Human Factors Topics

Case Study, Cessna A185E Skywagon Inappropriate Repair, 1998

HF

Reference: Transport Canada, TP14175E, 10/2003 Transportation Safety Board Report Number A89O0453 Cessna A185E Skywagon Jumping Cariboo Lake, Ontario September 15th, 1989 Synopsis Shortly after the aircraft took off from Jumping Cariboo Lake, Ontario, the engine lost power. The pilot commenced a turn in an attempt to return to the lake for a forced landing, but the aircraft descended steeply into …

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Case Study, Metro II In-Flight Fire, 1998

Human-factors

Reference: Transport Canada, TP14175, 10/2003 Transportation Safety Board Report Number A98Q0087 Mirabel/Montreal International Airport, Quebec 18 June 1998 Synopsis The aircraft, a Fairchild-Swearingen Metro II (SA226-TC), from Dorval / Montréal International Airport, Quebec, around 0701 eastern daylight time bound for Peterborough Airport, Ontario. On board were nine passengers and two pilots. About 12 minutes after take-off, at an altitude of …

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Case Study, Bell 206 Power Loss, 1994

HF

Reference: Transport Canada, TP14175E (10/2003) Transportation Safety Board Report Number A94A0180 Bell Helicopter Textron 206L Long Ranger Porcupine Point, Labrador September 15th, 1994 Synopsis About 12 minutes into the flight, the engine chip light illuminated. The pilot made a precautionary landing and shut down the engine to inspect the chip detector. Finding only a small quantity of metal paste (fuzz) …

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Dirty Dozen

D12

Definition A large number of maintenance-related aviation accidents and incidents occurred in the late 1980s and early 1990s. Then, Transport of Canada identified twelve human factors that degrade a person’s ability to perform tasks effectively and safely, which could lead to errors during aircraft maintenance. These twelve factors are known as the “dirty dozen“. It was eventually adopted by the …

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