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ATSB Preliminary Reports


ave8rr

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I know there has been a numerous amount of discussion in the Old Bar Accident thread.

 

I have always gained alot from ATSB reports both preliminary and final and was extremely pleased to see that the ATSB were involved in the Old Bar Ferris Wheel accident back in Oct. I still don't know why they attended this accident when clearly they will not attend others. What made them interested in this accident? The Preliminary Report has brought to light some failings in a number of areas and is to be commended. It is for this reason that I believe reports of this kind should be published for all RA Aus accidents / incidents whether fatal or not. If the ATSB cannot or will not attend then RA Aus should publish their preliminary findings as soon as possible after the event. I think it is ATSB policy to have a Prelim Report out with in 30 days.

 

Moderators. You may want to move this to one of the already running threads.

 

Cheers

 

 

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Nobody disagrees with your sentiments . the difficulty is that ATSB don't usually do any investigations of RAAus incidents. The police, and the coroner are in charge of ours , so there are restraints on what can be printed/ discussed., till the investigation/inquest is finalised. Nev

 

 

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Nobody disagrees with your sentiments . the difficulty is that ATSB don't usually do any investigations of RAAus incidents. The police, and the coroner are in charge of ours , so there are restraints on what can be printed/ discussed., till the investigation/inquest is finalised. Nev

Thanks Nev, but why the interest in this accident (Non fatal) that the ATSB were involved??

Cheers

 

 

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ATSB is free to do whatever it wants, but a possible reason would be the near miss to multiple victims. I know our land is not populated by wayward ferris wheels, but ATSB has exhibited a hit and miss approach to investigations before. One that comes to mind is what appeared to be a turn back crash by one of Australia's best pilots, which would have given ATSB the opportunity of educating a new generation of Australians on a problem as old as powered flight.

 

 

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ATSB is free to do whatever it wants, but a possible reason would be the near miss to multiple victims. I know our land is not populated by wayward ferris wheels, but ATSB has exhibited a hit and miss approach to investigations before. One that comes to mind is what appeared to be a turn back crash by one of Australia's best pilots, which would have given ATSB the opportunity of educating a new generation of Australians on a problem as old as powered flight.

Im with turbz,on this as I also think this one has been investigated because of the near miss to multiple victims. The ATSB have pick and choose which accidents they investigate, purely because there is only a certain amount of money and staff to go around.They try and investigate accidents "which enhance transport safety". Thats straight out of the link that Ahlocks has provided us.

 

 

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And had the ATSB not investigated this one then I guess we would not of been discussing the poor aviation engineering practices of the aircraft in involved amongst other things in the other thread. I can't help but think that this was brought on by CASA to show RA Aus they are looking for short falls in it's practices followed shortly after by an Audit. I have no beef with either CASA or RA Aus as I hold both a CPL and RA Aus Certificate.

 

Cheers

 

 

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Sorry to be slow in response av8rr. I speculated on this a while back. and all I could do is speculate again (and I won't bother). as I get a bit cynical.

 

Originally it was a a matter of cost and the fact that we don't carry anyone but an informed person who is (supposed to be) aware that we don't operate to "normal" certified standards. We are stuck with what we have, if they don't participate ,( which is nearly all the time). Nev

 

 

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In fact there's an opportunity for RAA to pull ahead of CASA in this. When you look at the standard in Macarthur Job's time, you just have to hang your head in shame at the coldn't care less approach by CASA today to teaching lifetime lessons.

 

Biggest issue with RAA is not publishing what it knows - I think. Srely no one could be so dumb as to investigate an accident and then write something like "shortly after landing the aircraft veered to the right, hit a ditch and went arx up?

 

 

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Well publish that then, at least we'd get the message to work on the system, even if on a voluntary basis. Plenty of Associations do that. No shame ever in admitting you aren't on top of things and need more help/could do better.

 

 

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Guest Maj Millard

I feel the ATSB got involved because it became such a high-profile accident, plus the fact that it could have easily have become a high casuality accident, as some of you have already suggested.

 

Had the ferris wheel been real busy, and had all it's seats occupied, the outcome could well have been different.

 

Maybe CASA has already said to the ATSB that we are having regular accidents, so we may well be on their radar now for investigations...What we need to do as a group is to identify what is giving us the regular incidents, and do what we can to fix that problem...................................................................Maj...024_cool.gif.7a88a3168ebd868f5549631161e2b369.gif

 

 

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I very recently was talking to one of the ATSB investigators and he said they were not interested in investigating the Old Bar incident.

 

They became involved due to public and political pressure to do so - read into that what you will. I suppose the public think that it is just not the done thing to land an aircraft in a ferris wheel that their little Johnny is riding on!

 

As for fatal accidents, they did not investigate the Mundubbera crash as the aircraft was destroyed by fire.

 

It would also appear that they are very happy in the way that RAAus handles both safety and accident investigations but as was stated earlier, it would be good to get a prelim report ASAP if only to quell the speculation.

 

I have lost three freinds in aircraft accidents this year so I wish people would stop killing themselves in aeroplanes - please.

 

 

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I have lost three freinds in aircraft accidents this year so I wish people would stop killing themselves in aeroplanes - please.

Yeah, well bilby, while the Police keep the results to themselves, we are going to continue to repeat those mistakes whether we are safety orientated or not.

 

 

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Interesting how the ATSB word their preliminary reports and it can be very misleading.

 

The recent loss of the C210 north of Injune states "Terrain Colloision". Well, yes but after it was ripped apart in mid air and the bits eventually hit the ground.

 

It can give the impression that the pilot flew the aircraft into the ground when it is not the case in this instance.

 

I can only assume (there's that word again!) that they comment on what they find when first on scene so that would lead to all preliminary reports being "Terrain Collision"??

 

 

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Interesting how the ATSB word their preliminary reports and it can be very misleading.The recent loss of the C210 north of Injune states "Terrain Colloision". Well, yes but after it was ripped apart in mid air and the bits eventually hit the ground.

 

It can give the impression that the pilot flew the aircraft into the ground when it is not the case in this instance.

 

I can only assume (there's that word again!) that they comment on what they find when first on scene so that would lead to all preliminary reports being "Terrain Collision"??

Just had a look on ATSB, and unless I missed it, the Prelim Report hasn't yet been done. What's on the site is just the bare details, investigators sent out. I suspect the collision with terrain classification is just to separate it from runway overruns, proximity etc. I'd expect the Preliminary Report to spell out the break up in the air at that time, so maybe a couple of months yet. Read that the pilot was well respected.

 

 

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  • 2 weeks later...
In fact there's an opportunity for RAA to pull ahead of CASA in this. When you look at the standard in Macarthur Job's time, you just have to hang your head in shame at the coldn't care less approach by CASA today to teaching lifetime lessons.Biggest issue with RAA is not publishing what it knows - I think. Srely no one could be so dumb as to investigate an accident and then write something like "shortly after landing the aircraft veered to the right, hit a ditch and went arx up?

Hi Turbo,

 

Some clarification. ATSB "owns" all accidents and incidents and it will pick and choose which ones it investigates. I personally would like to see them do all fatals, but they have budget constraints and only investigate those which it feels can provide learning. Sometimes it is directed to do high profile accidents by political pressure.

 

Re RAAus. If ATSB declines to investigate, it is passed to the police and although an RAAus Investigator may do the work his report is handed to the police and then on to the Coroner. It is the Coroner who releases the report, and yes I know this can take years and is unsatisfactory. I personally would like to see our investigators working under ATSB control and supervision. We could do the work and hand the report to ATSB and they could release a prelim. like they do now. But we can only lobby and hope.

 

Cheers

 

John McK

 

 

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I personally would like to see our investigators working under ATSB control and supervision. We could do the work and hand the report to ATSB and they could release a prelim. like they do now.

That sounds reasonable and more seamless to for day to day communications, training etc, and it may be good enough to convince Police to hand over parts of their report which would be of future use to pilots.

 

 

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If ATSB declines to investigate, it is passed to the police and although an RAAus Investigator may do the work his report is handed to the police and then on to the Coroner. It is the Coroner who releases the report, and yes I know this can take years and is unsatisfactory. I personally would like to see our investigators working under ATSB control and supervision. We could do the work and hand the report to ATSB and they could release a prelim. like they do now. But we can only lobby and hope.

Cheers

 

John McK

We need to lobby harder John to get reports out (even if preliminary) as soon as possible after an accident / incident. As TP stated in post 9 "shortly after landing the aircraft veered to the right, hit a ditch and went arx up" Was the aircraft landing with a tail wind, too fast, lost directional control etc etc?

 

 

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... If ATSB declines to investigate, it is passed to the police and although an RAAus Investigator may do the work his report is handed to the police and then on to the Coroner. It is the Coroner who releases the report, and yes I know this can take years and is unsatisfactory. I personally would like to see our investigators working under ATSB control and supervision. We could do the work and hand the report to ATSB and they could release a prelim. like they do now. But we can only lobby and hope.

I think the problem is that there is a risk of litigation if someone other than the coroner or ATSB releases information attributing "fault" which is then unable to be proven at a later stage. Unlike the coroner, ATSB is not immune but individual employees are protected by the vicarious liability of their employer and the ATSB itself has a very strong public interest defence). There is an added problem if charges are subsquently filed because defence can argue it is no longer possible to receive a fair trial because their client has already been identified and "judged" by publication in the media.

 

kaz

 

 

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Not a legal qualified person kaz, but that would be only likely to address the effect on the jury, being presumed " susceptible" to such an influence The "Judiciary' being posessed of superior intellect and capable of dissociating themselves from such bias or portrayal of facts, would not be affected (I presume). Forgive my cynicism, It comes with age, exposure to reality, and maturity. As said in animal farm . "All people are equal but some are more equal than others". Ain't that the truth... Nev

 

 

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I think the ATSB/CASA were waiting patiently for an RA-Aus incident/accident to involve more than a pilot and passenger. The last ATSB investigation involving an RA-Aus aircraft was the LaTrobe valley mid-air from memory. That aircraft was an amatuer-built and, apart from saying it had no maintenance records for over 10 years prior to the accident, they dismissed any construction issues. Pilot had 2400 hours also so they could dismiss training standards - although the instructor of the first-solo pilot of the 150 involved was dragged over the coals a little.

 

This being a factory-built aircraft, flown by a low-time pilot into a public gathering has a much better 'bang for your buck' from the ATSB/CASA's viewpoint i'd think.

 

 

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