Table of Contents How to Interpret Data 2 Executive Summary 4 Aviation Safety Accomplishments 5 Statistical Summary 7 USFS Owned and/or Operated Statistics 14 Fixed-Wing (contract) Statistics 16 Airtanker Statistics 18 Helicopter Statistics 21 SAFECOM Summary 23 Mishap Summary 33 How to interpret data within this report NOTE: Formulas used: Industry standard “per 100,000 hours flown” Accident Rate = Number of accidents divided by the number of hours flown multiplied by 100,000. Fatal Accident Rate = Number of fatal accidents divided by the number of hours flown multiplied by 100,000. Fatality Rate = Number of fatalities divided by the number of hours flown multiplied by 100,000. This report is available on-line at: http://www.fs.fed.us/fire/av_safety/ fy_safety_reports/index.html 2 2 How to interpret data within this report Aircraft Categories: USFS Owned and Operated which includes the 23 fleet aircraft (20 fixed-wing and 3 helicopter) and 14 leased fixed-wing aircraft. Fixed-Wing Aircraft (contract), this includes all contract fixed-wing, excluding all airtankers. Helicopters includes all types, including tanked helicopters also referred to as helitankers. Large Airtankers include all multi-engine including the Very Large Airtankers. SEAT’s are Single Engine Airtankers, the USFS only has one on contract through DOI-OAS, however the hours are obtained from DOI-OAS for all SEAT’s that flew on USFS missions. Mishap Definitions Aircraft Accident: An occurrence associated with the operation of an aircraft which takes place between the time any person boards the aircraft with the intention of flight and the time all such persons have disembarked, and in which any person suffers death or serious injury or in which the aircraft receives substantial damage. During a jump sequence, a Forest Service smokejumper is considered to have safely disembarked the aircraft after detaching from the static line from the parachute deployment system and when the parachute canopy has successfully deployed. (Refer to 14 CFR NTSB 830 for definition of reportable accidents) Aircraft Incident with Potential: An "in-flight incident" that narrowly misses being an accident by NTSB definition and circumstances involve some aircraft damage, property damage, or minor injury to crew or passengers. Classification of Incidents with Potential is determined by the US Forest Service, Branch of Risk Management. Operational Control is defined as the exercise of authority over initiating, conducting, or terminating a flight (14 CFR Part 1.1). This includes direct management oversight, supervision and accountability for a specific task, mission or assignment. Forest Service fleet aircraft or aircraft on contract to the USFS that have a mishap while under operational control of another agency (ie BLM, NPS, State, etc.) are not USFS reportable mishaps but that of the agency with operational control. Cooperator aircraft (fleet and contract) under operational control of the USFS that have a mishap are USFS reportable mishaps and are included in these statistics. Military aircraft remain under the operational control of the military even while supporting USFS operations. 3 Executive Summary The Forest Service Aviation Risk Management program is based on the philosophy that all aircraft mishaps are preventable and that mishap prevention is an inherent function of management. The Forest Service had one accident in 2014, ending the zero accident run of the previous three years. Risk Management Program Objective: The objectives of Aviation Risk Management and Training Systems are in keeping with the most modern approaches to the safe management of complex systems. Success in aviation safety is a result of coordinated efforts with cooperators and vendors who provide approximately 90% of all Forest Service aviation services. The Forest Service incorporates Safety Management Systems (SMS) in it’s aviation program. The Forest Service continues working with the FAA and HAI on implementing Safety Management Systems that target a reduction in the number of accidents experienced by aircraft vendors that service our natural resource missions. Safety Management Systems achieve high standards of efficiency and effectiveness within the four primary components which include: ✈ Policy is management commitment, responsibility and accountability for the program and the appointment of key safety personnel. Forest Service manuals are being revised using principle centered management for guidance of aviation operations. ✈ Risk Management identifies hazards and applies risk assessment and mitigation processes. ✈ Assurance is the process of monitoring controls that also includes safety and compliance audits, aviation accident prevention, review and analysis of historical data, accident investigation, error analysis, and corrective action plans. ✈ Promotion includes training for pilots, crews, managers, support personnel and endusers. Other communications, awards and lessons learned help to maintain safety awareness. The Branch of Aviation Risk Management monitors safety data, hazard reports and mishaps in its effort to identify hazardous trends. The SAFECOM system is a proactive method that monitors and corrects safety issues and shares lessons learned. 4 Aviation Safety Accomplishments Accomplishments achieved in aviation safety in FY 2014 include the following: Policy: ✈ Revised the Safety Management System (SMS) Guide ✈ Participated in the FSM 5700 rewrite ✈ Provided input to several guides and handbooks ✈ Participated in the revision of the National Aviation Safety Management Plan Risk Management: ✈ Instructed multiple risk management sessions nationally ✈ Participated in Change Management Plan for new C-23 aircraft ✈ Completed action Plan of the Aerial Supervision Risk Assessment ✈ Participated in Change Management Plan and Risk Assessment on changing from Round Parachutes to Square Parachutes for the Smokejumper Program ✈ Participated in Simultaneous Loading and Fueling risk assessment for new Airtankers Assurance: ✈ Coordinated investigations of one accident, two Incidents With Potential (IWP) and multiple other Facilitated Analysis and Peer Reviews. ✈ Revised and strengthened the Exclusive Use (EU) and Call When Needed (CWN) contract specifications for vendor SMS ✈ Participated in contract technical evaluation board proposals ✈ Participated on aviation safety and technical assistance teams ✈ Participated in quality assurance reviews Safety Promotion: ✈ Hired New Branch Chief, Aviation Safety Management Systems ✈ Published 4 monthly SAFECOM Summaries ✈ Published a combined total of 17 Safety Alerts, Technical Bulletins, Lessons Learned, Accident Prevention Bulletins and Information Bulletins 5 Aviation Safety Accomplishments Safety Promotion (continued): ✈ Presented A-200 Aviation Mishap Reviews at several Regional Aviation and Safety meetings, Helicopter Crewmember, Helicopter Manager and Helibase Manager Courses ✈ Added a mobile accessible SAFECOM page for users to access the system via smart phones and tablets. ✈ Provided SMS scholarships to Treasure Valley community college, 4 students graduated from the program and an additional 18 are completing courses. 6 Statistical Summary The USFS flew 57,483 hours in FY 2014 which well below the 10-year average of 69,149 flight hours. The primary mission of Forest Service Aviation is to support natural resource programs through a variety of means, including, but not limited to: Aerial delivery of firefighters by parachute, rappel rope, or on site landing Air tactical command and control Surveillance, reconnaissance, and intelligence gathering Infrared detection & mapping Aerial delivery of fire retardant and water Passenger transport for firefighting and resource missions Administrative flights Research Forest rehabilitation Forest Health Protection (aerial surveys, application and photography) Law enforcement Aerial photography Approximately 200 employees at the Washington Office, Regional Offices and Forest levels administer the Forest Service aviation program. The national staff is located in Washington D.C. and at the National Interagency Fire Center in Boise, Idaho. The vast majority of aviation personnel are located throughout the regions providing day-to-day operational oversight and program guidance. The Forest Service utilized approximately 500 aircraft in FY 2014. These include government owned and leased, but mostly contracted aircraft. The Forest Service owns and operates 23 aircraft (20 fixed-wing and 3 helicopters) and leases/operates 14 aerial supervision fixed wing aircraft. Numerous state agencies and county municipalities operate Forest Service owned aircraft under the Federal Excess Personal Property (FEPP) program. These aircraft are not included in these statistics or mishap data. 7 Statistical Summary accident rate USFS Aircraft Accident Rates 1999 to 2008 USFS Aircraft Accident Rates 2005-2014 8.17 4.96 4.46 4.07 5.21 4.46 1.73 0 20 20 20 20 20 20 20 20 14 13 12 11 10 09 08 07 06 05 Accident Rate 0 20 0 20 9 8 7 6 5 4 3 2 1 0 Trendline The trend line for the last 10-years shows a significant decrease with three years of a ZERO accident rate. The Forest Service had one accident in 2014 and two Incidents With Potential. FY 2014 Accident Statistics Aircraft Type Hours Number of Accidents Accident Rate Number of Fatalities Fatality Rate Fixed-Wing 17,910 0 0 0 0 Helicopter 27,769 0 0 0 0 Large Airtanker 3,405 1 29.36 0 0 (LGAT) *Single Engine Air505 0 0 0 0 tanker (SEAT) USFS Owned and/or 7,894 0 0 0 0 Operated (USFS O/O) *SEATTotal – flight hours for SEAT57,483 aircraft on USFS lands were 1 1.73 obtained 0from the DOI,0 Aviation Management Directorate 8 Statistical Summary FY 2014 Flight Hour Percentages 5.9% 13.7% 48.3% 0.9% 31.2% Fixed-Wing Helicopter LGAT USFS O/O SEAT 10-Year Average of Flight Hour Percentages 2005-2014 6.0% 11.5% 1.2% 47.4% 33.9% Fixed-Wing Helicopter LGAT 9 USFS O/O SEAT Statistical Summary Average vs Actual Hours Flown for FY 2014 80,000 69,149 57,483 60,000 40,000 20,000 0 Average Actual Comparison of Average vs 2014 10 Year Average 2014 Comparison 69,149 57,483 -11,666 Number of Accidents 2.3 1 -1.3 Number of Fatalities 2.6 0 -2.6 Accident Rate 3.32 0 -3.32 Fatality Rate 3.76 0 -3.76 Hours flown In the past 10 years there have been 23 accidents; of which 8 were fatal accidents with a total of 26 fatalities. The good news is that we have not had a fatal accident in the past 4 years. Average vs Actual for 2014 Average 4 Actual 3 3.32 2.3 1.73 1 Number of Accidents 2 3.76 2.6 1 0 Accident Rate 10 Number of Fatalities 0 Fatality Rate 0 Statistical Summary 10-Year Flight Hour Statistics Fiscal Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 10-year Totals Averages Fixed Wing Helicopter 17,910 27,769 22,972 34,860 26,299 40,904 22,846 34,106 15,227 18,707 18,576 26,439 23,600 35,512 29,631 41,571 34,564 39,735 22,521 28,362 LGAT 3,405 2,966 3,382 4,550 2,853 3,684 5,010 5,641 6,659 3,682 SEAT 505 534 821 578 379 781 1,318 628 1,792 674 USFS O/O 7,894 8,672 9,728 9,126 7,667 8,056 8,187 8,122 6,898 5,185 Total 57,483 70,004 81,134 71,206 44,833 57,536 73,627 85,593 89,648 60,424 234,146 327,965 41,832 8,010 79,535 691,488 23,415 32,797 4,183 801 7,954 69,149 10-Year Accident Rates Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 10-year Average # of Total All Accidents Aircraft FixedHelicopter LGAT Wing SEAT USFS O/O 1 0 0 0 2 3 3 7 4 3 1.73 0.00 0.00 0.00 4.46 5.21 4.07 8.17 4.46 4.96 0.00 0.00 0.00 0.00 6.56 0.00 4.23 3.37 2.89 4.44 0.00 0.00 0.00 0.00 0.00 7.56 5.63 9.62 7.55 7.05 29.36 0.00 0.00 0.00 35.05 27.14 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 318.47 0.00 0.0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.3 3.32 2.13 3.96 7.17 24.96 0.00 Accident Rate = Number of accidents divided by the number of hours flown multiplied by 100,000. 11 Statistical Summary 10-Year Fatal Accident and Fatality Rates Year Fatal Accidents Fatal Number of Accident Rate Fatalities Fatality Rate 2014 0 0 0 0 2013 0 0 0 0 2012 0 0 0 0 2011 0 0 0 0 2010 1 4.46 3 6.69 2009 2 3.47 4 6.95 2008 1 1.35 9 12.22 2007 1 1.16 1 1.16 2006 2 2.23 6 6.69 2005 1 1.65 3 4.96 10-year Average .8 1.16 2.6 3.76 Fatal Accident Rate = Number of fatal accidents divided by the number of hours flown multiplied by 100,000. Fatality Rate = Number of fatalities divided by the number of hours flown multiplied by 100,000. 12 Statistical Summary Forest Service Aircraft Accident Statistics in 5-Year Increments The total number of accidents in 5-year increments shows a steady decline, until the 20012005 period. The total number of fatalities in 5-year increments shows a major decline from the 60’s to the mid 70’s. There was a spike in the early 2000’s, then dropping in 2011 to “zero” for this latest 5 year increment. Unfortunately, the number of fatalities in the periods from 2001-2010 increased. With the adoption of Safety Management Systems, particularly new risk management processes and quality assurance programs we have seen a significant decrease in the number of accidents and fatalities in the last few of years. Total Number of Accidents for all aircraft (5-Year Increments) 90 80 70 60 50 40 30 20 10 0 85 67 60 45 34 38 32 28 26 19 17 1 4 01 5 01 0 01 5 00 0 00 5 99 0 99 5 98 0 98 5 97 0 97 5 96 -2 61 19 -2 11 20 -2 06 20 -2 01 20 -2 96 19 -1 91 19 -1 86 19 -1 81 19 -1 76 19 -1 71 19 -1 66 19 -1 61 19 ge ra ve A Total Number of Fatalities for all aircraft (5-Year Increments) 40 40 35 35 30 30 23 25 19 22 19 20 15 15 15 11 8 10 5 0 0 19 15 10 05 00 95 90 85 80 75 70 65 12 0 -2 0 -2 0 -2 0 -2 9 -1 9 -1 9 -1 9 -1 9 -1 9 -1 9 -1 0 -2 11 06 01 96 91 86 81 76 71 66 61 61 20 20 20 19 19 19 19 19 19 19 19 a er Av ge 13 USFS Owned and/or Operated Aircraft This includes the 23 Forest Service owned fleet aircraft and 14 leased Forest Service operated aerial supervision aircraft. The Forest Service owned aircraft accounted for 4,553 flight hours and the 14 leased aerial supervision aircraft flew 3,341 hours in FY 2014. This was 13.7% of the total flight hours, which is above the average of 11.5%. There have not been any accidents in the past 10 years and no fatal accidents for 19 years in USFS O/O aircraft. USFS Owned and/or Operated 10-Year Statistics Fatal # of Accident Fatal Fatality Accident Fatalities Accidents Rate Accidents Rate Rate Fiscal Year Hours Flown 2014 7,894 0 0.00 0 0.00 0 0.00 2013 8,672 0 0.00 0 0.00 0 0.00 2012 9,728 0 0.00 0 0.00 0 0.00 2011 9,126 0 0.00 0 0.00 0 0.00 2010 7,667 0 0.00 0 0.00 0 0.00 2009 8,056 0 0.00 0 0.00 0 0.00 2008 8,187 0 0.00 0 0.00 0 0.00 2007 8,122 0 0.00 0 0.00 0 0.00 2006 6,898 0 0.00 0 0.00 0 0.00 2005 5,185 0 0.00 0 0.00 0 0.00 Total Average 79,535 7,954 0 0 0.00 0 0 0.00 0 0 0.00 14 USFS Owned and/or Operated Aircraft USFS O/O Hours Flown 12000 10000 8000 6000 4000 2000 Hours Flown Trendline 0 13 20 14 20 0 0 12 20 13 20 14 20 12 20 0 11 20 11 20 0 10 20 10 20 0 09 20 09 20 08 20 07 20 06 20 05 20 0 USFS O/O Accident Rates 1 0.9 accident rate 0.8 0.7 0.6 0.5 0.4 Accident Rate Trendline 0.3 0.2 0 0 0 0 05 20 06 20 07 20 08 20 0.1 0 15 Fixed-Wing Aircraft (contract) Fixed-Wing contract aircraft accounted for 31.2% of the total hours flown; the 10-year average is 33.9%. There were 17,910 hours flown, which is well below the 10-year average of 23,415. There have not been any accidents in four years, the 10-year accident rate is 2.13 with 5 accidents. Fixed-Wing contract aircraft account for 22% of all the accidents and 11% of all the fatalities in the past 10 years. Fixed-Wing 10-Year Statistics Fatal Accident Fatal Fatality Accident Fatalities Rate Accidents Rate Rate Fiscal Year Hours Flown Accidents 2014 17,910 0 0.00 0 0.00 0 0.00 2013 22,972 0 0.00 0 0.00 0 0.00 2012 26,299 0 0.00 0 0.00 0 0.00 2011 22,846 0 0.00 0 0.00 0 0.00 2010 15,227 1 6.56 1 6.56 3 19.7 2009 18,576 0 0.00 0 0.00 0 0.00 2008 23,600 1 4.23 0 0.00 0 0.00 2007 29,631 1 3.37 0 0.00 0 0.00 2006 34,564 1 2.89 0 0.00 0 0.00 2005 22,521 4.44 0 3 0.00 234,146 0 1 0.00 Total 1 5 Average 23,415 0.5 2.13 0.1 0.42 0.3 1.28 16 Fixed-Wing Aircraft (contract) Fixed-Wing Hours Flown 40000 35000 30000 25000 20000 15000 10000 5000 Hours Flown Trendline 0 20 05 20 20 06 20 07 20 08 20 09 20 10 11 20 12 20 13 20 14 Fixed-Wing Accident Rates 6 accident rate 5 4.44 4.23 4 3.47 3.37 2.89 3 2 1 Accident Rate Trendline 0 0 0 0 11 20 12 20 13 20 14 20 0 0 10 20 09 20 08 20 07 20 06 20 05 20 17 Airtankers (contract) Large Airtankers accounted for 5.9% of the total hours flown; which is very close to the 10-year average of 6.0%. Single Engine Airtankers only accounted for 0.9% of the flight hours; which is below the average of 1.2%. We have seen a significant decrease in airtanker accidents since the 1960’s; however, in the past 10 years there have still been 5 accidents with 3 fatalities. Airtankers account for 22% (Large Airtankers 13% and SEAT’s 9%) of all the accidents in the past 10 years. Large Airtankers account for 12% of all the fatalities in the past 10 years. All Airtankers 10-Year Statistics Fiscal Year Hours Flown 2014 Fatal Fatal Fatality Accident Fatalities Accidents Rate Rate 0 0.00 0 0.00 Accidents Accident Rate 1 25.57 2013 3,910 3,500 0 0.00 0 0.00 0 0.00 2012 4,203 0 0.00 0 0.00 0 0.00 2011 5,128 0 0.00 0 0.00 0 0.00 2010 3,232 1 30.94 0 0.00 0 0.00 2009 4,465 1 22.39 1 22.39 3 67.18 2008 6,328 0 0.0 0 0.00 0 0.00 2007 6,269 2 31.9 0 0.00 0 0.00 2006 8,451 0 0.00 0 0.00 0 0.00 2005 4,356 0 0.00 0 0.00 0 0.00 Total 49,842 5 Average 4,984 0.5 1 10.03 18 0.1 3 2.0 0.3 6.01 Airtankers (contract) Large Airtanker 10-Year Statistics Fiscal Year Hours Flown 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 Total 3,405 2,966 3,382 4,550 2,853 3,684 5,010 5,641 6,659 3,682 41,832 Average 4,183 Fatal Accident Fatal Accidents Accident Fatalities Rate Accidents Rate 1 29.36 0 0.00 0 0 0.00 0 0.00 0 0 0.00 0 0.00 0 0 0.00 0 0.00 0 1 35.05 0 0.00 0 1 27.14 1 27.14 3 0 0.00 0 0.00 0 0 0.00 0 0.00 0 0 0.00 0 0.00 0 0 0.00 0 0.00 0 1 3 3 0.3 7.17 0.1 2.39 0.3 Fatality Rate 0.00 0.00 0.00 0.00 0.00 81.43 0.00 0.00 0.00 0.00 7.17 Single Engine Airtanker 10-Year Statistics Fatal Accident Fatal Accidents Accident Fatalities Rate Accidents Rate 0 0.00 0 0.00 0 Fiscal Year Hours Flown 2014 505 2013 534 0 0.00 0 0.00 0 0.00 2012 821 0 0.00 0 0.00 0 0.00 2011 578 0 0.00 0 0.00 0 0.00 2010 379 0 0.00 0 0.00 0 0.00 2009 781 0 0.00 0 0.00 0 0.00 2008 1,318 0 0.00 0 0.00 0 0.00 2007 628 2 318.47 0 0.00 0 0.00 2006 1,792 0 0.0 0 0.00 0 0.00 2005 674 0 0.0 0 0.00 0 0.00 Total 8,010 801 2 0.2 Average 0 24.96 19 0 Fatality Rate 0.00 0 0.00 0 0.00 Airtankers (contract) Airtanker Hours Flown 9000 8000 LGAT 7000 SEAT ALL AT's Trendline LGAT Trendline SEAT 6000 5000 4000 3000 2000 1000 0 20 20 20 20 20 20 20 20 20 20 14 13 12 11 10 09 08 07 06 05 Airtanker Accident Rates 350 318.47 300 accident rate 250 All AT's LGAT SEAT Trendline All AT's 200 150 100 31.9 50 0 0 0 0 0 20 0 0 0 0 20 20 0 20 20 14 13 12 11 10 09 08 07 06 05 20 0 0 20 0 25.57 29.36 20 0 35.05 20 0 30.94 20 0 20 0 22.39 27.14 Helicopters (contract) Helicopters accounted for 48.3% of the flight hours, which is above the 10-year average of 47.4%. There were no helicopter accidents again this year making it 5 years in a row without an accident . Even without having any accidents for the past 5 years, helicopters still account for 56% of all the accidents and 77% of the fatalities over the past 10 years. The 10-year accident rate for Helicopters is 3.96, with 13 accidents and 20 fatalities. Helicopter 10-Year Statistics Fatal Accident Fatal Accident Fatalities Rate Accidents Rate Fiscal Year Hours Flown Accidents 2014 27,769 0 0.00 0 0.00 0 0.00 2013 34,860 0 0.00 0 0.00 0 0.00 2012 40,904 0 0.00 0 0.00 0 0.00 2011 34,106 0 0.00 0 0.00 0 0.00 2010 18,707 0 0.00 0 0.00 0 0.00 2009 26,439 2 7.56 1 3.78 1 3.78 2008 35,512 2 5.63 1 2.81 9 25.34 2007 41,571 4 9.62 1 2.40 1 2.40 2006 39,735 3 7.55 2 5.03 6 15.01 2005 28,362 2 7.05 1 3.52 3 10.57 Total 327,965 13 Average 32,797 1.3 6 3.96 21 0.6 Fatality Rate 20 1.82 2 6.09 Helicopters (contract) Helicopter Hours Flown 45000 40000 35000 30000 25000 20000 15000 10000 Hours Flown 5000 Trendline 0 9.62 10 accident rate 14 20 13 20 12 20 11 20 10 20 09 20 08 20 07 20 06 20 05 20 Helicopter Accident Rates 12 87.05 7.56 7.55 5.63 6 4 Accident Rate 2 Trendline 0 0 0 0 0 0 14 20 13 20 12 20 11 20 10 20 09 20 08 20 07 20 06 20 05 20 22 SAFECOM Summary The SAFECOM system satisfies Federal Aviation Regulations requirements for incident reporting, but more importantly, it provides management and front line supervisors with near real time accident prevention information. Armed with data on emerging safety and effectiveness challenges, operators and management can take appropriate actions before a mishap occurs. The following charts trend the Forest Service SAFECOM data submitted to the Interagency SAFECOM database online at https://www.safecom.gov/. In FY 2014 there were 419 Forest Service SAFECOMs submitted, which is well below the 10-year average of 537. There were a total of 754 SAFECOMs (419 Forest Service, 278 DOI, 49 State and 8 Other/Unknown/Military/Vendor) submitted to the Interagency SAFECOM database in FY 2014. The most reported USFS SAFECOMs in FY 2014 were communications (56), precautionary landing (45), engine (37), hazard - mission equipment (29), chip light (21), maintenance - mission equipment (20), policy deviation (19), and electrical (18). Forest Service 10-Year SAFECOM Totals YEAR 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 Total 10 YR Average Number of SAFECOM’s 419 465 642 522 398 441 594 620 753 516 5,370 537 23 SAFECOM Summary 2014 SAFECOMs by Aircraft Aircraft Type Number Fixed Wing Helicopter Airtanker N/A SEAT USFS Owned/Operated Total 71 243 60 10 6 29 419 SAFECOMs by Aircraft Type for 10 Years 450 400 350 300 250 200 150 100 50 0 Fixed-Wing 2014 2013 Helicopter 2012 2011 Airtanker 2010 24 2009 USFS Owned 2008 2007 SEAT 2006 2005 SAFECOM Summary SAFECOMs by Category The numbers of SAFECOMs by category will be more that the total number of SAFECOMs reported as each SAFECOM may have more than one category assigned to it. For example several Incident and Hazard SAFECOMs also have Maintenance SAFECOMs associated with them. 2014 Percent of SAFECOMs by Category 2% 0% 6% 25% 38% 6% 23% Accident Hazard Incident Management Airspace Mishap Prevention Maintenance 10-Year Average Percent of SAFECOMs by Category 1% 0% 7% 25% 45% 3% 19% 25 SAFECOM Summary Airspace SAFECOMs by sub-category There were a total of 35Airspace SAFECOMs reported this year, which below the 10-year average of 46. Intrusions (6 reports) accounted for 14% of the reports in this category, which is considerably down from the average of 42%. Conflicts (16 reports) accounted for 39%, which is above the average of 26%. Procedural issues (9 reports) were up to 22% this year compared to the average of 12%. There was one near mid-air event investigated as an IWP, which is below the 10 year average of 2.4 reports. 2014 Percent of Airspace SAFECOMs 2% 22% 39% 7% 2% 14% 14% Conflict Near Mid-Air Route Deviation Congestion Other Intrusion Procedures 10-Year Average Percent of Airspace SAFECOMs 4% 1% 12% 26% 5% 10% 42% 26 SAFECOM Summary Hazard SAFECOMs by sub-category There were a total of 148 Hazard SAFECOMs reported. Below are charts indicating the top 5 Hazard SAFECOMs reported and the number of Hazard SAFECOMs for the past 10 years. The top 5 sub-categories are similar to the last few years, however the sub-category Instructions overtook Preflight Action this year. Communication issues are historically and continue to be the most reported hazard, accounting for 38% of the Hazard SAFECOMs reported in 2014. 2014 Top 5 Hazards reported 60 56 50 40 30 27 20 22 19 10 13 0 Communications Policy Deviation Mission Equipment Pilot Action Instructions Total number of Hazards reported by year 250 245 200 189 150 203 193 148 144 139 126 115 120 2010 2009 100 50 0 2014 2013 2012 2011 27 2008 2007 2006 2005 SAFECOM Summary Incident SAFECOMs by sub-category There were a total of 133 Incident SAFECOMs reported. Below are the top 5 Incident SAFECOMs reported and the total number of Incident SAFECOMs reported for the last 10-years. Precautionary Landings were again the most reported in this category with most attributed to maintenance problems. Mission Equipment was the next most reported in this category followed by Dropped Loads, Aircraft Damage and Ground Damage. 2013 Top 5 Incidents reported 45 45 40 35 30 29 25 20 15 15 10 11 8 5 0 Ground Damage Aircraft Damage Dropped Load Mission Equipment Precautionary Landing Total number of Incidents reported by year 180 160 165 140 120 133 156 143 127 124 100 125 104 95 80 74 60 40 20 0 2014 2013 2012 2011 2010 28 2009 2008 2007 2006 2005 SAFECOM Summary Maintenance SAFECOMs by sub-category There were a total of 216 maintenance SAFECOMs reported. Below are the top 8 Maintenance SAFECOMs reported and the total number of maintenance SAFECOMs reported for the last 10-years. Maintenance SAFECOMS accounted for 38% of all the USFS SAFECOM reports. Engine maintenance discrepancies continue to be the most reported; there were a total of 37, of which 5 of them were a engine failure or required shutdown. 2014 Top 8 Maintenance deficiencies reported 40 35 37 30 25 20 21 20 15 18 16 10 15 13 13 Caution Light Instrument 5 0 Engine Chip Light Mission Equipment Electrical Avionics Fuel Total number of Maintenance deficiencies reported by year 500 450 453 400 350 332 300 250 200 216 223 2014 2013 334 297 209 360 264 239 150 100 50 0 2012 2011 2010 29 2009 2008 2007 2006 2005 SAFECOM Summary Forest Service Mishap Prevention Mishap Prevention is a category to recognize the good things folks are doing in aviation. Most Airwards come from the SAFECOM system under this category. 50 50 45 40 41 35 36 30 29 25 20 15 10 13 12 5 7 7 8 2007 2006 4 0 2014 2013 2012 2011 2010 2009 2008 2005 Forest Service Management Below are the SAFECOM reports classified as Management, sub-categorized by internal and external. 16 External 16 14 Internal 12 11 10 10 8 9 8 6 4 11 5 4 2 3 0 2014 1 2 2013 2012 2011 3 2 2010 30 2009 2 2 2008 1 1 1 2007 2006 2 1 2005 2004 SAFECOM Summary FY 2013 SAFECOMs by Region Percent of SAFECOMs by Region R-8 6% R-9 R-10 2% 1% R-1 9% R-2 6% R-3 10% R-6 26% WO 0% R-4 NEA 9% 0% R-5 31% FY 2013 SAFECOMs by Aircraft Type and Region Region FixedWing Helicopter Airtanker SEAT USFS Owned N/A Total Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 8 Region 9 Region 10 NEA WO Total 7 2 8 9 15 22 2 2 4 0 0 71 20 2 11 19 88 76 24 2 1 0 0 243 2 0 12 6 30 9 1 0 0 0 0 60 1 0 0 1 2 2 0 0 0 0 0 6 2 2 2 3 6 6 2 4 1 1 0 29 1 1 1 2 2 1 0 2 0 0 0 10 33 7 34 40 143 116 29 10 6 1 0 419 31 SAFECOM Summary SAFECOMs by Region The numbers of SAFECOM’s by category are more than the total number of SAFECOMs reported as each SAFECOM can have more than one category assigned to it. FY 2013 SAFECOMs by Category and Region Region Accident Airspace Hazard Incident Maint. Mgt. Mishap Prevention Total Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 8 Region 9 Region 10 NEA WO Total 0 0 0 0 1 0 0 0 0 0 0 1 2 0 2 4 12 10 5 0 0 0 0 35 16 5 8 15 46 33 18 3 3 1 0 148 19 0 11 6 35 48 12 2 1 0 0 134 13 2 17 21 74 64 19 2 4 0 0 216 3 1 0 0 1 5 0 3 0 0 0 13 0 19 1 0 10 1 1 4 0 0 0 36 53 27 39 46 179 161 55 14 8 1 0 583 32 Mishap Summary The Forest Service investigated one accident and two incidents in 2014 as IWP’s. The table below shows the basic information. For additional information review the A-200 Mishap Review on the Interagency Aviation Training website at www.iat.gov Date Aircraft Type Incident Description 06/15/14 Region/ Forest R-5 Sierra NF Lockheed P2V (Accident) 05/21/14 R-3 Coconino NF Sikorsky CH-54 (IWP) Hydraulic Failure, nose wheel collapse SAFECOM 14-286 Tail Rotor Strike SAFECOM 14-227 07/12/14 R-5 Sequoia NF Lockheed C-130 & Lockheed P2V-7 (IWP) Near Mid-Air SAFECOM 14-0427 NTSB Preliminary Report—NTSB Identification: WPR14TA248 Accident occurred Sunday, June 15, 2014 in Fresno, CA Aircraft: LOCKHEED SP 2H, registration: N4692A 14 CFR Public Use - Injuries: 2 Uninjured. This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. NTSB investigators may not have traveled in support of this investigation and used data provided by various sources to prepare this public aircraft accident report. On June 15, 2014, about 2044 Pacific daylight time, a Lockheed SP-2H, N4692A, was substantially damaged when the nose wheel landing gear collapsed during landing roll at the Fresno Yosemite International Airport (FAT), Fresno, California. The airplane was registered to Minden Air Corporation, Minden, Nevada, and operated as Tanker 48 by the United States Department of Agriculture (USDA), Forestry Service, as a public use flight. The airline transport pilot (ATP) rated captain and the ATP rated first officer were not injured. Visual meteorological conditions prevailed and a company flight plan was filed for the local fire fighting flight. The flight originated from Porterville Municipal Airport (PTV), Porterville, California, at 1934. The captain reported that following an uneventful aerial drop, the flight was returning to PTV. During the descent check, he noticed that the hydraulic pressure indicated 0 and that the first officer subsequently verified that the sight gauge for the main hydraulic fluid reservoir was empty. The first officer opened the jet engine doors successfully as the captain selected gear down with no response. The captain notified base personnel at PTV of the situation and informed them that they would be orbiting to the east of the airport to troubleshoot. The captain and first officer performed the emergency checklist, and extended the nose wheel landing gear successfully. The captain stated that the first officer then installed the pin to the nose wheel landing gear as part of the emergency checklist. 33 Mishap Summary The flight diverted to FAT due to a longer runway and emergency resources as both pilots briefed the no-flap landing procedure, airspeeds, and approach profile. As the flight continued toward FAT, the flight crew informed Fresno Approach Control of the hydraulic system failure and continued to perform the emergency gear extension checklist. The first officer extended the main landing gear using the emergency gear release, which resulted in three down and locked landing gear indications in the cockpit. As the flight neared FAT, the first officer added two gallons of hydraulic fluid to the main hydraulic reservoir while the captain attempted to extend the flaps unsuccessfully. Subsequently, the flight landed on runway 26R. During the landing roll, the nose wheel landing gear collapsed and the airplane came to rest nose low. Examination of the airplane by representatives from the Forest Service revealed that the forward portion of the fuselage was structurally damaged. The airplane was recovered to a secure location for further examination. 34