Flight Comment Issue 2, 2012
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National Défense Defence nationale ISSUE 2, 2012 IN THIS ISSUE: From the Flight Surgeon 9 The Common Cold Dossier 16 Mountainous Terrain Clearance Profiles Lessons Learned 26 Do You “Think” or Do You “Know” ? Views on Flight Safety By Chief Warrant Officer Jacques Boucher, Directorate of Flight Safety “INVEST” IN FLIGHT SAFETY t one time or another, you have likely There are several factors constantly at work all applicable paperwork prior to releasing the been briefed on the significance of that challenge our Flight Safety record: personnel aircraft for service, ensuring that close-out A investing prior to retirement. However, inexperience, new fleets in service and high checks are completed at the end of inspections, have you given any thought to “investing” operational tempos are only a few of the ensuring that tool control is adhered to, and in a new generation of air force personnel, examples. For most members of the Royal last but not least, ensuring that junior technicians prior to retirement? Whether intentional or Canadian Air Force, these factors are largely understand the importance of properly not, hopefully this is occurring! out of our control. One key factor within your completing their work and how it fits within control, and one that could help reverse the the big picture of flight safety. As experience For those who have participated in this year’s rising trend of the “personnel” cause factor, levels remain low, the need for effective annual Flight Safety briefing, you are likely is ensuring effective supervision. I am not supervision is not only applicable in the aware that with respect to ground occurrences, referring to micro-management here but maintenance arena, but critical throughout the “personnel” cause factor is the only one more about the basics of good supervision. the air force. that has consistently increased since 2005. As related to the maintenance world: being Although part of this trend might be explained there for critical juncture points during Before you leave the Canadian Forces, how through better reporting, which is a good maintenance tasks, ensuring that the tasks were much of your valuable experience are you thing, this does not account for many of the carried out as per the approved maintenance willing to “invest” in your subordinates, incidents occurring. manual, ensuring that subordinates complete today? 2 Flight Comment — Issue 2, 2012 Photo: Cpl Igor Loutsiouk TABLE OF CONTENTS Issue 2, 2012 Regular Columns Views on Flight Safety 2 Good Show 4 For Professionalism 5 18 The Editor’s Corner 8 From the Flight Surgeon – The Common Cold 9 Diminishing Skills? Maintenance in Focus – Maintenance Documentation 11 Check Six – If you want to live, have Something In Reserve 14 From the Investigator 35 Epilogue 37 The Back Page – 2012 RCAF Flight Safety Conference 40 26 Dossiers Mountainous Terrain Clearance Profiles 16 Diminishing Skills? 18 Wildlife Strikes – Part 1 22 Do You“Think” Lessons Learned Do You “Think” or Do You “Know”? 26 or Do You“Know”? Near Miss 27 No Problemo 28 32 Supply and Demand – of Attention! 29 Share the Power 30 The Wrong Mix 32 Snowmobile vs Twin Otter 34 27 DIRECTORATE OF THE CANADIAN FORCES Send submissions to: Subscription orders should be directed To contact DFS personnel FLIGHT SAFETY FLIGHT SAFETY MAGAZINE Editor, Flight Comment to: Publishing and Depository Services, on an URGENT flight safety issue, Directorate of Flight Safety PWGSC CGP/EGC, Ottawa, ON K1A 0S5 please call an investigator who Director of Flight Safety Flight Comment is produced three times Telephone: 1-800-635-7943 is available 24 hours a day at Colonel Yvan Choinière a year by the Directorate of Flight Safety. NDHQ/Chief of the Air Staff MGen George R. Pearkes Building Email: [email protected] 1-888-927-6337 (WARN-DFS). Editor The contents do not necessarily reflect official policy and, unless otherwise 101 Colonel By Drive Annual subscription rates: for Canada, The DFS web page at Captain John Dixon stated, should not be construed as Ottawa, Ontario Canada $19.95, single issue, $7.95; for other www.airforce.forces.gc.ca/dfs Graphics and design regulations, orders or directives. K1A 0K2 countries, $19.95 US, single issue, offers other points of contact d2k Marketing Contributions, comments and criticism Telephone: 613-992-0198 $7.95 US. Prices do not include GST. in the DFS organization or Communications are welcome. Contributions become the FAX: 613-992-5187 Payment should be made to write to [email protected]. property of Flight Comment and may be Email: [email protected] Receiver General for Canada. Imagery Technician ISSN 0015-3702 edited for content, length or format. This publication or its contents A-JS-000-006/JP-000 Corporal Alex Paquin may not be reproduced without the editor’s approval. Corporal Dean Smith n 21 February 2011, Corporal Smith, a Flight Engineer under training at 440 Transport Squadron Yellowknife was deployed O on exercise Northern Bison in Churchill Manitoba. He was part of a CC138 ski-equipped Twin Otter crew which had been tasked to support and resupply members of the 38 Canadian Brigade Group who would be travelling by snowmobile over frozen tundra and ice. 440 (T) Squadron utilizes an Engines Running Operation (ERO) to maximise utilization of the aircraft and minimise turn-around time. This ensures that an aircraft does not become disabled in remote areas, while guaranteeing that safety is not jeopardized. On one such ERO resupply, Corporal Smith was directed to organise and supervise the next offloading from the Twin Otter to the inbound snowmobiles. Corporal Smith was situated outside and to the rear of the engines running aircraft while awaiting their arrival when he observed the first snowmobile approaching his position. It quickly became evident that the snowmobile was not stopping at the rear of the aircraft as directed, but intended to continue towards the spinning propeller. Corporal Smith took immediate action by physically grabbing the shoulder of the driver to prevent further movement towards the front of the aircraft. The snowmobile came to a stop approximately six feet Corporal Smith currently serves with 440 Transport from the running propeller. Squadron, Yellowknife. Corporal Smith’s quick recognition of a dangerous situation and immediate actions most likely prevented a serious injury or possibly even loss of life. His exemplary actions serve as an inspiration to his peers and supervisors alike, and make him very deserving of this Good Show Award. 4 Flight Comment — Issue 2, 2012 Professionalism For For commendable performance in flight safety Private Matthew Ligon Pte Ligon was a new apprentice aviation technician recently arrived from Borden. His n 18 November 2010, a work crew was experience level at recognizing and repairing tasked with conducting the replacement aircraft faults was very limited, yet he had O of the Air Cycle Machine in the tail the aptitude to identify an anomaly and the compartment of Dash 8 aircraft CT142803. confidence to bring this to his supervisor for During the close out and inspection phase, what he thought to be an issue of importance. Private Matthew Ligon noticed what appeared to be damage to one of the flight control Inspection of the flight control cable was cables in an adjacent area of the compartment. not a part of the task at hand, and Pte Ligon He brought this to the attention of his supervisor, is commended for his exceptional diligence who confirmed that there was significant in looking beyond the immediate work area. damage to the cable requiring immediate Through his acute attention to detail and replacement. personal drive, he was able to eliminate the possibility of an airborne failure of the elevator It was eventually determined that the damage flight control system, and thus, avoid a occurred during a previous maintenance activity significant and hazardous flight control that occurred approximately one year earlier. malfunction. He is most deserving of this Private Ligon serves with 402 Squadron, A flight safety incident report was initiated For Professionalism award. Winnipeg. and all squadron aircraft were inspected. Corporal James Meikle Cpl Meikle assisted flight safety personnel by researching technical orders and doing visual hile performing a visual inspection inspections of hydraulic line checks on other of the utility hydraulic system as part aircraft. It was subsequently determined that W of a Supplementary Inspection on a the line chaffing was caused by bends in the CH124 Sea King helicopter, then Private Meikle, hydraulic lines that compromised the allowable from 423 (MH) Squadron, discovered a serious clearance criteria, and that this was an isolated chaffing condition that posed a significant flight incident. safety risk. Cpl Meikle’s action averted the possible Cpl Meikle went above and beyond the failure of multiple CH124 utility systems such required scope of inspection by removing a as blade fold, hoist, landing gear, main probe flight control access cover to gain better access and sonar. His initiative to go above and to hydraulic system lines for inspection. While beyond the inspection requirement and his Corporal Meikle currently serves with in this area he discovered that a rotor brake exceptional professional attitude averted 423 Maritime Helicopter Squadron, hydraulic supply line and a hoist hydraulic a potentially serious accident and is highly 12 Wing Shearwater. line had come into direct contact with a cyclic deserving of a For Professionalism flight pitch control rod. He immediately informed safety award. a Level “A” technician who confirmed the existing unsafe condition and they contacted the flight safety section. Issue 2, 2012 — Flight Comment 5 Professionalism For For commendable performance in flight safety Corporal Jonathan McArthur In trying to locate the u/s pylon, Cpl McArthur discovered that the pylon had been installed n Friday 08 April 2011, Cpl McArthur, on aircraft 188928 and was scheduled to fly.