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intervention in preventing the events studied and the feasibility of implementing that
intervention in the United States. This document outlines the results of this JSAT
activity. It is intended specifically as input to the CAST and Joint Safety Implementation
Team (JSIT) and not for other purposes.
The JSAT found 21 interventions that were judged to have top overall effectiveness
scores and to be no worse than moderately difficult to implement. These “recommended -
highest priority” interventions can be grouped into the following general categories:
· Install TAWS-EGPWS
· Ensure CFIT prevention programs are developed, published, and implemented
· Implement flight operations quality assurance
· Expand availability and utilization of precision approach capability
· Maximize the effectiveness of MSAW
· Ensure ATC awareness/training/procedures include CFIT prevention
programs
Interventions within these general categories vary in their level of specificity. Specific
interventions were considered necessary in some cases to provide the detailed elements
required to understand the recommendation and to aid the industry in implementation.
This report also contains other recommendations that did not fall into the “recommended
- highest priority” category but may have validity within specific areas of the industry.
Review of these interventions might provide beneficial guidance or support to existing
programs.
The team recognized that many of these recommendations have already been
Page vii
implemented by various segments of the industry and government. In reviewing the
interventions, organizations which have already implemented a recommendation should
consider this a validation of the need for continuation of that portion of their program.
Results of this study, which used a sample of accident data, correlated closely with results
of the more exhaustive studies by the Flight Safety Foundation (FSF), the CFIT task
force, the Netherlands National Aerospace Laboratory (NLR), and others. This serves to
validate the process and the results and complies with the direction from the CAST. It
also provides validation for using the JSAT process for other areas of interest. The
predominance of intervention strategies in this report which are targeted at operational
issues is consistent with the results of the previous CFIT studies. This predominance is to
be expected with this type of event.
This study demonstrated that a joint industry/government team can work together to
develop recommended safety intervention strategies. The team recommends:
· Continuation of JSAT’s.
· Review and disposition of this report by the appropriate JSIT.
Page viii
II. TEAM MEMBERS
TEAM CO-CHAIRPERSONS:
RON WOJNAR
Manager, Transport Airplane Directorate
Federal Aviation Administration
JAY J. PARDEE
Manager, Engine and Propeller Directorate
Federal Aviation Administration
PAUL RUSSELL
Chief Engineer, Airplane Safety Engineering
The Boeing Company
TEAM LEADER:
KYLE L. OLSEN
Transport Airplane Directorate
Federal Aviation Administration
TEAM MEMBERS:
TONY AIKEN
Aircraft Investigation Division
Federal Aviation Administration
ANN AZEVEDO
Engine and Propeller Directorate
Federal Aviation Administration
JOE BRACKEN
Staff Engineer
Air Line Pilots Association
JOHN BROOKS
Airplane Safety Engineering
The Boeing Company
Page ix
JERRY DAVIS
Flight Safety
Airbus Industrie
DAVE DOWNEY
Engine and Propeller Directorate
Federal Aviation Administration
JEFF DUVEN
Transport Airplane Directorate
Federal Aviation Administration
MIKE EITEL
Seattle Aircraft Evaluation Group
Federal Aviation Administration
ED GARLICK
Air Traffic Division
Federal Aviation Administration
SHARON HECHT
Transport Airplane Directorate
Federal Aviation Administration
SALLY HICKMAN
Airplane Safety Engineering
The Boeing Company
WIN KARISH
Flight Standards
Federal Aviation Administration
JOHN D. MOGUL
Aviation Systems Standards
Federal Aviation Administration
HANK REED
Airplane Safety Engineering
The Boeing Company
CRAIG RICHESIN
Douglas Products Division
The Boeing Company
STEVE SLOTTE
Transport Airplane Directorate
Federal Aviation Administration
Page x
JOHN J. WHITE II
Langley Research Center
National Aeronautics & Space Administration
DAVE WILLIAMS
Douglas Products Division
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