command that influences good decision making at all levels.good decision making at all levels.
Navy-Marine Corps leadership translates Navy-Marine Corps leadership translates into practices and behaviors that result in into practices and behaviors that result in safe operations which in turn enhance safe operations which in turn enhance mission effectivenessmission effectiveness
ASSASS COMMANDING OFFICERS
• Entrusted with every aspect of Squadron Operations
• “Naval Aviation Safety program is an inherent responsibility of command.”
• Set Standards and Ensure Accountability• Enable a Just Culture to establish a Command
Climate that will promote safe and professional operations to achieve mission accomplishment
ASSASS AVIATION SAFETY OFFICER
• Act as principal advisor to Commanding Officer on all aviation safety matters
• Advise and assist Commanding Officer in complying with instructions
• Maintain safety records & mishap statistics• “ASO” shall be primary billet assignment• Coordinate safety matters among squadron staff• Graduate of ASO course (recommended within 4
yrs.)• Principal Investigator for mishaps and near misses
ASSASS
The “Swiss Cheese” Model of Accident Causation (Reason, 1990)
Excessive cost cutting
Reduction in flight hours resulting from inability to control cost of spare parts
Organizational Factors
Deficient training program
Improper crew pairing
UnsafeSupervision
Loss of Situational Awareness
Poor Crew Resource Management
Preconditionsfor
Unsafe Acts
Failed to Scan Instruments
Penetrated IMC when VMC only
UnsafeActs
Mishap & Injury
Crashed into side of mountain
Failures in theFailures in theSystemSystem
ASSASS
SAFETY INVESTIGATION REPORTS (SIR)
• The final product written by the Aircraft Mishap Board after a mishap
• Used to Report Hazards Uncovered by the Investigation
• Offers Opportunity to Make Recommendations
• Assigns Risk Assessment to Each Hazard• Command Influence Strictly Prohibited• Requires “Special Handling” Due to Privileged
Info
ASSASS HAZARD REPORTINGHAZARD REPORTING
• Every mishap represents many more near Every mishap represents many more near misses and incidents that may go unreportedmisses and incidents that may go unreported
• ““Obligation” to report HazardsObligation” to report Hazards• Identify Human or Material Causal FactorsIdentify Human or Material Causal Factors• Recommend Recommend corrective actioncorrective action to Eliminate to Eliminate
the Hazard (Minimize/Mitigate Risk)the Hazard (Minimize/Mitigate Risk)• Document a continuing hazard to establish Document a continuing hazard to establish
severity/probability and FUNDING to severity/probability and FUNDING to eliminate Hazardeliminate Hazard
• Proactive vs ReactiveProactive vs Reactive
ASSASS SUMMARY
Active Safety Climate Set by Leadership and Required by All
Hands
Mishap Prevention Leads to Combat Effectiveness