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Get Out of Jail Free

Investigating Accidents Before They Happen

If> you've ever played the board game Monopoly, you probably recall "Get Out of Jail Free" cards. Land on the right square after going to "jail" and you're free as a bird! But did you know there's a modern-day flying equivalent? Actually, there's a way to make sure you never go to jail to begin with - a responsible, easy, and painless way to help yourself and other pilots; enhance safety; and improve aviation-at-large.

You can do all of those things by reporting "mess ups" you see in the system - including your own - and doing it quickly. Let's face it, pilots are human. As conscientious as most of us are, we make mistakes every now and then. Most of the time, we're lucky, and nothing comes back to bite us, so we just press on and forget about it. But that's neither a responsible nor an effective way to handle the situation.

When In Doubt, Write It Out

Have you ever inadvertently busted an altitude or violated airspace without clearance? Ever seen a poorly marked taxiway or a sign so old you could barely make it out? Maybe you've noticed a shredded airport windsock that should have been replaced years ago or an AWOS that never seems to give an accurate reading.

These things happen. If you fly often, you will see them sooner or later. The question is, what will you do about them? The answer should be: Tell someone so that other pilots won't find themselves in potentially dangerous situations or make the same mistakes that you and I have. According to Linda Connell, director of NASA's Aviation Safety Reporting System (ASRS), the "someone" to tell is NASA - with no risk of personal jeopardy, guaranteed.

In her words, "When in doubt about whether you should report something, do it!" Your action could help to identify and remedy a dangerous situation. To ensure that the word gets to where it can do the most good, procedures agreed between the FAA and NASA guarantee immunity for those who report their own violations and other hazards - as long as they follow a few simple rules.

The main purpose of NASA's ASRS is to ensure that unsafe or potentially unsafe practices, procedures, facilities, circumstances, and similar items are identified and called to the attention of the people who can do something about them. Improved aviation system safety is the ultimate objective. Good data, trend identification, and a comprehensive safety database are bonuses. (Details are covered in Advisory Circular 00-46.)

Shortly after the safety reporting system's inception a quarter-century ago, it was apparent that the only way to guarantee the free flow of the honest, useful information was to ensure the anonymity of the person reporting the violation or unsatisfactory condition. FAR 91.25 states, "The Administrator of the FAA will not use [ASRS] reports...in any enforcement action, except information concerning accidents or criminal offenses...." For more than 20 years, that promise of anonymity has held, and no one reporting through the ASRS has ever been compromised thanks to built-in safeguards.

The hand-written original reports (nearly 3,000 a day) are destroyed after the identifying section of the reporting form is torn off, date- and time-stamped, and returned to the person making the report along with two blank forms and a letter of appreciation. That "receipt" is the only evidence that an ASRS report was ever filed. Don't lose it.

Reports are then transcribed, summarized, and classified at ASRS headquarters in California, all identifying information (location, aircraft, etc.) is removed from printed documents, and the original hand-written reports are destroyed. Originals are not sent to the FAA, and no record of reporters is kept by either NASA or the FAA.

How The ASRS Works

The ASRS has strict rules to follow, but staying out of trouble is easy to do. If you understand the system, you can avoid having your certificate revoked, suspended, or worse. Use NASA Form 277B, which is available online from the Web site (http://asrs.arc.nasa.gov) or from AOPA ( www.aopa.org ) or in hard copy at any FSDO and at many FBOs. Send reports to the address on the form at NASA's Ames Research Center in California. Anything that is potentially dangerous or points out a safety condition or situation that needs to be fixed is fair game. When in doubt, fill it out and send it in.

Most reports are submitted by pilots, air traffic controllers, mechanics, or flight attendants, but anyone can initiate a report. Airline pilots submitted two-thirds of the more than 34,000 reports received last year. General aviation pilots submitted 23 percent.

New ASRS reports are initially referred to a minimum of two analysts, both of whom are experts in general aviation, air traffic control, airline operations maintenance, or some other appropriate area of special qualification. If clarification is required, the person submitting the report is contacted by phone so that unclear areas can be straightened out. At this point, all identifying information is removed from the report.

The analysts who review the form also determine whether an immediate "alert" needs to be issued. Since 1976, well over 1,000 alert notices have been issued. These "source protected" alerts are then sent to the FAA, the National Transportation Safety Board, or industry members (airlines, manufacturers, etc.) that can make the needed changes.

Of the more than 34,000 reports submitted in 1999, 9,318 received special scrutiny because of their content and potential to prevent trouble. Some 67 were sent to the FAA as alerts. More than 100 went to the NTSB, manufacturers, and others in positions to fix them. Based on a separate evaluation, reports are entered into a database and made available to the public, again without identifying information.

ASRS, ASRP And Enforcement Action

Though NASA is the liaison between the FAA and users of the system, the overall program - the Aviation Safety Reporting Program (ASRP) - is under the jurisdiction of the FAA's Office of System Safety. This office provides the immunity granted to qualifying users of the system.

When the phone rings and the FAA inspector says, "A violation of the FARs has been alleged against you, when can we talk about it?" your ASRS report becomes very valuable. Remember, the tear-off receipt sent back to you is the only record that you ever filed a report. You need to keep it in a safe place.

Over the past 10 years, the FAA has pursued official enforcement action against nearly 30,000 pilots for various violations of the FARs. Enforcement action can include anything from a decision to take no action, a warning letter, or referral to other agencies through certificate suspension or revocation and legal prosecution. Almost 30 percent of the pilots cited in the last 10 years - more than 6,000 - had their certificates revoked or suspended.

Many of the nearly 30,000 enforcement actions involved infractions pertaining to "fly for pay" certificates: ATPs (10,777) and commercial pilots (8,452) comprised about two-thirds of the total. Most of the remaining third (9,265) were alleged against private pilots. After further investigation of these private certificate holders, no action was taken against 15 percent of them. Roughly half (52 percent, or 4,852) faced administrative action such as a warning letter, letter of correction, or some similar reprimand, but more than a quarter of the charges against private pilots resulted in suspension or revocation of the certificate.

This raises an interesting aspect of the ASRS. Only 132 of these private pilots avoided penalties because they had immunized themselves against action by submitting ASRS reports. A critical point here is that they could prove they had filed reports by providing the receipt when they received that call from the FAA. Of the rest, most probably didn't file reports at all.

Immunity rules are important to understand, so here they are: 1) The violation reported must have been inadvertent, not deliberate; 2) The violation must not have involved a crime, accident, or lack of qualification or competency on the part of the reporter; 3) Evidence of having filed an ASRS report within 10 days of the event's occurrence (your receipt) must be presented; and 4) Immunity from action under the ASRS cannot have been used in the last five years.

There is no limit to the number of ASRS reports you can file, of course. The more valid reports, the better! However, only one report can be used to provide you with "immunity" in a given five-year period.

When these conditions are met, the ASRS receipt in your possession is literally your "stay out of jail free" card. Even more significant is the fact that your action will have identified an unsatisfactory or potentially dangerous condition or factor, and we are all much safer because of it.

Is The Profile Too Low?

Surprisingly, both the ASRS and the ASRP which it serves seem to be two of the best kept secrets in aviation. ATPs and commercial pilots are the most frequent users of ASRS, possibly because of the financial implications of enforcement action. Except for the temporary notation "Waiver Penalty ASRP" on their records, nearly 1,100 ATP and commercial certificate holders were spared all FAA sanctions because they had filed ASRS reports. "The filing of a report with NASA concerning an incident or occurrence involving violation...is considered by the FAA to be indicative of a constructive attitude...," according to published policy.

Contrasted with nearly 8 percent of ATPs and just over 3 percent of commercial certificate holders avoiding enforcement action through the ASRS, barely 1 percent of private pilots who were "charged" have enjoyed ARSP immunity over the last 10 years. It is clear that the GA community isn't getting the word about how to use this system. Although CFIs, private pilots, and student pilots comprised over one-third (10,369) of the nearly 30,000 pilots cited for FAR violations, their ASRS penalty waivers are barely noticeable when compared to pilots with ATPs and commercial certificates. That's too bad, because great benefits accrue for both aviation and all pilots involved through use of the ASRS - regardless of pilot qualification.

According to Mark Blazy, manager of the ASRP in the FAA's Office of System Safety, the ASRS "...alerts us early to problems out there and gives us anecdotal and descriptive information [straight from the reporters]. Fifty-five percent of the reports we receive identify specific hazards and risks to pilots," he said.

When asked if any problems have emerged unexpectedly as a result of ASRS reports, Blazy cited recent reports of dangerous electrical wiring, "specifically computer power port wiring installations and wiring for aircraft entertainment systems."

Blazy believes everyone should take advantage of the system and especially encourages documenting potential safety problems. "For us, the ASRS serves as an early warning system," Blazy said. "It allows us to investigate accidents before they happen."

All that is possible, but only if we help. If you don't have an ASRS form, get one. Keep it with you when you fly. When in doubt about a hazard or violation, write it down and submit your report within 10 days. You have everything to gain by participating in the program and absolutely nothing to lose. Who knows when you might need to "get out of jail free"?

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