FAA's Risk Management Handbook

Risk Management Handbook 2009 U.S. Department of Transportation FEDERAL AVIATION ADMINISTRATION Flight Standards Service ii Preface Accident Categories – Pilot Related Maneuvering Accident Trend This handbook is a tool designed to help recognize and 30% 4.3% (42) Total manage risk. It provides a higher level of training to the Preflight/Taxi 2.3% (5) 27.5% 16.4% (160) Fatal 25.8% 26.1% pilot in command (PIC) who wishes to aspire to a greater Takeoff/Climb 25.2% 25.0% 14.4% (31) 24.1% 25% understanding of the aviation environment and become Fuel 8.8% (86) a better pilot. This handbook is for pilots of all aircraft Management 5.1% (11) 22.3% 5.2% (51) from Weight-Shift Control (WSC) to a Piper Cub, a Twin Weather 14.8% (32) 20% Beechcraft, or a Boeing 747. A pilot’s continued interest 1.6% (16) 20.2% Other Cruise Total 6.5% (14) in building skills is paramount for safe flight and can assist Fatal Descent/ 6.7% (65) in rising above the challenges which face pilots of all Approach 19.0% (41) backgrounds. 4.4% (43) 15% Go-Around 2.3% (5) 9.7% (94) Some basic tools are provided in this handbook for developing Maneuvering 25.0% (54) 9.9% 9.3% 9.7% 9.5% 9.8% 9.7% a competent evaluation of one’s surroundings that allows for 40.3% (392) 10% 9.2% Landing 7.7% assessing risk and thereby managing it in a positive manner. 3.7% (8) 2.5% (24) Risk management is examined by reviewing the components Other 6.9% (15) that affect risk thereby allowing the pilot to be better prepared 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 5% '99 '00 '01 '02 '03 '04 '05 '06 to mitigate risk. Fig. 4 Fig. 5 Figure I-1. The percentage of aviation accidents by phase of The pilot’s work requirements vary depending on the mode flight. accounted for 73.8 percent of total and 79.1 percent of Descent and Approach Accident Trend of flight. As for a driver transitioning from an interstate onto fatal GA accidents. As previously discussed, pilot-relat- 20% the city streets of New York, the tasks increase significantly 18.3% 19.0% ed accidents also represented a smaller proportion of 17.8% 17.1% during the landing phase, creating greater risk to the pilot and overall accidents in 2006. 16.7% warranting actions that require greater precision and attention. Occasionally, the word “must” or similar language is used where the desired action is deemed critical. The use of such This handbook attempts to bring forward methods a pilot can The accident categories shown in Figure 4 are defined 15% language is not intended to add to, interpret, or relieve a use in managing the workloads, making the environment safer by the phase of flight in which the accident occurred 14.3% duty imposed by Title 14 of the Code of Federal Regulations for the pilot and the passengers. [Figure I-1] (for example, landing or maneuvering), or by primary (14 CFR). 12.4% factor (such as fuel management or weather). Accidents 11.2% This handbook may be purchased from the Superintendent in the categories of weather, other cruise, 10% Comments regarding this publication should be sent, in email Total of Documents, United States Government Printing Office descent/approach, maneuvering, and “other” resulted in 7.7% Fatal (GPO), Washington, DC 20402-9325, or from the GPO form,disproportionate to the followingly hig address:h numbers of fatal accidents when 6.8% 7.0% website at http://bookstore.gpo.gov. compared to total accidents for that category. 6.7% [email protected] 5% 5.6% 5.2% 4.9% 4.8% This handbook is also available for download, in PDF format, Leading causes of pilot-related fatal accidents in 2006 were: from the Regulatory Support Division (AFS-600) website at •Maneuvering: 25.0 percent (54) • Descent/Approach: 19.0 percent (41) http://www.faa.gov. 0% •Weather: 14.8 percent (32) '99 '00 '01 '02 '03 '04 '05 '06 •Takeoff/Climb: 14.4 percent (31) Fig. 6 Maneuvering accidents, which accounted for one of four 2005 to 19.0 percent in 2006. This area will be tracked (25.0 percent) fatal GA accidents, showed an improve- closely over the next several years to monitor progress. ment from the 27.5 percent recorded the previous year. These accidents often involve questionable pilot judg- Pilot-related weather crashes were comparable to the ment, such as decisions to engage in buzzing, low passes, previous year, registering 51 (5.2 percent) total and 32 or other high-risk activities. The trend in maneuvering (14.8 percent) fatal pilot-related accidents. Most often, accidents shows a slight increase in the percentage of these fatal accidents resulted from pilots continuing both total and fatal maneuvering accidents since 1999. VFR flight into instrument meteorological conditions (IMC). In the long term, weather accidents continue Fatal descent and approach accidents, on the other their gradual increase. Figure 7 charts the trend of hand, increased from 11.2 percent of the fatal crashes in weather-related accidents. iii 5 iv Introduction According to National Transportation Board (NTSB) statistics, in the last 20 years, approximately 85 percent of aviation accidents have been caused by “pilot error.” Many of these accidents are the result of the tendency to focus flight training on the physical aspects of flying the aircraft by teaching the student pilot enough aeronautical knowledge and skill to pass the written and practical tests. Risk management is ignored, with sometimes fatal results. The certificated flight instructor (CFI) who integrates risk management into flight training teaches aspiring pilots how to be more aware of potential risks in flying, how to clearly identify those risks, and how to manage them successfully. “A key element of risk decision-making is determining if the risk is justified.” The risks involved with flying are quite different from those experienced in daily activities. Managing these risks requires a conscious effort and established standards (or a maximum risk threshold). Pilots who practice effective risk management have predetermined personal standards and have formed habit patterns and checklists to incorporate them. If the procedures and techniques described in this handbook are taught and employed, pilots will have tools to determine the risks of a flight and manage them successfully. The goal is to reduce the general aviation accident rate involving poor risk management. Pilots who make a habit of using risk management tools will find their flights considerably more enjoyable and less stressful for themselves and their passengers. In addition, some aircraft insurance companies reduce insurance rates after a pilot completes a formal risk management course. This Risk Management Handbook makes available recommended tools for determining and assessing risk in order to make the safest possible flight with the least amount of risk. The appendices at the end of this handbook contain checklists and scenarios to aid in risk management consideration, flight planning, and training. v vi Acknowledgments The Risk Management Handbook was produced by the Federal Aviation Administration (FAA) with the assistance of Safety Research Corporation of America. The FAA wishes to acknowledge the following contributors: Dr. Pat Veillette for information used on human behaviors (chapter 2) Cessna Aircraft Company and Garmin Ltd. for images provided and used throughout the Handbook Additional appreciation is extended to the Aircraft Owners and Pilots Association (AOPA), the AOPA Air Safety Foundation, and the National Business Aviation Association (NBAA) for their technical support and input. vii viii Table of Contents Preface....................................................................iii Visual Illusions ...........................................................3-7 E = External Pressures ...................................................3-9 Introduction .............................................................v Chapter Summary ..........................................................3-9 Acknowledgments ................................................vii Chapter 4 Assessing Risk ....................................................4-1 Table of Contents ..................................................ix Introduction ....................................................................4-1 Quantifying Risk Using a Risk Matrix ..........................4-2 Chapter 1 Likelihood of an Event ...............................................4-2 Defining Elements of Risk Management ...........1-1 Severity of an Event ...................................................4-2 Introduction ....................................................................1-1 Mitigating Risk ...........................................................4-4 Hazard .......................................................................1-2 Chapter Summary ..........................................................4-4 Risk .............................................................................1-5 Managing Risks .............................................................1-5 Chapter 5 Chapter Summary ..........................................................1-8 Aeronautical Decision-Making: A Basic Staple......................................................5-1 Chapter 2 Introduction ....................................................................5-1 Human Behavior ..................................................2-1 History of ADM .............................................................5-2 Introduction ....................................................................2-1 Analytical Decision-Making ..........................................5-3

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