The Federal Aviation Administration

1
ATS Incidents Reporting and Investigation Teams

• The Federal Aviation Administration
• Presented By
• Rick Baker

2
ATS Incident Reporting and Investigation

• Reporting OE/Ds to Team Supervisor
• Preliminary Investigation
• Headquarters Call-in
• Controller Decertification
• Final OE Report
• Investigation Teams
• Follow-Up from Investigation

3
Reporting OE/Ds to Team Supervisor

• Every controller is responsible to report a loss
  of separation
• Aircraft to Aircraft
• Aircraft to Airspace
• Every supervisor is responsible to investigate a
  reported loss of separation
• Unreported OE/Ds can result in disciplinary
  action

4
Reporting (cont.)

• Safety takes precedence over personal loyalties
• Reputation of national ATC system at stake

5
Preliminary Investigation

• Controller relieved from position
• Investigation conducted by supervisor
• Controller interviews
• Listen to voice tapes
• Review computer data
• Management determines if OE/D occurred

6
Headquarters Call-In

• Involves headquarters in QA process
• What happened
• Who was doing what
• What action have you taken
• Required within a pre-determined time limit

7
Controller De-certification

• Controller initially relieved from position
• Controller may be decertified if OE/D occurred
• Must receive training before returning to work
• Could be decertified on one or all positions

8
Investigation Teams
Researches and identifies contributing factors

• Equipment problems
• Supervision
• Weather
• Controller proficiency

• Airspace
• Procedures
• Distractions
• Workload

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Final OE Report

• Final Analysis of OE/D
• Identifies causes of OE/D
• Summary of event in time order
• Identifies responsible persons
• Action taken by facility as a result of OE/D
• Report is used in trend analysis

10
Follow-Up From Investigation

• Changes to procedures
• Changes to airspace
• Additional Training
• Controller performance review
• Supervisory performance review
• Follow-Up recorded reviews
• Increased oversight by headquarters

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