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RT-273. Note to Instructors: Download the power point and add your own graphics to the presentation. The notes section of each slide for the lesson plan. Safety Review RT-273 2011. Safecom Review. Web Site: https://www.safecom.gov/default.asp How can I submit a Safecom?

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  1. RT-273 Note to Instructors: • Download the power point and add your own graphics to the presentation. • The notes section of each slide for the lesson plan.

  2. Safety ReviewRT-273 2011

  3. Safecom Review Web Site: https://www.safecom.gov/default.asp How can I submit a Safecom? • Electronic submission from the web site above. • Hard Copy using AMD-34 / FS5700-14 forms. • Faxed to AMD @208-433-5007 Attn: Safety • Faxed to USFS @ 208-387-5735 Attn: Safety • Call – 888-464-7427 NEW !

  4. NEW FEATURE for SAFECOMS !! Attachments can now be added to your SAFECOM, such as a photo or diagram to help clarify the narrative.

  5. Web Site: https://www.safecom.gov/default.asp Last year you were able to take a survey of the Safecom system. The results of the survey were published in 12/ 2010

  6. SAFECOM Survey • The survey collected 473 responses. Of those, 355 identified themselves as federal, 51 state/other, and 67 as vendors • There were over 3,500 comments with an average of 271 comments per question that the SWG reviewed, analyzed and categorized by Management, Field/Pilot and Vendor. • The SAFECOM system is widely seen as a good way to prevent accidents through lessons learned. Personnel have identified reasons why they do not report and none of the reasons are insurmountable.

  7. Top 3 Items Identified for improvement SAFECOM Survey • Training and Promoting the SAFECOM System • Maintenance reporting in SAFECOM. Non safety and unscheduled maintenance reported in the system. • Fear/ Repercussion/Punitive/Negative Connotation

  8. Key Action Items SAFECOM Survey • Develop a SAFECOM training program • Develop a promotional campaign for the SAFECOM system • Provide consistent guidance on maintenance reporting in the SAFECOM system • Ensure that policy establishes a clear understanding that the SAFECOM system is not to be used punitively • Provide consistent SAFECOM guidance throughout various policy documents, handbooks and guides • System functionality and programmatic changes

  9. Web Site: https://www.safecom.gov/default.asp Safecom Survey Report Results published 12/ 2010. See the Safecom Web Site!

  10. Web Site: https://www.safecom.gov/default.asp Click on “Search Safecom’s” to help you narrow down your search or provide you with specific information.

  11. Web Site: https://www.safecom.gov/default.asp Click on the different categories to narrow down your search.

  12. Web Site: https://www.safecom.gov/default.asp

  13. Incidents & Hazards • 4- Dragged or dropped external loads • 18 -Communication issues: Flight Following; Equipment issues; Frequency congestion • 2 -Incidents with Potential: Bucket in powerline and fixed wing fuel exhaustion • 4 -Fixed wing mechanical induced precautionary landings • 5 -Pilot duty day violations • 7 -Weather related: 2 precautionary landings; 2 causing damage to aircraft while on the ground • 3 -Longline: 1 longline over a skid; 2 incorrect swivel configurations.

  14. There were a total of 760 SAFECOMs (398 Forest Service, 312 DOI, 39 State and 11 Other/Unknown/Military/Vendor) submitted to the Interagency SAFECOM database. The following charts trend the Forest Service SAFECOM data submitted. In FY 2010 there were 398 Forest Service SAFECOMs submitted, which is well below the 10-year average of 644.

  15. 2010 Number and Percent of SAFECOMs by Category 10-Year Average Number and Percent of SAFECOMs by Category

  16. Top 10 reported SAFECOMs in FY 2010 were: Communications - 47 Engine - 37 Precautionary landing - 29 Electrical - 22 Avionics - 20) Mission Equipment - 18 Dropped Load - 17 Pilot Action - 15 Airframe - 14 Landing Gear - 13 Avionics and Mission Equipment historically have not been in the top 10. This was due in part to the issues associated with the new radios and the rappellers utilizing the SAFECOM system to report all equipment issues.

  17. SAFECOM Trending & Analysis Access the Lessons Learned Web site to download Safecom Trending and Analysis : http://www.wildfirelessons.net/Additional.aspx?Page=177

  18. Review Safety Alert No. IA 08-07

  19. New Lesson Learned Web SiteOne Stop Shopping for Safety Reference Informationhttp://www.wildfirelessons.net/Additional.aspx?Page=177 “It is the mission of these web pages to facilitate the sharing of information between all aviation users for the purpose of promoting a learning culture and to enhance and sustain safe and effective work practices. ”

  20. New Lesson Learned Web Sitehttp://www.wildfirelessons.net/Additional.aspx?Page=177 • Click on the “Promoting Aviation Safety” • Safety Alerts • Prevention Bulletins • READ Files

  21. New Lesson Learned Web Sitehttp://www.wildfirelessons.net/Additional.aspx?Page=177

  22. New Lesson Learned Web Sitehttp://www.wildfirelessons.net/Additional.aspx?Page=177 • Visit the “Assuring Aviation Safety” section for • Mishap Investigations • Accident Reviews

  23. New Lesson Learned Web Sitehttp://www.wildfirelessons.net/Additional.aspx?Page=177 The “Aviation Risk Management” has many tools to use in helping identify and manage risk.

  24. New Lesson Learned Web Sitehttp://www.wildfirelessons.net/Additional.aspx?Page=177 The “Aviation Policy” section has all the guides and manuals for each agency !

  25. Alerts and Bulletins There are 6 general types of alerts and bulletins that are tracked through the agencies: • Safety Alerts: Safety Alerts are red bordered and published on an as needed basis. They are utilized to disseminate information of significant nature regarding aviation safety. They are segregated into three areas: operations, maintenance, and publications. • Technical Bulletins: Technical Bulletins are blue bordered and are published on an as-needed basis to advise field users of technical changes which could range from facilities to aircraft and everything in between. • Accident Prevention Bulletins: Aviation Accident Prevention Bulletins are green bordered and published on an as needed basis. They are  utilized to disseminate information of a general nature regarding aircraft mishap prevention concepts, methods, procedures and efforts. • Aviation Lessons Learned: Lessons Learned are purple bordered and published on an as needed basis. They are utilized to disseminate information of significant nature regarding aviation safety. They are segregated into three areas: operations, maintenance, and publications. • Information Bulletins: Bulletins are yellowbordered and are published on an as-needed basis to provide field units and personnel with critical operational information in a timely manner. • BLM Operational Alerts: Operations Alerts areredbordered and are published on an as-needed basis to provide field units and personnel with critical operational information in a timely manner. The system is intended to respond to emerging issues as identified through such means as SAFECOMS, SAFENETS, investigation reports, after action reviews, etc. This system is not a replacement for any existing formal notification and alert system such as AMD Safety Alerts, AMD Aviation Accident Prevention Bulletins or FFAST Safety Alerts.

  26. Alerts and Bulletins • Alerts and Bulletins can be issued as an Interagency notice …OR…each individual agency can issue their own. • You can find the Alerts and Bulletins issued by each agency on their web sites, generally under the aviation safety section ...OR… most notices are posted on the Lessons Learned web site under the “Promoting Aviation Safety” section. This web site is a good place for one stop shopping for critical safety information. • Alerts and Bulletins should be reviewed with all crew members when they are issued, and posted at your base for reference. • Remember to review the alerts and bulletins with other crew members who work out of your base throughout the season.

  27. 2010 Safety Alerts Issued Interagency Safety Alerts: • 10-01 - Defective PremoFire/Vanguard Plastic Spheres • 10-02 - Throwing Objects Under Turning Rotors Department of Interior (DOI) Safety Alerts: • 10-01 - Christmas is Coming! • 10-02 - Midair Collision Avoidance

  28. 2010 Prevention Bulletins Issued Interagency Aviation Accident Prevention Bulletins: • 10-01 - Winter Weather Safety • 10-02 - Medications, Flying and Fitness • 09-03 - (Re-issue) Bird Strike Avoidance • 10-03 - Inadvertent Instrument Meteorological Conditions • 10-04 - Helmet Saved the Day! • 10-05 - New ATC Taxi Instructions • 10-06 - Summer Operations DOI Aviation Accident Prevention Bulletins: • 10-01 - Safety and Aircraft Contract Compliance

  29. 2010 Aviation Lessons Learned Issued Interagency Aviation Lessons Learned: • 10-01 - Aircraft Pre and Post Flight • 10-02 - Near Miss with a Wire Fence • 10-03 - Foreign Object Debris in Plastic Sphere Dispensers • 10-04 - Wire Hazards DOI Lessons Learned: • DOI LL 10-01 - Inadvertent Instrument Meteorological Conditions (IMC) • DOI LL 10-02 - Devil is in the Detail • DOI LL 10-03 - Boats and Planes Don’t Mix • 2010 Technical Bulletins Issued • Interagency Technical Bulletins: • 10-01 - Air Tanker Base Radio Frequencies • 10-02 - Guidance on Toning National Flight Following Frequency • 10-03 - TDFM-136A Radio Problems • 10-04 - Hazmat Special Permit: DOT-SP-9198

  30. 2010 Information Bulletins Issued Interagency Information Bulletins: • 10-01 - Utilization of Peer-to-Peer Accountability Tools (detailed review on the next slide) • Forest Service Information Bulletins: • 10-01 - FM Transmission Interference with Glideslope • 10-02 - Lat / Long Information for GPS Navigation • 10-03 - Rappel Equipment Handling • 2010 BLM Operational Alerts Issued • 10-01 - Use of Aerial Supervision Aircraft to Enhance • Safety, Effectiveness, and Efficiency of • Incident Operations.

  31. Utilizing Peer-to-Peer Accountability Tools Tools have been developed to enhance aviation Safety Management Systems (SMS) through better utilization of peer-to-peer accountability. The majority of accident interviews reveal at least one individual who had a “bad feeling” about the aircraft, pilot, or set of circumstances prior to the mishap. The peer-to-peer tools were developed to encourage personnel to speak out and share their concerns and hopefully prevent an accident. The tools include: • Evaluation of Aerial Supervision and Ground Personnel • Evaluation of Retardant and Bucket Operations • Daily Flight Crew Briefing Checklist • Daily Risk Assessment • AAR Log Review “Interagency Information Bulletin 10-01: Utilizing Peer-to-Peer Accountability Tools

  32. Utilizing Peer-to-Peer Accountability Tools Evaluation completed by the SEAT pilot Evaluation Completed by Aerial Supervision or Ground Personnel Encourage SEAT pilots to provide feed back to the field. Encourage ground / Aerial supervision to provide feed back to the SEAT pilot.

  33. 2011 Alerts / Bulletins /Lessons Learned New Alerts issued 2011…… New Bulletins issued 2011…… Lessons Learned 2011………

  34. Safety Management System (SMS) What are the highlights ? • Aviation Safety Management System (SMS) is an approach to managing safety that includes the necessary organizational structures, accountabilities, policies and procedures. • The foundation of SMS consists of four “components,” they are: Policy, Risk Management, Assurance and Safety Promotion • The SMS process identifies hazards and control risks, then provides assurance that risk controls are effective. • When fully implemented SMS provides and promotes a Positive Safety Culture. The desired positive Safety Culture is informed, flexible, learning, just and a reporting culture that captures the operational knowledge and experience of the employees.

  35. Safety Management System (SMS) What are the four “components” that will achieve the SMS goal? • 1. Safety Policy. We have existing policy in place that supports the foundation of SMS in our aviation safety programs. This policy is reflected in the “Red Book”, Interagency Standards for Fire and Fire Aviation Operations. • 2. Safety Risk Management. This workbook contains the completed program assessments on Helicopter Operations, Rappel/RADs, External Loads, Aerial Supervision, SEATs, Heavy Airtankers, Infra-Red, EHELL, and Forest Health programs. • 3. Safety Assurance. Accident Investigation, Program Reviews, Fire Aviation Safety Teams (FAST), Aviation Safety Technical Assistance Teams (STAT), Aviation Safety Assistance Teams (ASAT), and numerous other tools monitor and report the health of our prevention efforts. Currently we are working towards implementation of an Aviation Lessons Learned web site and work towards a “Reporting Culture”. • 4. Safety Promotion. We have the ability to implement very positive change in this area by creating a positive “Learning Culture”. Communication is the key to success in this component. Training systems are being updated to reflect the principles and procedures being implemented in SMS. Other tools include SAFECOMs, Safety Alerts, Technical Bulletins, Lessons Learned, SAFECOM trending, safety memoranda, Aviation Safety Committees, tailgate sessions and video clips such as the Six Minutes for Safety series.

  36. Safety Management System (SMS) SEAT Assessment Spreadsheet

  37. Risk Management Workbook Look for the new 2011 coming soon! This workbook helps to establish an Interagency Safety Management System that incorporates all four of the SMS components mentioned in the last slide.

  38. Risk Management Workbook Risk Management Workbook: This workbook is intended for use in the management of flight operations. Each section is designed to provide you with information regarding the hazards, risks, and suggested mitigations for most of the agencies aviation missions. Follow these steps during your review: • Review the description of each hazard, risk level and mitigation. • Determine if your local unit complies with the suggested mitigation(s). Log your answer by checking the YES/NO column. • If you checked NO; and if the associated risk level is Yellow or RED; you need to assure that the risk is mitigated to an acceptable level. • Go to the reverse side of the page to the blank spreadsheet. • Enter your list of Hazards that require mitigation. • Enter new or additional hazards not identified, assess the level of risk, and enter the new mitigation to be completed.

  39. Mitigation Achieved Column ? Yes or NO ???

  40. Pilot Read Files Highlights of the Read File: • The Read File is intended to assist pilots in understanding critical Safety of Flight information. • The Read File contains safety related materials (like Alerts, Bulletins, Lessons Learned, etc) that has been identified at a national level as critical information. • The Read File also contains aviation related Six Minutes for Safety topics. These topics are being jointly developed by Agency and Vendor personnel. • The cover sheet identifies the Read File topics and provides blocks for the pilot’s name and completed review items. • SEMG are required by the ISOSG to download a copy of the Read File and have it available for all pilots to review that come into the base.

  41. Read File Cover Sheet Add the different topics to the list as they are issued and identified. Pilot signs name, and check off the different items listed above.

  42. Read File / Six Minutes Safety SEMG should go to the site and download the documents list above to make their own Read File for the field.

  43. Read File / Six Minutes Safety Remember ! The Read File is part of the new Initial Pilot / Loader In-briefing form.

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