Aviation Safety Regulation Chronology 1981-2001 (Chronology 2 2000-01) http://www.aph.gov.au/library/pubs/chron/2000-01/01chr02.htm

Chronology 2 2000-01

Aviation Safety Regulation Chronology 1981-2001

Matthew James Science, Technology, Environment and Resources Group 26 June 2001

Contents

Introduction

Chronology

Glossary

AMSA Australian Maritime Safety Authority

AusSAR Australian Search and Rescue

ASA Airservices Australia

ASF Aviation Safety Forum

ATC Air Traffic Control

ATSB Australian Transport Safety Bureau

BASI Bureau of Air Safety Investigation

CAA Civil Aviation Authority

CASA Civil Aviation Safety Authority

FAA Federal Aviation Administration

IATA International Air Transport Association

ICAO International Civil Aviation Organisation

NTSB National Transportation Safety Board of the United States

NTSC National Transportation Safety Committee of Indonesia

TAAATS The Australian Advanced Air Traffic System

Introduction

A good safety record is a judgement of past performance but does not guarantee the future, although

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it is a useful indicator. Last year it was demonstrated that even top operators are not fail safe, with the crash of an Air France Concorde at Paris and a Singapore Airlines Boeing 747 at Taipei. While major Australian airlines may be a good choice, because they have not had a recent fatal event, they may also be a poor choice for the same reason. Technical development and continuing pressure to maintain an accident free record will counter this.

While pilot error is said to be on the decline, factors of fatigue, weather, congestion and automated systems have complicated safety. Airline operators, pilots, mechanics, flight attendants, government regulators and makers all have a stake in making aviation as safe as possible. In Australia, regional and commuter airlines seem to face the greatest task of improving their safety. Airports too must be safe, with some cited by pilots as having critical safety deficiencies. Our wide, flat continent with generally mild weather and limited congestion assists with safety.

The industry is continually finding means to make flying safer through better training and new safety technologies. The International Air Transport Association (IATA), the International Civil Aviation Organisation (ICAO), manufacturers and others bodies cooperate in this aim. As world air traffic is expected to double or more by 2020, the accident rate must be reduced in order to avoid major accidents occurring more frequently around the globe.

The safety record of overseas operators is only relevant to the Australian scene through a comparison of accident or fatality rates and then on a category by category basis. The most relevant comparative safety figures for passenger carrying activities are the number of fatalities per 100 million passenger miles and/or the number of accidents per the number of aircraft operation cycles. ICAO publishes these figures on worldwide and major airline operating country bases.

This chronology of major international and domestic events related to aviation safety, over the past two decades, takes a global perspective of the subject. The many references to overseas accidents are included for their influence on Australian aviation operations and safety. Nonetheless, the chronology is a selective record of events, particularly including those airlines that fly here. Legislative links are available separately on a Library web site found at: http://www.aph.gov.au/library/intguide /law/transportlaw.htm#air.

The author prepared the Information and Research Services Background Paper no. 10 of 1997-98 'Airspace Safety: Air Traffic Control and Airline Operations in Australia' which provides information on the Australian aviation safety system, legislation and matters referred to herein. For further details of aviation safety and aircraft accidents prior to 1981, please refer to the series of Aerospace Publications by Macarthur Job titled 'Air Crash' in 2 volumes for Australia and 'Air Disaster' in 3 volumes covering major incidents in the rest of the world.

Chronology

Date Details Source Documents

22 August 1981 Far Eastern Air Transport airlines Boeing 737 Flight International, crashed in Taipei killing 110, apparently due to 23 January 1982. structural failure.

13 January 1982 Air Florida Boeing 737 crashed in Washington Flight International, River during severe snow and ice conditions, 22 January 1983. killing 74. The case highlighted the effects of severe weather conditions.

24 June 1982 A British Airways Boeing 747 bound for Job, M. Air Disaster 2, dropped 25000 feet, when its engines failed March 1996. after passing through a volcanic plume over Indonesia, but landed safely. The CSIRO later undertook ash detection development.

7 May 1982 Department of Aviation established with http://www.airservices. regulated responsibility for 441 government or gov.au licensed airports operating around Australia and almost 7000 aircraft. This was previously the

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responsibility of the Department of Transport. The Minister for Aviation was Mr Wal Fife.

9 July 1982 Pan American flight 759 Boeing 727 crashed Flight International, near New Orleans, probably due to severe wind 22 January 1983. shear, killing 145.

19 August 1982 Air Accidents (Commonwealth Government House of Liability) Amendment Bill 1982 debated in Representatives Parliament. Debates, p.735.

26 August 1982 Air Navigation (Charges) Amendment Bill 1982 ibid., p. 455 was before Parliament to impose a levy for aviation infrastructure.

15 September 1982 The Air Navigation Legislation (Validation and Senate Debates, Interpretation) Bill 1982 was before Parliament p. 1011. to facilitate the Department of Aviation's legal position.

1983 The Advance Inquiry chaired by Sir Sydney Morning Frost looked into the 21 February 1980 crash of Herald, 7 October a turboprop Beech Super King Air aircraft at 1996. Sydney Airport, into the main sea wall, killing 13. This was the first fatal airline crash in Australia since the loss of Vickers Viscounts in 1968 (26 dead), 1964 (24 dead) and 1961 (19 dead).

31 August 1983 Korean Airlines flight 007 Boeing 747 shot Flight International, down over Sea of Japan by a Soviet fighter 28 January 1984. killing 259. On 23 September, a Gulf Air Boeing 737 was lost to alleged sabotage killing 111. Both cases raised wide concerns and an extraordinary assembly of ICAO.

27 November 1983 Avianca Boeing 747 crashed near Madrid Airport Flight International, killing 181 of the 192 aboard. On 12 December, 28 January 1984. two aircraft collided at Madrid Airport, killing 92.

9 May 1984 The Minister for Aviation Mr Kim Beazley House of introduced the Air Navigation Amendment Bill Representatives 1984, to provide protection to aircraft Debates, p. 2127. crew-members from the use of cockpit voice recorders for purposes not related to safety.

13 September 1984 The Air Navigation (Charges) Amendment Bill ibid., p. 1288. 1984 and the Air Navigation Amendment Bill (No. 2), 1984 introduced by the Minister for Aviation Mr Kim Beazley to provide for charging arrangements. On 13 December 1984, Mr Peter Morris became the new Minister.

1984 The Department of Aviation's Review of the Airspace 2000 and Future Role of the Flight Service Officer in the Related Issues, p. 1; Provision of Air Traffic Services envisaged the Canberra Times, integration of air traffic control functions. With 24 May 1985; a booklet titled Two Years in the Aviation Hall of Australian, 2 March Doom aviator and entrepreneur Mr Dick Smith 1985; Flight

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declared that the Department had 'had its day' International, and was 'totally stupid' with regulations that 1 December 1984. 'reduced safety'. The Minister for Aviation Peter Morris reaffirmed the safety record showing Australia as having a low accident rate.

22 November 1984 Report released of the Independent Inquiry into Australian Financial Aviation Cost Recovery (Bosch report). A Review, 21 December separate independent review of the two-airline 1994. policy was under way.

23 June 1985 Air India flight 182 Boeing 747 destroyed over Flight International, the Irish Sea, due to a terrorist bomb later 8 March 1986; The traced to unaccompanied baggage. 329 people Australian, 7 June died. Security measures were reviewed. 2001. Canadian authorities charged a first suspect in June 2001.

2 August 1985 Delta Airlines flight 191 Tristar L-1011 crashed Age, 27 July 1987; at Dallas Airport killing 135, due to a violent Sydney Morning wind shear microburst. The development of Herald, 10 August wind shear detectors continued. 1985.

12 August 1985 Japan Air Lines Boeing 747 crashed into a The Australian, mountain killing 520 of 524, after a structural 29 October 1986. failure related to maintenance occurred. A review of Boeing 747 structure integrity followed including inspections of all aircraft.

22 August 1985 A British Airtours Boeing 737 caught fire at New Scientist, Manchester Airport killing 54. Many died while 29 August 1985. trying to escape.

12 March 1986 The Minister for Transport and Minister for House of Aviation Mr Peter Morris introduced the Air Representatives Navigation Amendment Bill 1986 to ratify the Debates, p.1198. (Chicago) Convention on International Civil Aviation and to give effect to its provisions in Australia. The Convention arose from the Korean Airlines flight 007 case.

13 June 1986 Federal Airports Corporation established under Flight International, the Federal Airports Corporation Act 1985 to 25 January 1986. assume responsibility for management of 17 major airports by 1988. Meanwhile, Ratner Associates reviewed the Air Traffic Services System while the concept of affordable safety emerged in the literature.

3 September 1986 An AeroMexico DC9 and a Piper Archer collided Age, 3 September on approach to Airport and crashed 1986. killing 85, highlighting problems of air congestion and light aircraft detection.

24 July 1987 Departments of Transport, Aviation and Airservices Australia Communications amalgamated to form the web site, Department of Transport and Communications http://www.airservices. under its Minister Senator Gareth Evans, who gov.au was replaced a year later by Mr Ralph Willis.

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August 1987 Severe turbulence injured 48 on a flight from Age, 17 May1988; Tokyo to Sydney. The following May, on a San Sydney Morning Francisco to Sydney Qantas flight, 24 people Herald, 16 May1988. were thrown around and injured. The compulsory wearing of seat belts while in flight became an issue, as did the search for effective clear-air turbulence detectors.

24 August 1987 Northwest Airlines flight 255 MD-80 crashed on The Australian, take-off from Detroit killing 154 due to 25 August 1987. suspected wind shear.

10 October 1987 Cargo Westwind jet on charter to Ansett crashed Age, 28 September off Sydney Airport killing two. As was usual, the 1987. Bureau of Air Safety Investigation (BASI) began a subsequent inquiry.

8 December 1987 Presentation of the Government's responses to House of the House of Representatives Standing Representatives Committee on Expenditure report, No Port in a Debates, p. 2943. Storm, on aviation safety regulation, as well as a separate report on sports aviation safety.

28 April 1988 Aloha Airlines Boeing 737 lost part of its side, Aviation Week and as a result of fatigue while in flight, taking with Space Technology, it an attendant. The aircraft later landed safely 24 July 1989; The but with injured passengers. Ageing aircraft Australian, 5 May 1988. became an aviation industry issue.

June 1988 In an embarrassing debut, an Air France Airbus Canberra Times, A320 crashed during a Paris Air Show 27 January 1992. demonstration killing three. As the first 'fly-by-wire' airliner, it came under scrutiny.

1 July 1988 Civil Aviation Authority (CAA) established under the Civil Aviation Act 1988 as a separate body from the Department. The Department of (Civil) Aviation and its precedents had operated from 1945, but Parliament and the Government determined that separation was the best way ahead.

1 July 1988 With the introduction of the BASI Confidential Australian Financial Aviation Incident Reporting system, widespread Review, 7 December claims emerged of poor maintenance and pilot 1988. standards.

21 December 1988 Pan Am flight 103 Boeing 747 exploded by an ibid., 16 May 1989, allegedly Libyan terrorist device over Lockerbie, Sydney Morning Scotland, killing 270 in the air and on the Herald, 1 February ground. The issue of airline and airport security 2001. continued apace, but only in early 2001 was a Libyan convicted for the sabotage, in a Scottish trial.

8 January 1989 British Midland Airways Boeing 737 crashed New Scientist, after a fan blade fractured and the crew shut 23 November 1996; down the wrong engine. Of the 126 people on Flight International, board, 47 died near East Midlands Airport. 1 April 1989. Cockpit design emerged as an issue in crashes.

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In early 1989, the United States Federal Aviation Administration (FAA) began to permit long-range twinjet flights over the oceans, previously restricted to larger craft.

24 February 1989 United Airlines flight 811 Boeing 747 lost a Job, M., Air Disaster 3, cargo hatch door and nine passengers after April 1999. leaving Honolulu for Sydney. In 1999 after checks for explosives or metal fatigue, the United States National Transportation Safety Board (NTSB) amended the cause to faulty wiring.

3 May 1989 The Minister for Transport and Communications House of Mr Ralph Willis introduced the Air Navigation Representatives Amendment Bill 1989 to vary the means of Debates, p. 1819. suspending international airline rights.

19 June 1989 United Airlines flight 232 DC-10 crash-landed at Job, M., Air Disaster 2, Sioux City, Iowa, after an engine fan explosion. March 1996. Through exceptional handling the crew managed to save 184, while 112 died, in what became a famous case of crew and ground heroism. It also highlighted maintenance issues.

November 1989 The CAA developed an airspace model that Age, 6 September rationalised air traffic control (ATC). Meanwhile, 1998; Australian after a series of hot air balloon accidents, a Financial Review, consultant Mr Phil Hanson reported to the CAA 7 October 1997; CAA on measures to regulate balloons and Media Release, 20 operators. 1990, 4 April 1990; Age, 5 April 1990.

August-November The pilots' dispute between members of the Norington B., Sky 1989 Australian Federation of Air Pilots and major Pirates, ABC, 1990. airlines led to serious disruptions and costs to regular air services and the provision of some flights by government agencies.

January 1990 Aviator and entrepreneur Mr Dick Smith Australian, 16 May appointed Chair of the CAA under an 'affordable 1990; Sydney Morning safety' policy crusade. He recruited Mr Frank Herald, 11 June 1990. Baldwin from the New Zealand Aviation Authority to restructure the organisation on a district basis, and reduced staff from 7300 down to 3500 over five years. The CAA Chief Executive Mr Colin Freeland and deputy Mr Alan Rainbird both resigned soon after Mr Dick Smith arrived. Mr Kim Beazley became the new Minister for Transport and Communications.

February 1990 An Indian Airlines Airbus A320 crashed at Canberra Times, Bangalore killing 90. The incident suggested 27 January 1992. that pilot error and computer malfunction were contributing and intertwined factors and would later become of increased concern.

11 May 1990 A Cessna Citation 500 crashed at Mareeba Senate, Debates, Plane killing 11. The Civil Aviation Amendment Act Safe, p.112; Sydney

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1990 established the CAA as a government Morning Herald, business enterprise. The August 1990 Federal 11 June 1990 and Budget announced that the $73 million 11 September 1990. contributed towards safety regulation would be phased out in favour of the costs being met by the aviation industry. CAA Chair Mr Dick Smith said that ways to maximise safety and economy existed.

11 September 1990 Qantas Boeing 747 with 360 aboard missed a Age and Sydney USAF C-5 Galaxy plane by a reported 17 Morning Herald metres, while flying over Phuket. The case 14 September 1990. raised air traffic control clearance issues.

30 October 1990 The Commonwealth's formalised economic Transport and regulation of the domestic airline industry was Telecommunications eliminated with the abolition of the two-airline Reform Prime policy. However, operational and safety Ministerial Statement regulatory frameworks were retained and a House Hansard, number of the States continued to regulate 8 November 1990. intrastate services. In December, the operation of Compass Airlines started, to challenge the Australian/Qantas and Ansett airlines duopoly, before the demise of Compass in late 1991.

17 December 1990 The Minister for Shipping and Aviation Support Ministerial Media Senator Bob Collins reaffirmed faith in high Release 35 1990; safety standards when he spoke at the opening Sydney Morning of new headquarters for BASI. Herald, 4 December 1990.

26 May 1991 Lauda Air Boeing 767 crashed in Thailand Mercury, 3 November killing 223 after the inadvertent deployment of 1999; Australian, reverse thrust during flight. The FAA later 18 October 1991; ordered specific thrust reverser changes. Sydney Morning Meanwhile, concerns were growing about the Herald, 4 May 1991. effects of lap-top computers and mobile telephones affecting aircraft systems during flight. The issue of bogus aircraft spare parts was of concern here and overseas.

3 March 1991 United Airlines flight 585 Boeing 737 crashed Australian Financial near Colorado Springs killing 25, leading to Review, 23 September speculation about the aircraft's rudder design 2000. and operation at low speeds.

12 August 1991 A Thai Airways DC-10 overshot the Sydney Sydney Morning Airport runway to just miss an incoming Ansett Herald, 13 August 1991 Airbus A320 and a waiting Qantas Boeing 747. and 3 July 1993. The 661 people on board the respective aircraft remained unharmed.

December 1991 The CAA introduced a new Airways Management Australian Financial Air Traffic Services (AMATS) system to a mixed Review, 19 April 1992; response from pilots. Australian Aviation, 8 1998.

20 January 1992 An Airbus A320 crashed into a mountain near Canberra Times, Strasbourg killing 87. This was the third such 27 January 1992. loss in less than four years.

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January 1992 Pressure mounted for an inquiry into the Canberra Times, contractor chosen by the CAA for The Australian 20 September 1997 Advanced Air Traffic System (TAAATS) after and 8 May 1992; Hughes Aerospace missed out. Meanwhile, a Australian Financial study into the air traffic system by a United Review, 8 May 1992; States safety consultant Dr Robert Ratner Canberra Times, Associates found Australia was safe, but with 23 November 1991. room for improvements, citing 24 recommendations.

18 February 1992 CAA Chairman Mr Dick Smith stepped down Canberra Times, after announcing the best set of aviation safety 18 February 1992; figures in five years, but frustrated by his Australian, 23 March inability to introduce affordable safety 1999. regulations and to restructure military airspace. As President of the Aircraft Owners' and Pilots' Association, he remained a critic of BASI.

March 1992 CAA selected Thomson Radar Australia for Canberra Times, TAAATS while parliamentarians on both sides of 20 September 1997; politics criticised the choice. The Minister for Age, 20 July 1997. Shipping and Aviation Support Senator Bob Collins reconsidered the choice when Parliament heard of unorthodox processes. In May, he called for a Senate Inquiry before being replaced by Senator Peter Cook, who later announced an independent inquiry chaired by the Honourable Ian Macphee AO. Senator Bob Collins became the new Minister for Transport and Communications.

April 1992 Southern Cross Airlines started in a bid to ABC Radio 'The World challenge the two-airline duopoly, but hardly Today', 10 August saw the year out before it failed. 1992.

31 July 1992 Thai Airways Airbus A310 crashed at Katmandu Australian, 26 October killing 113. Two months later, 167 died there 1993. when a PIA Airbus A300 crashed. Automated flight systems came under question.

14 September 1992 A leaked internal CAA document cited poor Sydney Morning management, inadequate internal processes and Herald, 15 September external influences as rife, while major staff 1992. cuts and turnovers continued apace.

4 October 1992 El Al flight 1862 Boeing 747 freighter crashed Australian Financial into two tall apartment blocks, after leaving Review, 2 July 1993. Amsterdam Airport, due to an engine pylon failure. Four crew aboard and 39 on the ground died.

December 1992 The Macphee Independent Review of the Civil Australian Financial Aviation Authority's Tender Evaluation Process Review, 21 July 1994. for the Australian Advanced Air Traffic System report strongly criticised the CAA Board and senior management over the awarding of a $200 million contract for TAAATS to Thomson of France.

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February 1993 CAA Chief Executive Mr Frank Baldwin resigned Australian Financial after the dispute over the TAAATS contract and Review, 7 July 1997. senior executive Dr Rob Edwards lost his job.

February 1993 Captain Alan Terrell appointed by the CAA Board Plane Safe report, to report on the effectiveness of the operations Aviation Week and of the Safety Regulation and Standards Space Technology, Division. 8 March 1993.

30 March 1993 The Terrell Report found that general aviation Australian Financial safety standards had fallen under CAA reforms. Review, 21 July1994. The Board later accepted all but one of 59 Report recommendations. Mr Ted Butcher stepped down early as Chairman, to be replaced by General Peter Gration with Mr Doug Roser as Chief Executive.

11 June 1993 Monarch Airlines Piper Chieftain crashed near The Bulletin, Young NSW killing seven aboard. The 5 September 2000; subsequent coronial inquiry found that the CAA Sydney Morning failed to properly monitor the airline while the Herald, 7 June 1996; NSW Air Transport Council had done nothing to Canberra Times, 3 June alert its Minister about problems with the airline 1994. (see 20 July 1994 and 6 June 1996).

29 September 1993 Major Class G airspace management initiative Australian Aviation, known as '11 January1' cancelled at the last August 1998; minute due to industry objections and protests Australian Financial from the former chairman Mr Dick Smith and air Review, 21 July1994; traffic controllers. Australian, 1 October 1993; Canberra Times, 30 September 1993; CAA 74/93.

26 October 1993 The Auditor-General's Project Audit into the CAA Audit Report no. 8 Centre for Air Traffic Services at Launceston 1993-94, ANAO. found problems with the ATC centre and valid reasons for its subsequent closure.

5 December 1993 The Mueller consultant report found a lack of Canberra Times, consistent CAA application of safety regulations 5 December 1993. across Australia.

7 February 1994 Contract signed for The Australian Advanced Air Airservices Australia, Traffic System (TAAATS) by CAA with Thomson www.airservices.gov.au Radar Australia Corporation and its parent company.

24 April 1994 South Pacific Airmotive DC-3 on Army charter to Age, 19 January 1997; Norfolk Island ditched into Botany Bay after Australian, 30 March engine failure with 25 people aboard who all 1996; Sydney Morning survived. The resulting BASI report found that it Herald, 5 August 1994. was overloaded, poorly kept and flown. However, its pilot Mr Rod Lovell disputed all of these points.

26 April 1994 China Airlines (of Taiwan) Airbus A300 crashed Sydney Morning at Nagoya Japan to claim 279 lives. The airline Herald, 6 May 1994. had previously lost Boeing 737 aircraft in February 1986 and October 1989 with 67 killed.

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A growing trend of poor Asian airline records continued.

4 May 1994 Opposition Transport spokesman Mr John Sharp Sydney Morning labelled Seaview Air as operating dangerously Herald, 8 October and a passenger risk. The CAA upgraded 1994. Seaview's licence from charter to regular public transport operator on 27 July.

20 July 1994 The Bureau of Air Safety Investigation report BASI Investigation into the Monarch Airlines crash at Young in June Report, 9301743; 1993 suggested the need for new arrangements Minister for Transport in air regulation and funding, due to latent News Release, T44/94; organisational failures and deficiencies within Plane Safe. the CAA. The Minister for Transport Mr Laurie Brereton removed the head of CAA safety Mr George Macionis. He also established an Aviation Safety Agency as a separate entity within the CAA. The CAA remained under Chair General Peter Gration and Mr Doug Roser. The Minister also agreed to a parliamentary inquiry into air safety by the House of Representatives Standing Committee on Transport, Communications and Infrastructure, headed by Mr Peter Morris, to investigate air safety standards as well as their supervision and compliance. BASI remained under Director Dr Rob Lee.

8 September 1994 USAir flight 427 Boeing 737 flight crashed while AAP, 17 April 2000; approaching Pittsburgh Airport killing 132, after New Scientist, 4 March a rudder malfunction. The FAA would much 2000; NTSB Press later recommend design changes to 737 rudders Release, 24 March for low speed operations. The 737 remains the 1999 SB 99-09; most common airliner in Australia and now our Australian Financial airlines fly them faster on landing approaches. Review, 5 October 1999.

2 October 1994 Fatal accident of Seaview Air Rockwell Aero Australian, 8 October Commander enroute to Lord Howe Island killed 1994, 1 November nine aboard. On 17 October, the Minister 1995, 9 October 1996; announced a judicial inquiry to be conducted by Aircraft, November Sir Lawrence Street into the handling of 1994; Sydney Morning operations of Seaview Air by the CAA. On 23 Herald, 8 October December, the Minister announced the 1994; Age, 8 October appointment of a second commissioner Mr 1994. James Staunton who later replaced Sir Lawrence Street. The Commission of Inquiry into the Relations Between the CAA and Seaview Air commenced on 16 January 1995. The intended reporting date was 31 May 1995, to the Minister of Transport Mr Laurie Brereton but the report did not appear until 8 October 1996 (see below) with a new Government and Minister Mr John Sharp. Three other inquiries were conducted by the Parliamentary (Morris) committee, the Federal Police inquiry into dealings between some CAA officers and Seaview, and by the BASI investigation. Some CAA staff were dismissed.

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19 October 1994 Ansett flight 881 Boeing 747 crash-landed onto Australian, 20, 21 and its nose at Sydney Airport with 274 aboard. The 22 October 1994; subsequent BASI report questioned Ansett Sydney Morning safety procedures and training. In Parliament, Herald, 17 July 1996, the Prime Minister Mr Paul Keating defended the 27 September 1996. Minister for Transport over aviation safety matters.

16 November 1994 The CAA grounded four airlines-Seaview Air, Minister for Transport, Yanda Airlines, Newcastle Aviation and Uzu News Release T68/94; Air-after intense surveillance. They were able to Australian Financial resume once deficiencies were rectified. Review, 21 October Meanwhile, Qantas Airlink was the subject of 1994. media attention on safety concerns. The Parliamentary inquiry into air safety received a submission from a CAA officer claiming that 200 Australian aircraft including commuter planes could lose wings due to structural fatigue.

3 December 1994 A position paper by the Royal Aeronautical Age, 23 March 1995; Society titled A Study of the Safety of General Australian Financial Aviation in Australia found unsafe flight Review, 5 December practices in light aircraft operations. The CAA 1994; Sydney Morning Board cleared its Chief Managing Director Herald, 14 November Mr Doug Roser of any 'impropriety', following 1994. allegations of alterations to aviation safety reports about smaller airlines.

30 March 1995 The Civil Aviation Legislation Amendment Bill Minister for Transport 1995 and Air Services Bill 1995 introduced. News Release T15/95; Comment was sought from the House House of committee inquiry on aviation safety. Representatives, Debates, 30 March 1995, p. 2598; Senate Debates, 21 September 1995, p. 1225.

16 April 1995 CAA officers revealed a backlog of Australian, 28 March approximately 800 manufacturer warnings, 1995, 17 April 1995. apparently one month after the discovery of some 140 airworthiness directives that had not been implemented.

23 May 1995 The Advisory report on the break up of the CAA Canberra Times, 24 from the (Morris) House of Representatives May 1995; Australian, Standing Committee on Transport, 7 October 1995. Communications and Infrastructure contained legislative drafting recommendations to clearly define a proposed rearrangement of the CAA into two aviation safety organisations. On 30 June, a confidential study by former FAA officials recommended that the CAA Act be amended to stop cost recovery applicable to airworthiness.

9 June 1995 Ansett New Zealand Dash 8 crashed on top of a Australian, 17 June hill near Wellington killing four and injuring 17. 1997; AAP, 4 July Investigators found that an undercarriage issue 1997. distracted the pilots.

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6 July 1995 The combined Civil Aviation Legislation House of Amendment Act 1995 and Air Services Act 1995 Representatives, established the rationale and operating Debates, 7 June 1995, arrangements for the creation of the Civil p.1372; Australian Aviation Safety Authority (CASA) and Financial Review, Airservices Australia (ASA) out of the former 7 October 1997; CAA. ASA became responsible for the delivery Minister for Transport, of airspace management, control services, News Release, T48/95. aviation search and rescue. In turn, CASA became responsible for the regulation of the aviation industry, licensing of pilots, aircraft certification and the setting of airspace design and safety standards in accordance with the Civil Aviation Safety Act 1988. CAA Chairman Peter Gibson and chief executive Mr Doug Roser departed when Minister Mr Laurie Brereton announced the changes. The new CAA board had Justice William Fisher as Chairman, Mr Leroy Smith as Executive Head, and Dr Clare Pollock, Captain Geoffey Molloy and Ms Gabi Hollows.

21 September 1995 The Transport Legislation Amendment Bill (No. Senate Debates, 3) 1995 proposed changes to the investigative 21 September 1995, powers of BASI. At the same time, CASA p. 1235; Australian, announced the mandatory fitting of Traffic Alert 7, 20 and 23 and Collision Avoidance Systems to regular September 1995. passenger transport operators, after a series of near misses and a BASI recommendation. The Transport Legislation Amendment Bill (No. 3) 1995 would provide for the transfer of air safety investigation powers of BASI from the Air Navigation Regulations to the Air Navigation Act 1920.

November 1995 Controversy surrounded the safety of operation Australian Aviation, of cross or parallel runways at Sydney Airport September 1995; in conjunction with aircraft noise measures. Sydney Morning Parliamentarians on both sides of politics made Herald, 7 November claims, but it appeared that either means of 1998. runway operations was safe enough.

7 December 1995 Class G airspace trial introduced to replace the House of previous low level uncontrolled airspace. The Representatives, Air Navigation Act 1920 was amended to better Debates,28 November define the role of BASI to investigate accidents, 1995, p. 3945. serious incidents and deficiencies.

14 December 1995 The House of Representatives Standing Media Release Peter Committee on Transport, Communications and Morris MHR, Infrastructure produced the Plane Safe Inquiry 23 February 1996; into Aviation Safety: the Commuter and General Canberra Times, Aviation Sectors report that concentrated on the 24 December 1995; regulation of a competitive aviation industry by Australian, an organisation in conflict, CASA. It said that a 22 December 1995. combination of poor management and internal battles were counter-productive to aviation safety over the period since 1988. The report contained an extensive set of recommendations pertaining to the operation of CASA and the need for promulgated safety statistics. The

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Government Response of 5 December 1996 largely agreed with the recommendations and noted work on aviation safety indicators and the creation of an independent advisory panel to review regulations. On the whole, it would seem that the recommendations were implemented, in terms of subsequent reports issued by CASA, the Program Advisory Panel (Kimpton inquiry) and other agencies, as detailed below. Note that a change of government and ministers occurred on 11 March 1996.

20 December 1995 American Airlines flight 965 Boeing 757 crashed Aviation Week and into the Columbian Andean mountains after the Space Technology, crew became disorientated, killing 159 of 163 9September 1996, 29 aboard. Crew resource management and flight September 1997. automation remained of concern.

28 February 1996 Alas Nacionales flight 301 Boeing 757 crashed AAP, 1 March 1996. into the sea off Dominica, killing 189.

April 1996 CASA board members rejected calls for their Australian, 20 April resignations from the new Minister for Transport 1996, 10 July 1997. and Regional Development Mr John Sharp.

11 May 1996 ValuJet flight 592 DC-9 crashed into the Florida Australian, 15 May 96; Everglades killing 110 after a fire on-board. In Aviation Week and response to criticism of the airline and itself, Space Technology, 25 the FAA brought in tougher measures for airline August 1997. inspections.

6 June 1996 NSW Coroner John Gould handed down findings Canberra Times, 7 June into the 1993 Monarch Airlines crash critical of 1996; Minister for the airline, the former CAA and the NSW Air Transport Media Transport Council. The Minister (Mr John Sharp) Statement, 6 June foreshadowed a review and other actions to 1996 TR46/96. address the report's recommendations.

25 June 1996 The Minister for Transport and Regional House of Development Mr John Sharp announced reviews Representatives, of the regulatory framework and role in an Debates,25 June 1996, aviation safety ministerial statement. He also p. 2653. introduced the Civil Aviation Amendment Bill 1996 to increase the CASA Board size from four to six people. While the Opposition supported the Bill, it questioned the motives.

17 July 1996 TWA flight 800 Boeing 747 exploded at cruise Engineering World, level, after leaving New York, killing all 230 October 2000; aboard. Investigations would prove Commentary, May controversial, suggesting factors of aged wiring 2001. failure causing a short circuit explosion in the fuel tanks. Other lay explanations suggested electromagnetic radiation in the flight corridor or even a meteorite strike. The investigation was the most lengthy and costly ever undertaken by the NTSB. The FAA later issued 40 actions on fuel tank safety but the issue of aged aircraft wiring would continue to cause

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concern.

26 September 1996 The Minister for Transport and Regional Minister for Transport Development announced an industry-based Media Statement 20 panel to oversee the CASA regulatory review and 26 September headed by Ansett's Mr James Kimpton. The 1996,TR101 and review produced recommendations that could 110/96. be implemented in 1998, while reporting monthly.

8 October 1996 The (Staunton) Report of the Commissioner of House of the Commission of Inquiry into the Relations Representatives, Between the CAA and Seaview Air was Debates, 8 and 9 particularly scathing of CAA operations and October 1996, p. 5046; identified a number of systemic problems. Sydney Morning Herald Recommendations included action against two and Australian 9 CAA officers, and suggested mechanisms for October 1996. responsibility, accountability and documentation. There seems to be no official Government response to the Inquiry aside from comments reported in Hansard and a Ministerial Statement in Parliament. The Minister urged changes to CASA and its management board positions. BASI undertook a separate investigation of the incident.

10 October 1996 The CASA Board released a media statement in Australian, 12 October relation to certain findings of the Seaview 1996; Sydney Morning inquiry and lamenting comments about it made Herald, 10 October by the Minister in Parliament. 1996.

30 October 1996 A large newspaper advertisement with 512 Australian, 21, 23, 25 listed names published, later found to be and 30 October 1996; sponsored by the Aircraft Owners' and Pilots' Canberra Times, 23 Association, requested the CASA board and 31 October 1996. members to stand aside. It followed the publication of a letter by the CASA Chairman stating why the board should remain in full control despite Ministerial denigration. Meanwhile, CASA developed a program known as Airspace 2000 planned for introduction in 1998. The scheme aimed to achieve an ICAO standard with the use of systems safety, harmonisation and staged delivery.

3 November 1996 Falcon Airlines plane crashed into the sea off AAP, 18 February Cairns with the occupants safely reaching the 1997; Canberra Times, shore. The subsequent report by David 8 November 1996. Wheelahan QC found a possible conflict of interest between CASA, the airline and Minister John Sharp. The Minister had sought an independent report after stating that a response from CASA was inadequate.

13 November 1996 350 people died when a Saudi Arabia Airlines Associated Press Boeing 747 collided with a Kazak freighter over 13 November 1996. India. The event highlighted local concerns over ATC standards.

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19 November 1996 Concerns expressed in the letter of resignation Minister for Transport, of the CASA Director of Aviation Medicine Dr Media Statement Robert Liddell, caused the Minister to ask the TR152/96; Age, Board to reconsider safety. 27 November 1996.

5 December 1996 Government response to the Plane Safe report Minister for Transport, tabled by the Minister for Transport and Media Statement Regional Development Mr John Sharp. (Refer to TR167/96; Australian, 14 December 1995). It included a monthly 6 and 9 December CASA update on safety breaches. The Senate 1996; Age 6 December decided to investigate the purchase of 1996. Australia's new search and rescue equipment after faults were found.

February 1997 Stormy scenes in Parliament regarding CASA Australian, 13, 15 and Board placements by the Minister for Transport, 17 February 1997. Mr John Sharp, who continued his criticism of the CASA Board in response to the Wheelahan report and Kimpton inquiry.

March 1997 CASA controversy continued with the Report on Canberra Times, 14 the Purchase of the Precision Aerial Delivery May 1997. Systems (PADS) by Airservices Australia by the Senate Rural and Regional Affairs and Transport References Committee in March 1997. The report urged the Government to request CASA to address problems highlighted in a report completed by Turtleair regarding search and rescue practices. The June 1997 Government Response to the committee report indicated that resolution of the matters was in hand.

19 March 1997 Parliament debated the Aviation Legislation House of Amendment Bill (No.1) 1997 to allow for Representatives, environmental standards at airports and Debates,p. 1834. establish a register of encumbered aircraft.

6 May 1997 After new legislation expanded the CASA board Australian, 10 July to seven positions, Mr Dick Smith was 1997. appointed CASA Deputy Chairman under Chairman Justice William Fischer. Mr Laurence Foley joined the board. In June, Ms Gabi Hollows and Captain Molloy retired to be replaced by Dr Paul Scully-Power and Mr Bruce Byron.

1 July 1997 Aviation search and rescue responsibilities were House of transferred from ASA to Australian Search and Representatives, Rescue (AusSAR) within the Australian Maritime Debates, p. 5552, 18 Safety Authority (AMSA). The Aviation June 1997. Legislation Amendment Bill (No. 2) 1997 was debated and covered airport security and passenger compensation issues.

6 August 1997 Korean Air flight 801 Boeing 747 crashed into Aviation Week and terrain on approach to Guam Airport killing 228 Space Technology, 1 of 254 aboard. The NTSB would attribute the November 1999. crash to crew error and training, factors apparent in later events for the airline.

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26 August 1997 Broderick/Willoughby report into the House of relationship between the Director of Aviation Representatives, Safety and the CASA Board made Debates, p. 2288, recommendations on corporate governance. 12 October 2000.

12 September 1997 CASA also considered the Airspace 2000 Australian Aviation, proposal of Mr Dick Smith, but deferred it for a October 1997; year, following lengthy aviation industry BP10/98, NPRM objections, even though ASA had approved it on 9701RP. 4 April for implementation on 4 December.

26 September 1997 CASA Director Mr Leroy Keith left after the Australian Financial Board passed a no-confidence motion in his Review, 26 September management strategy. Chairman Justice William 1997, 7 October 1997. Fischer and member Dr Clare Pollock both resigned in protest at the Board's handling of the former Director. The new Minister for Transport and Regional Development, Mr Mark Vaile, replaced Mr John Sharp.

26 September 1997 Garuda Indonesian Airways flight 152 Airbus Aviation Week and A300 crashed on approach to Medan airport Space Technology, 6 killing 234 persons. Prior to this event, Garuda October 1997; had 28 major accidents with 197 fatalities in Australian Financial nine cases. Review, 21 February 1998.

9 October 1997 CASA produced Systems for Safety: Reviewing CASA Public Report; Systems in Civil Aviation Safety. This was a Australian Aviation report on the safety standards of charter and August 1998. low-capacity regular passenger transport operators and followed on the concerns expressed in the Plane Safe report. The report's 22 recommendations had accompanying implementation actions and timeframes to be followed. The Civil Aviation Legislation Amendment Bill 1997 introduced in October aimed to simplify the continuous passenger liability insurance arrangements.

28 November 1997 A Report to the Minister of Transport and Australian Aviation, Regional Development from the Program November 1997. Advisory Panel regarding its oversight of the CASA Regulatory Framework and Regulatory Role Programs in the CASA Reviews noted substantial outcomes in respect of draft rules and standards since 1996. This independent (Kimpton) panel foresaw continued consultation and regulatory review ahead, while noting that the Regulatory Framework Program would ensure implementation of the Plane Safe recommendations, as well as aspects of the Seaview Commission in line with international standards.

19 December 1997 Singapore Airlines subsidiary Silk Air flight Sydney Morning MI185 Boeing 737-300 crashed in Indonesia Herald, 16 December killing all 104 aboard. Subsequent United States 2000. NTSB investigations suggested a cause of pilot suicide, but separately, Indonesia's National Transportation Safety Committee (NTSC) would

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not agree.

24 December 1997 Mr Dick Smith appointed as Chairman of CASA Age, 6 September and goes on to centralise the authority and 1998. close some district offices. Dr Paul Scully-Power became Deputy Chairman, and Mr Michael Ryan and Mr Tony Pyne joined the Board. On 28 August 1998, Ms Janine Shepherd joined the CASA board.

16 February 1998 China Airlines flight CI 676 Airbus A300 crashed Flight International, at Taipei Airport killing 203 people. The crash 22 July 1998, p. 31. was later attributed to pilot error. Training was said not to have improved since a similar crash in 1994.

February 1998 BASI produced a Review of Airservices BASI Report; Australian Australia's Team Operations in Air Traffic Control Financial Review, and Flight Services. As was normal with all 16 June 1998. BASI investigations, it identified any major safety deficiencies and provided a Safety Advisory Notice for appropriate action. Meanwhile, the privatisation of ATC services became an issue.

26 February 1998 CASA, through ASA, introduced a radar- Australian, 27 March controlled Class E airspace trial, to replace 1998; CASA, 28 August Class G for six months. It required transponders 1997. to be fitted to all aircraft using the region.

15 April 1998 CASA proposed changes to its charging system, CASA Discussion Paper. reducing aviation fuel duty while imposing fee for service charges.

6 May 1998 Aquatic Air licence suspended by CASA for 13 Australian Aviation, days. September 1998.

1 July 1998 The Minister for Transport and Regional House of Development, Mr Mark Vaile introduced the Civil Representatives, Aviation Amendment Bill 1998 to implement the Debates, 1 July 1998, Regulatory Framework reform Program. p. 5543.

2 July 1998 Airline Passenger Safety Association Inc was Minister for Transport launched. It consisted of a number of News Release. individuals interested in promoting the safety- related interests of airline passengers on a national basis.

26 July 1998 Aquatic Air, trading as South Pacific Seaplanes, Australian, 23 March Cessna 185E seaplane crashed at Berowra 1999; Age, 6 Waters NSW killing five people. CASA came September 1998; under fire for failing to ground it, having lifted Sydney Morning a suspension for previous infringements 17 Herald, 29 July 1998. days prior to the crash. Mr Laurie Foley was appointed as CASA's assistant director of compliance by the Chairman Mr Dick Smith and led an inquiry into the crash, despite external criticism of a conflict of interest. CASA suspended the three most senior officials in NSW and warned that over 10 per cent of local

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operators could lose their permits.

August 1998 After several reported incidents, BASI reported BASI Air Safety on Systemic Investigation into Factors Investigation Report Underlying Air Safety Occurrences in Sydney B98 1990; Aviation Terminal Area Airspace. The report contained Week and Space nine safety recommendations for ASA and Technology, CASA, noting some confusion between their 7 September 1998; respective roles and responsibilities. The report Australian, 20 August suggested that political meddling in the ATC 1998. procedures in airspace above Sydney Airport, aimed at more evenly distributing noise pollution, had significantly reduced safety margins. As well, ATC staff were tired by constant changes. Meanwhile ASA held discussions with several companies about privatising ATC services, including firefighting, while Labor vowed to oppose the plan.

2 September 1998 Swissair flight 111 MD-11 airliner crashed after Australian, 4 leaving New York. All 229 people aboard were September 1998. killed following a cockpit fire under mysterious circumstances, although likely to be a wiring fault. Aircraft wiring became a major air safety issue.

October 1998 The Review of the Regulation by the Civil Canberra Times, Aviation Safety Authority of Aquatic Air Pty Ltd 9 October 1999. trading as South Pacific Seaplanes; prepared by Mr Stephen Skehill, of October 1998 followed the fatal Aquatic Air crash north of Sydney in July. The report (released 18 February 1999) found that a small number of CASA actions were defective and not preferable although not improper, including non-suspension of Aquatic Air. The CASA Actions arising from the Skehill Report dated 1 February 1999 detailed a specific list of responses to the findings.

22 October 1998 The Airspace 2000 Class G airspace trial Australian Aviation, commenced between Canberra and Ballina amid January and February concerns expressed by pilots, ATC staff and 1999; Aviation Week others. In early November, Qantas acted to stop and Space Technology, flights into four regional centres until CASA 1 March 1999; Sydney made some changes. After receipt of over 70 air Morning Herald, safety incident reports and a BASI investigation 7 November 1998. of two of them, CASA terminated the trial on 13 December 1998, noting that much had been learned. The interim BASI report found ten major safety concerns. The BASI investigation had required BASI to access CASA files, much to the chagrin of Chairman Mr Dick Smith, who had strongly championed the trial.

11 November 1998 Kendall Airlines Saab 340A aircraft rolled over Australian, 8 December and dived 700 metres in icy conditions on an 1998, 22 June 1999, Albury to flight with 31 aboard. The 25 May 2001; ATSB crew recovered control and landed safely. The investigation VH-LPI. subsequent investigation found a need for modified stall warning systems on this type of aircraft for icing conditions.

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16 November 1998 A media report suggested that an Eastern Age, 20 November Australian Airlines flight with 18 passengers 1998. missed an RAAF King Air jet by 10 seconds north of Newcastle, NSW.

8 December 1998 CASA grounded Coral Sea Airlines after one of Australian, 9 December its aircraft ditched, on 21 October, some 400 1998. metres short of Horn Island, in Torres Strait.

9 December 1998 The new Minister for Transport and Regional House of Services, Mr John Anderson re-introduced the Representatives, Civil Aviation Amendment Bill 1998 to the Debates,9 December House. The Bill was said to facilitate the 1998, p.1254. findings of the review of civil aviation legislation and the Plane Safe and Seaview Air inquiries reports. The aborted Class G airspace trial became the subject of a Matter of Public Importance in the House debate. The Senate continued to monitor air safety by questions and through its committee.

22 December 1998 A separate Review of Roles and Responsibilities http://www.dot.gov.au for the Regulation, Design and Management of /aviation/hawke Australian Airspace (The Hawke Report) /index.htm. concluded. It defined an airspace management regime, by agreement between ASA, CASA, BASI and Government but was not publicly released until later (see 4 November 1999).

January 1999 Uzu Air Britten-Norman Islander aircraft crashed The Bulletin, 5 in Torres Strait killing three people, twelve days September 2000. after a CASA grounding warning and a total grounding in 1994 due to safety concerns.

20 January 1999 CASA released an independent (Pearce) report Minister for Transport, into how it handled a serious air safety Media Release, complaint in 1996. CASA Chairman Mr Dick 20 January 1999; Smith referred the matter to the Federal Police. Canberra Times, Later, a CASA participation for safety program 21 January 1999. was announced to centralise aviation safety compliance functions, but with field staff to be given more freedom for taking action.

9 February 1999 The Minister for Transport and Regional Minister for Transport, Services Mr John Anderson released the terms Media Release, of reference for an independent review of BASI, 9 February 1999; following the reviews of CASA and ASA. The Senate, Debate ASA review, completed in March 1998 was not Question 171; p. 2188, released. The Opposition renewed its call for an Canberra Times, inquiry into CASA operations. The Minister 12 February 1999. stated that he saw no need for another review but reports of unrest continued in the aviation safety bureaucracy, along with a charge of cronyism made against BASI by the CASA Chairman Mr Dick Smith.

18 February 1999 The Review of the Regulation by the Civil Canberra Times, Aviation Safety Authority of Aquatic Air Pty Ltd 19 February 1999, trading as South Pacific Seaplanes prepared by 9 October 1999; Mr Stephen Skehill, dated October 1998 Bulletin, 13 June 2000.

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released by the Minister for Transport and Regional Services. It followed the fatal Aquatic Air crash north of Sydney in July 1998. The report found that a small number of CASA transactions were defective and not preferable, although not improper, including non-suspension of Aquatic Air. The CASA Actions arising from the Skehill Report dated 1 February 1999 detailed a specific list of responses to the findings. CASA Chairman Mr Dick Smith reported as believing that the Skehill report showed the existence of deficiencies continuing at CASA.

22 March 1999 CASA Chairman Mr Dick Smith resigned amid Sydney Morning allegations of collusion between the CASA Herald, 1 April 2000; board and airlines over the Class G airspace Australian, 27 and 30 trial. The Senate Rural and Regional Affairs and March 1999. Transport References Committee announced an inquiry into Airspace 2000 and related issues including BAe 146 aircraft fumes. The subsequent hearings revealed many issues in air safety and daily concerns.

24 March 1999 Consequent to the El Al Amsterdam disaster, the House of Damage by Aircraft Bill 1999 was introduced to Representatives, Parliament and passed to provide for increased Debates,24 March compensation. Some Civil Aviation Regulation 1999; Senate, Debates, amendments relating to the privatisation of ATC 8 March 1999. and firefighting services were disallowed in the Senate, as was foreshadowed by the Opposition.

15 April 1999 Korean Air Cargo MD-11 plane crashed in China Age, 11 May 1999. killing eight, raising continued concerns about the airline's management.

25 June 1999 A software glitch in the new TAAATS system AAP, 16 July 1999. shut down ATC over Brisbane for seven minutes. ASA claimed later to have fixed it. ASA had joined a consortium bidding to update the FAA's United States ATC systems.

29 June 1999 Dr Paul Scully-Power appointed as CASA Deputy PM Chairman. He announced a reform program and Mr J Anderson, Media rewriting of the aviation regulations with a new Release. regulatory services division.

19 July 1999 A BASI report on regional air travel raised Canberra Times 19 July issues of wide concern. A separate House of 1999, 22 July 1999, Representatives Committee Inquiry into 5 August 1999 and managing fatigue received submissions from 13 August 1999. aircraft engineers complaining of excessive working hours resulting in mistakes.

6 August 1999 The (McGrath) Review of the Bureau of Air Deputy PM Safety Investigation found an effective and Mr J Anderson, Media respected air accident investigation Release, 6 August organisation. However, the report contained 58 1999. recommendations for action. In response, the

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Government merged BASI with road and maritime safety agencies into a single agency, the Australian Transport Safety Bureau (ATSB). There was a call for the ATSB to not report to the Minister for Transport, but another Minister or entity, in order to ensure its complete independence. BASI Director, Dr Rob Lee departed.

August 1999 The International Civil Aviation Organisation Minister for Transport, (ICAO) completed a Universal Safety Oversight Media Release, 11 May Audit Program of Australia between 9 and 20 2000 A69/2000; House August 1999. CASA developed an Action Plan to of Representatives, address the 16 recommendations. Although the Debates, 7 June 2001, ICAO audit found an adequate comprehensive question no. 2212, regulatory system with no significant safety p. 26409. deficiencies, it did note the reorganisation and policy challenges facing CASA. In June 2001, it emerged that three recommendations were not accepted by CASA.

22 August 1999 China Airlines lost yet another aircraft, a China Airlines News McDonnell Douglas MD-11 at Hong Kong Airport Archive. when it flipped, killing three during a severe storm. The pilot was criticised for ignoring standards.

23 September 1999 A serious acccident occured with a fully laden Sydney Morning Qantas Boeing 747 aircraft landing at Bangkok Herald, 27 November Airport, Thailand in wet weather, when it 1999; Minister for overshot the runway and came to rest on a golf Transport, Media course. While some passengers received minor Release A57/01; CASA, injuries the aircraft required major repairs at a MR0022, 25 April reported total of $100 million. The subsequent 2001; ATSB Media ATSB investigation cited contributing factors Release, 25 April 2001; stemming from airline operating procedures and ATSB Investigation management as well as the need for CASA to Report, 199904538. adopt systems safety auditing. It was also critical of actions of crew on board after the accident, which led to a long delay in allowing passengers to exit. A CASA Board member, Mr Michael Ryan, of Consolidated Press Holdings corporate air fleet was aboard with 410 others.

30 September 1999 The Senate forced the tabling of a report by Mr Senate, Debates, p. Stephen Skehill on the appointment of a CASA 9309. Board member Mr Laurie Foley as Assistant Director Aviation Safety Compliance. This (second) Skehill investigation into CASA corporate governance cleared Mr Laurie Foley over selection processes.

31 October 1999 Egyptair Boeing 767 crashed after leaving New Australian Financial York, killing all 217 aboard leading to Review, 21 August considerable speculation on the cause, given 2000. that it was the third major disaster in the same corridor in less than four years. A claim of pilot suicide appeared to gain the greatest credibility, although contested by his relatives and the

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airline.

4 November 1999 The Minister for Transport and Regional Canberra Times, Services released a policy statement-A 7 November 1999 and Measured Approach to Aviation Safety Reform, 10 November 1999. along with new charter letters for ASA and CASA, following the Hawke report (see 22 December 1998). The statement indicated that airspace design, declaration and management would remain with ASA while CASA would retain responsibility for minimum airspace standards and operating procedures. The Minister also sought resolution of experimental and sports aviation, education and ATC matters. Meanwhile ASA settled in secret the TAAATS contract dispute with Hughes Corporation.

9 November 1999 ASA was awarded the International Air Minister for Transport, Transport Association (IATA) 'Eagle Award' as a Speech AS20/99. world leader in the provision of air navigation services. After much work, the air safety system would pass through the Year 2000 'millennium bug' barrier without incident, amid reports of contaminated fuel in planes.

22 November 1999 The ATSB Systemic Investigation into the Class ATSB Investigation G Airspace Demonstration report found several Report B98/166; major safety deficiencies in airspace Canberra Times, management. CASA stated its acceptance of the 24 November 1999; BASI recommendations following termination of Australian, 26 the trial period and the view that CASA's November 1999. previous role in airspace reform was in conflict with its role as the safety regulator. The ATSB report was also critical of the previous CASA Chairman Mr Dick Smith, while he in turn accused ATSB of being captive to union and airline interests in order to thwart efficient change. The ATSB also noted that the trial did provide information for future planning.

23 November 1999 The Australian National Audit Office reported on Audit Report No. 19 Aviation Safety Compliance by CASA in response 1999-2000 to a recommendation in the Plane Safe report. Performance Audit, While finding a competent agency, the report ANAO; Deputy PM noted continuing turmoil within CASA that Media Release. warranted stable management processes. CASA agreed with all of the 13 recommendations relating to safety targets and corporate plans so that procedures and documentation adhere to regulations. The audit also noted that CASA had no 1998-99 corporate plans.

January 2000 Contaminated aviation gasoline fuel (avgas), The Australian, 31 created by a temporary variation at the Mobil March 2001; Australian refinery, led to the grounding of general Aviation, March 2000. aviation aircraft for inspection. The subsequent ATSB report noted inadequate international standards for avgas. Mobil subsequently paid over $17.6 million in compensation to over 4000 claimants, to avoid a class action.

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16 February 2000 Civil Aviation Amendment Bill 1998 finally Senate, Debates, passed the Senate. The Bill provided for p. 11835. harmonised and changed regulations.

18 February 2000 The Federal Government appointed a new Deputy PM speech consultative body, the Aviation Safety Forum notes. (ASF), to provide strategic advice to CASA on matters of cultural change, cost structures, the Regulatory Reform Plan and policy aspects. The ASF would serve as a link to industry interests.

1 March 2000 After a nine-year gestation, TAAATS was Australian Aviation, officially commissioned. The delay was in part May 2000. due to litigation by one of the five unsuccessful contract bidders, Hughes Corporation. Final cost estimate was $377.5 million for completion by the Thomson-CSF company. TAAATS would win a number of international and local awards and become recognised as one of the most advanced air traffic control systems in the world. However, some early glitches and power failures, at Sydney Airport on 6 July and 1 August, tested both ATC and TAAATS.

23 March 2000 The Aviation Safety Foundation Australia Deputy PM Media launched an aviation industry code of best Release. practice containing a set of guidelines for excellence in operating standards.

April 2000 The Aviation Legislation Amendment Bill (No. 2) House of 2000, later to become (No. 1) 2001, proposed Representatives, after a review of civil aviation legislation by Debates, 12 April CASA. The Bill sought to facilitate the ongoing 2000, p. 15754. review of civil aviation regulations in line with ICAO standards. The Aviation Legislation Amendment Bill (No. 1) 2000 aimed to liberalise restrictions on airline ownership and increase penalties for breaches of the Sydney Airport curfew.

22 April 2000 Another accident with a Qantas Boeing 747 Age, 15 June 2000. aircraft occurred at Rome Airport Italy. While taxiing with 317 aboard, a strut failed. A reconditioned wing strut was declared a contributing factor.

11 May 2000 ICAO concluded that Australia's air safety Deputy PM Media system was generally satisfactory after a safety Release. audit of CASA found 16 action points. This followed Senate Estimates Committee hearings in which allegations emerged of wastage of CASA information technology resources.

31 May 2000 The fatal crash of Whyalla Airlines Piper Navajo Australian, 1 August Chieftain aircraft flight 904 on 31 May 2000 in 2000. Spencer Gulf in , with eight dead, led to further claims of inadequate air safety regulation. CASA later grounded the airline after a suspension hearing in the Administrative Appeals Tribunal.

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8 June 2000 An Ansett Airbus A320 and a Qantas Boeing 767 Australian, 15 June passed within a reported mile of each other 2000, 25 May 2001. over Alice Springs, after a traffic and collision avoidance system alert. As a result, some ASA staff were stood down. Meanwhile in June, Impulse Airlines expanded domestic operations to challenge the incumbent airline duopoly.

21 June 2000 CASA announced a rewrite of aviation Sydney Morning maintenance regulations over a two-year Herald, 22 June 2000. period. Subsequent introduction of regulatory changes proved controversial and not always successful, according to reports.

25 July 2000 An Air France Concorde crashed after take-off Canberra Times, 27 from Charles de Gaulle Airport killing 113 July 2000; Intelligence people. The cause was attributed to damage Newsletter, no. resulting from the ingestion of debris on the 40223 March 2001. runway but also was linked to poor design and maintenance factors.

25 August 2000 Gulf Air Airbus A320 crashed in the sea off Australian, 1 Bahrain killing 143. Meanwhile, Virgin Blue September 2000. Airlines commenced operations in Australia to also challenge the incumbent airline duopoly.

5 September 2000 A Beechcraft Super King Air plane crashed, The Australian, when all eight aboard suffocated, after 13 October 2000; depressurisation. The ATSB had previously Canberra Times, recommended mandatory audible 8 February 2001. depressurisation alarms but CASA did not follow up this action until the next year.

11 October 2000 Senate Rural and Regional Affairs and Transport CASA Media Release, Legislation Committee reported on the 12 October 2000. Administration of the Civil Aviation Safety Authority Matters related to Arcas Airways. The inquiry concerned the concealment of unofficial aircraft defect records and led to recommendations for legal prosecutions and creation of a new Director of Aviation Safety within CASA. CASA responded by taking action on the recommendations and demoted its head of aviation compliance Mr Laurence Foley.

12 October 2000 Senate Rural and Regional Affairs and Transport Australian Financial Legislation Committee reported on Air Safety Review, 13 October and Cabin Air Quality in the BAe 146 Aircraft 2000. following many reported cases of fumes. A history of such events and related factors was examined with resulting recommendations for national standards for air flows. CASA later issued a directive for the grounding of any BAe 146 aircraft with cabin fumes, but its makers rejected the findings.

31 October 2000 Singapore Airlines flight SQ006 Boeing 747 Australian, crashed while attempting to leave Taipei Airport 16-17 December 2001. during a typhoon. Later investigation revealed that the plane used a runway that was closed

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for construction. 83 aboard the jetliner died.

1 November 2000 CASA Director Mr Mick Toller came in for Canberra Times, continued criticism over breaching air laws 1 November 2000. during personal flights. He received counselling about the incidents but remained in his position. The CASA Chair Dr Paul Scully-Power also came under scrutiny over his incorrectly alleged status as a fighter pilot and astronaut. He was a private pilot and payload scientist.

1 November 2000 China Eastern Airlines Airbus A340-300, with a Sydney Morning hydraulic leak, skidded off a runway while Herald, 2 November landing at Sydney Airport. 2000.

22 December 2000 Just prior to Christmas, Ansett grounded seven Australian Financial of its Boeing 767 aircraft after an employee Review, 17 April 2001; discovered that required inspections had not Sydney Morning occurred in March. The mandatory inspections Herald, 13 April 2001; were performed with CASA supervision. A Australia Aviation 6/01 Boeing Alert Service Bulletin was then (Ansett Chronology). rediscovered (but did not become public until April 2001). Hairline cracks were discovered in the horizontal tail surfaces of some aircraft. Cracks were then found in the engine pylon mounts of three aircraft along with a crack in the tail of one that remained grounded after Christmas. These were similar to those that doomed the El Al Cargo Boeing 747 (see 4 October 1992). CASA placed conditions on Ansett operations and maintenance procedures, although it emerged that CASA had granted Ansett an extension for inspections a year previously. CASA had adopted a new systems audit approach to apply management programs to airlines. The ATSB also investigated the groundings and compliance of CASA, Boeing and Ansett as a safety deficiency issue.

22 February 2001 The Director of Aviation Safety at CASA, Mr The Australian, Mick Toller, stated that it was twice as safe to 22 February 2001. fly on a scheduled airline flight in Australia than in Europe or North America. The Aviation Legislation Amendment Bill (No. 1) 2001 passed to provide minor technical amendments to existing legislation.

3 March 2001 Fire destroyed a Thai Airways International Australian Aviation, Boeing 737-400 after it exploded while at the 6/01. Bangkok Airport Terminal, killing a flight attendant and injuring seven other people, shortly before the Thai Prime Minister was due to board. The event was linked by Boeing to empty centre fuel tank pumps and the need to follow proper operating procedures mindful of the infamous TWA loss.

7 March 2001 The Deputy Prime Minister and Minister for House of Transport and Regional Services, Mr John Representatives, Anderson, described Australia's air safety record Debates, Question as outstanding, noting that Ansett was the Time, p. 25275.

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second safest airline in the world and Qantas the third, but not stating the first. He appointed Air Vice Marshall Neil Smith to the CASA Board.

5 April 2001 Senate Rural and Regional Affairs and Transport Airspace 2000 and Legislation Committee concluded an extended Related Issues; inquiry into the impact of airspace Australian Aviation management, ASA services, and aspects of air 6/01. safety. The report noted the criticisms of the Airspace 2000 model, location specific pricing of terminal navigation and firefighting services as leading to increasing costs for regional aviation. The report generally called for more study into these matters. The Inquiry later continued on to CASA's Administration of Air Operator Maintenance, Regulation and Oversight functions as well as CASA's oversight and auditing of Ansett's maintenance regimes. A leaked internal audit report suggested that CASA had not improved since the 1999 Auditor General's report. The Opposition called for the next Australian National Audit Office review of CASA to be brought forward.

12 April 2001 Just prior to Easter, CASA grounded ten of Canberra Times, 17 Ansett's Boeing 767 aircraft after one was found and 22 April 2001; to be flying with an inoperable emergency slide. Aviation Week and The continuing problems were said to reflect a Space Technology, 23 lack of control and alleged deficiencies in April 2001; Australian CASA's surveillance perhaps due to cost cutting Financial Review, and staff cutbacks. CASA threatened Ansett with 18 April 2001, withdrawal of its Air Operators Certificate by 20 Australian Aviation, April 2001. 6/01.

20 April 2001 CASA accepted Ansett's plans for changes to its CASA MR0121, Courier maintenance and operational areas. Ansett Mail, 21 April 2001. embarked on a major media campaign as its grounded aircraft began to return to the air, just as leaked photographs of cracked pylons appeared in the press.

2 May 2001 Qantas announced a takeover of Impulse Sydney Morning Airlines operations. Late in the month, it also Herald, 2 May 2001. announced a bid for a stake in Air New Zealand which in turn might have divested itself of a stake in Ansett.

7 May 2001 CASA and ATSB in dispute over the latter's Canberra Times, 8 May investigation into the former's grounding of 2001. Ansett planes. The Minister for Transport Mr John Anderson counselled both organisations.

24 May 2001 CASA announced a new penalty regime for Sydney Morning minor safety breaches, while the Federal Budget Herald, 25 May 2001, gave it an extra allocation of $24.2 million for Canberra Times, 25 aviation safety compliance. May 2001.

25 May 2001 Further disruption to Ansett operations when Australian, 26 May three Boeing 767 aircraft and a Boeing 737 2001. were temporarily grounded for minor repairs.

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31 May 2001 Release of the Tom Sherman (consultant) report Minister for Transport, to CASA into two incidents involving the CASA Media Release A75/01, Director of Aviation Safety Mr Mick Toller. The A78/2001. report cleared Mr Toller of any criminal actions, stating that counselling was sufficient. He was re-appointed for another three-year term, while the CASA Chairman Dr Paul Scully-Power retired to be replaced by Mr Ted Anson, then Chairman of the Australian Maritime Safety Authority. The Opposition criticised both appointments. The Government asked Mr Anson to consider the existing CASA Board structure and to report in 2002 on whether it is appropriate for safety regulation to be a statutory authority.

6 June 2001 The FAA announced a US$11.5 billion, 10-year National Public Radio plan to modernise ATC by greater use of News. modern space-based satellite communications systems.

7 June 2001 The Auditor-General reported on Air Traffic Data ANAO Audit Report Collection by ASA. The audit found some no. 48, 2000-01. problems with manual data at smaller airports that ASA agreed to address.

12 June 2001 ATSB found general aviation in Australia as Deputy Prime Minister safer than in the United States and Canada, Media Release A83/01. with a decline in accidents here over the past decade. However, general aviation was the sector with the most accidents.

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