Home Aviation AIB-N Charges Stakeholders on Use of Agency’s Investigation Safety Recommendations

AIB-N Charges Stakeholders on Use of Agency’s Investigation Safety Recommendations

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…harps on capacity building
…as Agency releases 3 final reports, 2 safety bulletins

 

In fulfillment of its promise, the Accident Investigation Bureau, Nigeria (AIB-N), Wednesday released another three final serious incident reports and two Safety Bulletins to the general public, urging stakeholders to avail themselves of the safety recommendations by the Agency.

Releasing the reports on Thursday, at the Agency’s Corporate Headquarters in Abuja, Commissioner of AIB-N, Engr. Akin Olateru, noted that the Ministry of Aviation, the agencies, the airline operators, even the air traffic controllers and other professionals, observe their various duties daily with the safety of the Nigerian airspace at the forefront of their minds because ensuring safety in the Aviation Industry is very important.

In view of this, Olateru said the AIB-N fulfills its obligations of ensuring safety of the Nigerian airspace through the release of these occurrence reports as they serve as the strong foundation on which the safety of the Industry is built.

He said: “Like I always say, timely release of occurrence reports is very crucial to the delivery of AIB’s mandate of investigating air accident and serious incidents with the aim of forestalling such occurrence from reoccurring.

“This is why the Bureau under my administration is doing all its best possible to ensure that aircraft accident and serious incidents that fall under the purview of AIB-N are promptly, excellently and professionally investigated by our well-seasoned air safety investigators.”

He therefore urged the stakeholders, on their part to ensure that they avail themselves of the AIB-N reports, draw useful lessons from them and implement the safety recommendations where applicable, saying that If they fail to do these, all the time and resources invested into the investigation of serious incidents and accidents by AIB-N would have been wasted.

The Commissioner also implored all domestic airline operators and professionals in the Industry especially, to always take time to read AIB-N reports with a view to drawing lessons that can improve aviation safety in their individual operations. “This is regardless of whether they were involved in the occurrences investigated or not.

“Safety recommendations are critical to the Bureau’s basic role of accident prevention since it is the lever used to bring about safety changes to, and improvements in the nations aviation system.

“It is therefore expected that the stakeholders would take the AIB-N safety recommendations very seriously and complement AIB-N’s efforts by implementing the recommendations, where applicable, to prevent future recurrence of similar events.

“Safety in the aviation sector is a collective exercise and therefore requires that stakeholders including agencies, operators and relevant professionals accept responsibilities and play their parts creditably. This is the way to go if we must sustain the current impressive level of safety in the Nigerian aviation sector.

“The purpose of accident investigation, however, is not to apportion blame or liability but to prevent future recurrence of similar incidents,” the he further pointed out.

Three weeks ago, AIB-N released four final reports to the public. Inclusive in those final reports were eight (8) Safety Recommendations.

With the release of three additional reports on Thursday, AIB-N has so far released a total of 59 final reports since its establishment in 2007 while a total of 40 final reports out of these were under the current administration of the Bureau.

The three reports came with 16 safety recommendations making a total of 211 Safety Recommendations released since the inception of AIB and a total of 127 Safety Recommendations released under the current administration.

According to Olateru, the two Safety Bulletins released on Thursday made the total of three Safety Bulletins released by the Bureau, noting that all Safety Bulletins released by the Bureau so far were released under his administration at AIB-N.

The reports:
A. Report on the Serious Incident involving a Gulfstream G-IV aircraft owned and operated by Skybird Air Limited with nationality and registration marks 5N-BOD, which occurred at Nnamdi Azikiwe International Airport, Abuja on 12th September, 2018.

Causal factor
Delayed response by the crew to recognise that the ground spoilers and thrust reversers were locked out led to the runway overrun.

Contributory factor
The delayed deployment of ground spoilers led to the flight crew’s problems in stopping the airplane within the remaining available runway length.

Nine safety recommendations were made:

1. The Federal Airports Authority of Nigeria (FAAN) should ensure that disabled aircraft are promptly removed from the incident site in accordance with Disable Aircraft Recovery Manual of the Nnamdi Azikiwe International Airport (NAIA) Abuja (Chapter 3 Removal Instructions NAIA).

2. FAAN should ensure the roles and responsibilities of stakeholders as stipulated in the Airport Emergency Plan (AEP) are strictly adhered to in case of any occurrence.

3. FAAN should ensure that ARFFS units are adequately staffed at a level that enables ARFFS personnel, upon arrival at an accident scene, to conduct exterior fire-fighting activities, interior fire suppression attack and a rescue mission concurrently.

4. The Nigeria Civil Aviation Authority (NCAA) should ensure that all G-IV operators adhere strictly to normal operating procedures regarding the nutcracker system.

5. NCAA should ensure that all G-IV operators require flight crew to call-out if the ground spoilers do not automatically deploy and the thrust reversers are not deployed during landing, also a call-out when the ground spoilers have deployed, and verify they include these procedures in their checklists, and training programs. The procedures should clearly identify which pilot is responsible for making these call-outs and which pilot is responsible for deploying the spoilers if they do not automatically deploy.

6. NCAA should intensify its oversight function on Skybird Air Limited’s operations.

7. NCAA should comply with the Air Operators Certificate (AOC) application/renewal process and ensure that the process is completed in accordance with the guidance materials issued by the Authority prior to issuance of the AOC to applicants.

8. SkyBird Air Limited should ensure that all their cabin crew are adequately and properly type rated on specific aircraft to be flown by a cabin crew member in accordance with the Operations Manual.

9. SkyBird Air Limited should ensure that all flight release documents are duly signed by the commander of the flight before departure and appropriate copies kept on board the flight.

B. Report on the Serious Incident involving a Boeing 747-200 aircraft owned and operated by Kabo Air Ltd with nationality and registration marks 5N-JRM which occurred at Sultan Abubakar Airport, Sokoto (DNSO), Sokoto State on 4th October, 2013.

Causal factor
Inappropriate visual approach profile at night with no vertical guidance.
Contributory factors
1. Unserviceable Visual Approach Slope Indicator (VASI) on Runway 26.
2. Decision to land on the non-precision runway 26 at night.

One safety recommendation was made:
Kabo Air should ensure that flight recording devices (FDR and CVR) installed on all aircraft in its fleet are preserved, maintained, serviceable, and operated in accordance with the provisions of the existing Nigeria Civil Aviation Regulations (Nig. CARs) Parts 7.8.1.3, 7.8.1.4 (a), 8.5.1.24 (b)(c) and 8.14.10.3 (a).

C. Report on the Serious Incident involving a B737-500 aircraft owned and operated by Aero Contractors Company of Nigeria Ltd with nationality and registration marks 5N-BLG, which occurred on Runway 18R, Murtala Muhammed International Airport, Ikeja, Lagos on 9th April, 2016.

Causal factor
Excessive rudder application by the crew after touchdown.

Contributory factors
1. Reduced visibility due heavy rain on touchdown.
2. The decision to continue approach in an unfavourable weather condition with crosswind component of 090˚ /15kt.

Three Safety Recommendations were made:
1. Aero Contractors Company of Nigeria Limited should lay more emphasis during flight crew simulator trainings, on the effects of excessive rudder application at high speeds during landing roll, particularly on wet/contaminated runways.

2. Aero Contractors’ management should sensitise their crew members on the necessity of reporting notifiable occurrences.

3. NCAA should ensure that all airline operators review their Standard Operating Procedures (SOPs) to include procedure for isolating power to the cockpit voice recorder to preserve its contents from being overwritten, in the event of any reportable occurrence.

Bulletin reports
1. Bulletin- report on the incident involving a tampico club tb-9 aircraft owned and operated by nigerian College of Aviation Technology (NCAT) with nationality and registration marks 5N-CBG which occurred at Zaria aerodrome, Kaduna state on 10th December, 2013.

One Safety Recommendation was made:

NCAT should ensure that Flight Instructors emphasise to the student pilots the need for a Go-Around whenever excessive ballooning/bouncing occurs during landing exercises.

2. Bulletin- report on the incident involving a Tampico Club TB-9 aircraft owned and operated by NCAT with nationality and registration marks 5n-CCB which occurred at Zaria Aerodrome, Kaduna State on 18th June, 2014.

Two Safety Recommendations were made:

1. NC AT should include into its Flying School Procedure Manual requirements for mandatory occurrence reporting (MOR) by student pilots.

2. NCAT should include into its Flying School Procedure Manual that any unplanned exercise/maneuver that the Student Pilot wishes to practice should be discussed with the Flight Instructor.

Therafter, Olateru appreciated the Minister of Aviation, Sen. Hadi Sirika, for his continuous support of our activities at AIB-N, as well as his team of air safety investigators for their relentless effort in ensuring that aircraft accidents and serious incidents are effectively, efficiently and professionally investigated with final reports on these occurrences promptly released.

He boasted that AIB-N’s air safety investigators are well seasoned and well-trained professionals even as the Agency’s facilities are among the best in the world as regards aircraft accident investigations.

The Commissioner posited that every organisation needs to recognise that continuous human training and capacity building is very important in order to get the best out of their staff.

“This, coupled with equipping them with the right tools that they would require during the discharge of their duties will allow them to effectively and efficient perform excellently.

“This we have been able to recognise and achieve at AIB and I would like to call on other agencies and organisations in the Aviation Industry and outside the Aviation Industry to recognise human training and capacity building as one of the most important means of boosting their staff performance thereby boosting their prestige and resources,” he advised.

Olateru also appreciated organisations and agencies who had worked with AIB-N during the course of its investigations, saying that without their cooperation, “we cannot effectively and efficiently achieve our mandate.

“An enhanced positive working relationship during the course of achieving its mandate is what AIB is seeking from its collaborations with other organisations and agencies.”

He assured that AIB-N would not relent in its efforts of seeking new innovative ways that would ensure the continuous safety of the Nigeria airspace and Africa.
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