AM EDITORIAL: Why Safety Recommendations from Accident, Incident Reports Should Be Implemented
After every aviation incident or accident, the Nigerian Safety Investigation Bureau, (NSIB) formerly called the Accident Investigation Bureau, Nigeria (AIB-N) investigates the occurrence and releases reports after carrying out investigations in accordance with Annex 13 to the Convention on International Civil Aviation, Nigerian Safety Investigation Bureau (Establishment) Act, 2022, and Civil Aviation (Investigation of Air Accidents and Incidents) Regulations 2023.
Accident and incident reports are not intended to apportion blames or liability but to seek prevention of reoccurrence and further safety enhancements. This is why the NSIB reports are confined to matters of safety significance, which should not be used for any other purpose.
Most of such safety recommendations are “addressed to the Regulatory Authority of the State (NCAA) as well as other stakeholders, as appropriate. This authority ensures
enforcement.”
It is on this basis that we encourage all aviation stakeholders to treat safety recommendations from each accident or incident report as an emergency in terms of implementation. Each safety recommendation if implemented, fills a loophole in the relevant segment of aviation safety.
For instance, the safety recommendations in the NSIB report on the Serious Incident involving Beech Baron 58 aircraft operated by Nigerian College of Aviation Technology (NCAT), Zaria with nationality and registration marks 5N-CAG which occurred on runway 05 at General Hassan Usman Katsina international Airport, Kaduna Nigeria on December, 31 2022, reads: “Nigeria Civil Aviation Authority should ensure that the Nigerian College of Aviation Technology (NCAT), Zaria strictly adhere to the Flight Instructor’s refresher courses in accordance with the NCAT Flying School Procedure Manual Chapter 4 subsection 4.4.1 and section 3.2.1.14 (d) (1) of Nig. CARs 2015 and 2023 respectively,” and “Nigeria Civil Aviation Authority should ensure that the Nigerian College of Aviation Technology (NCAT), Zaria strictly adhere to the Flight Maintenance Engineer’s refresher course, in accordance with the NCAT Maintenance Management Exposition Part 3 Subsection 3.4.0 and section 3.2.1.14 (d) (1) Nig. CARs 2015 and 2023 respectively.”
Apart from safety enhancement, compliance with the above recommendations on NCAT Courses will improve the institution’s academic standards and help forestall reoccurrence of similar incidents.
NSIB Final report on the ground collision incident involving an EMB-135BJ aircraft operated by Max Air Limited with nationality and registration marks 5N-BXK and a parked ATR 42 aircraft operated by Nigerian Air Force registered NAF 930, which occurred on the apron of the General Aviation Terminal of Nnamdi Azikiwe International Airport Abuja on April 26, 2022 stated that “Apron Congestion was identified as a HAZARD to operation of aircraft at the aprons of the airport and the associated high risk level was in the unacceptable region.”
Recommendation was that ”Federal Airport Authority of Nigeria (FAAN) should provide adequate resources to ensure effective implementation of its safety management system, including the immediate recruitment, subsequent training and deployment of adequate number of Marshallers to provide guidance to aircraft for safe operation at the Nnamdi Azikiwe International Airport.
Federal Airport Authority of Nigeria (FAAN) should adhere to Section 3.6 of Nnamdi Azikiwe International Airport Safety Management System Manual to ensure the implementation of all the outstanding Risk Control measures contained in its Hazard and Risk Register, including the timely completion of the GAT/Cargo Apron expansion project to ensure additional parking space is made available to reduce the congestion of the apron.”
It also recommended that “Nigerian Air Force should ensure that all its personnel deployed to perform duties at the GAT/Cargo Apron of Nnamdi Azikiwe International Airport are provided with the required training, tools and equipment to enable them perform the assigned duties in line with the procedures, instructions, safety rules and guidance established by the airport authority to ensure safety of operations” and “Nigerian Civil Aviation Authority should facilitate cooperation between the Federal Airports Authority of Nigeria and the military authorities, in particular, the Nigerian Air Force to ensure coordination and harmony is achieved in order to improve safety of operations at the Nnamdi Azikiwe International Airport.”
Implementation of these recommendations would no doubt, help address challenges of apron congestion, shortage of Marshallers, training of personnel, collaboration between aviation civil and military personnel and other ground safety threats at the airport. It will also help to strengthen capacity on aircraft marshalling and enhance guidance while improving safety alongside enhancement of professionalism.
On the ground collision between a conveyor belt TUG660 truck with fleet number 49/9 operated by Skyway Aviation Handling Company (SAHCO) Plc and a parked Arik Air’s Boeing 737-800 aircraft, which happened on February 3, 2022 at Nnamdi Azikiwe International Airport Abuja, involving aircraft nationality and registration marks 5N-MJQ owned and operated by Arik Air Limited, NSIB recommended that “SAHCO PLC should ensure adherence to the provisions section 19 (1) of the Civil Aviation (Investigation of Air Accidents and Incidents) Regulations 2019 regarding tampering with evidence.”
The criticality of implementation of this recommendation is in the criticality of prevention of reoccurrence of such incident which might not reoccur in a way as “mild” as it has happened in this case.
We posit that implementation of safety recommendations from accident and incident reports should be given a priority attention by stakeholders when they are released. Safety recommendation implementation is in the interest of safety. AM
