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Safety Management System

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"Anything that can go wrong will go wrong."                             Edward Murphy

What?

The Safety Management System is a method to have safety taken into account by the whole community, not only its leading frame, in order to create a safety culture and reduce more efficiently the accidents/incidents figures.

Why?

Such a system is standard in civil aviation, and may partly explain their well-known and desserved high reputation: "The International Civil Aviation Organization (ICAO) requires SMS for the management of safety risk in air operations, maintenance, air traffic services and aerodromes. These requirements have been expanded to include flight training and design and production of aircraft." - FAA

How?

A simplified version, especially designed for Hang Gliding and Paragliding, was unanimously adopted at the 2016 CIVL Plenary. To become plainly efficient, it needs now to be implemented by the National Federations, which for many of them already have some similar system.

Safety Officers

rc raymondAfter engineer studies and an Army officer career, Raymond Caux was 6 years hang gliding technical adviser at the FFVL, of which 4 years national team leader. Hang gliding since 1984, national team member in 3 world championships 2003 to 2007, he also practised skydiving and some gliding. With own experience (forgotten to hook in, tumbled while aerobatic training), he has been involved in safety concerns since 2007. Safety committee chairman since 2011, then safety officer since 2012, he manages these pages.

rc dennis

Probably the most famous writer and editor of hang gliding and paragliding technical books, Dennis Pagen has been long involved in the sport, as US delegate and hang gliding committee member or leader since 1991, working on standards as early as 1978. Competition pilot, he conducts also cross country seminars all over the world. Steward in countless hang gliding and paragliding championships, he has driven the implementation of the hang gliding sprog setting policy, and has been safety officer since 2015.

Safety Links

rc condor

Federation & manufacturer safety corners, safety & psychology related websites...

Advance (CH)
Aeros (UA)
APPI (INT)
BHPA (GB)
DHV (D)
Dynamic Flight (AUS)
FAA (USA)
Flight Safety (AUS)
Gin (ROK)
HGFA (AUS)
HGMA (INT)
HPAC/ACVL (CDN)
ICAO (INT)
ISSW (INT)
Mentalpilote (F)

Moyes (AUS)
Oregon HG
(USA) & Airmanship 1 2 3
Ozone (GB/F)
P@r@2000 (F)
Paramania (GB)
PMA (INT)
Safetyrisk.net (USA)
Skybrary (EU)
SSF (USA)
Supair (F)
Swing (D)
UP (D)
USHPA (USA) & Safety Advisories
Wills Wing (USA)

Safety Handbook

Foreword

Safety Management System is a standard in civil aviation. From the US Federal Aviation Administration (FAA): "The International Civil Aviation Organization (ICAO) requires SMS for the management of safety risk in air operations, maintenance, air traffic services and aerodromes. These requirements have been expanded to include flight training and design and production of aircraft."

The SMS designed for professionals is heavy but fortunately, the Royal Dutch Aeronautical Association (KNVvL) has its own one. Henry Lemmen, paragliding safety officer, wrote a light version adapted to the paragliding and hang gliding sections, later shared by Andre Bizot, EHPU safety representative, and freely translated by Raymond Caux (2015). Thanks to the KNVvL and Henry Lemmen, this Safety Handbook is now available to the national hang gliding and paragliding federations, to download here.

Lastly, regulations applicable to air law, air traffic and control in the respective countries are reserved. They must be observed and, where applicable, take precedence over any sport regulations.

 

SAFETY HANDBOOK

Index

Foreword
Index
1 Introduction
2 Definitions
3 Safety Management System
3.1 Objectives
3.2 Contents
4 Structure and Tasks
4.1 Safety Manager's Tasks
4.2 Safety Commission's Tasks
4.3 Members' Tasks

5 SMS in Practice
5.1 Safety Promotion and Training
5.2 Event Management
5.3 Analysis and Registration
5.4 Implementation of Improvement
      Measures
5.5 Assessment of Measures
5.6 Communication Tools
6 Annex 1 Risk Identification
7 Annex 2 Event Reporting

1  Introduction

Paragliding (PG) and hang gliding (HG) are sports with lots of pleasure to experience. They are also sports with associated risks. The purpose of this handbook is to keep the risks within acceptable limits and to avoid accidents. It describes the structures, methods and measures used by the PG and HG sections to make their sports as safe as possible. It offers a guide showing how these structures, methods and measures function in practice and should be applied. The objective of this handbook is thus to foster a safety culture, where events are actively and systematically analysed and measures are taken to reduce the risk of recurrence.

For the function of these structures, methods and measures, it is important that everyone involved in PG and HG, like (help) instructors, winch men, launch marshals, school owners, board members and pilots, promote flight safety. Everyone must (want to) face the hazards and consequent risks, and be prepared to take appropriate measures to remove or at least reduce these hazards and risks.

Adverse events and particularly accidents can never be ruled out completely, not even with a handbook. But it is possible to learn from events to avoid recurrence. This requires openness of those directly involved and understanding of the others. It is not here about finding someone guilty or blaming those involved, but well about finding together the reasons and then the solutions to reduce the chance of recurrence. This handbook provides guidance for this purpose.

2  Definitions

 Event:

 Hazardous
 situation:

 Incident:

 Near-accident:

 Accident:

Any situation that deviates from the normal course of actions

A situation where the sum of the factors "chance" and "effect" is
an unacceptable risk for persons and/or goods

A hazardous situation or action that could have led to an accident

An adverse event without damage nor injury, but where it could
have occurred in slightly different circumstances

An adverse event resulting in personal injury or property damage

3  Safety Management System

The Safety Management System (SMS) provides a proactive approach to managing safety within associations (shorter thereafter clubs) and instruction bodies (schools), including the necessary organisational structures, responsibilities, procedures and policies.

3.1 Objectives

The purpose of the sections is to:
- Reduce the risk of accidents
- Increase knowledge about safe operation for their customers and members
- Promote an environment where safety is paramount and a second nature

The aim is thus to create a culture not only made of reporting and analysis of events, but also where pilots can talk to each other about their behaviour regarding flight safety. The SMS is therefore a tool to contribute to the previously mentioned objectives in a systematic way.

3.2 Contents

The components of the SMS are:
- Risk management (hazard identification + event management)
- Assessment of improvement measures
- Safety promotion and training

An important principle of the SMS is to pay attention to incidents. By doing so, risks can be better identified and serious accidents can be avoided. This is the preventive approach to safety. It means that not only accidents or near-accidents must be reported, but also events that could lead to a dangerous situation. In addition, the analysis of all events is necessary. This is the reactive approach to safety, that deviates from the normal course of actions.

4  Structure and Tasks

The PG and HG sections consist in boards and commissions, schools, clubs and individual members. The SMS of the section is therefore arranged as follows:
- Certified pilots are responsible for their own safety, have rights and obligations
  concerning safety, based on the PG and HG rules, and must report the events.
- Each school or club has its Safety Manager (SM), who is responsible for its SMS:
  establishing, performing and monitoring compliance of it.
- The section board supports and coordinates indirectly, through the Safety
  Commission or Committee (SC), the SMs of the clubs or schools.

 Level  Tasks  Person
 CIVL
 Support safety policy of the federations  Board member
 Federation
 Coordinate safety policy for all sections  Board member

 Section SC

 Design, implement and monitor
 section
safety for schools, clubs and
 individual
members


 Coordinate and supervise SMs of
 schools
and clubs

 Options:
 · Safety representative of the
  
section board
 · SC president
 · SC member
 · Combination of representative
   and
president (representative
  becoming SC president, not
  
board member anymore

 School/club SM

 Ensure flight operation safety,
 establish
and check compliance of
 safety policy
within the school or club


4.1 Safety Manager's Tasks

- Establish a safety culture where event reporting is normal and pilots can talk to each
  other
- Internally analyse events
- Implement improvement measures and ensure compliance
- Ensure that methods and material are used properly
- Ensure compliance of improvement proposals and assess them
- (Monitor) adjustment policies/rules where necessary
- Inform pilots/students/instructors about flight safety improvement measures and
  procedures
- Report events to the SC
- Produce an annual safety report

All events are handled within the school or club and collected in the annual report. Serious incidents, near-accidents and accidents, according to the rules of PG and HG, must be also reported immediately.

4.2 Safety Commission's Tasks

- Educational material for pilots/students/instructors (how to proceed)
- Events/hazards/risks registration material (as part of students' flight registration, for
  instance)
- Support and coordinate SMs of schools and clubs
- Supervise implementation of SMS
- Keep total record of events
- Coordinate research on serious events

4.3 Members' Tasks

Beside members are expected to respect laws and regulations, they are required to:
- Keep up-to-date knowledge about flying technique, meteorology, aviation regulations,
  aerodynamics, PG and HG rules, navigation if relevant, and other information
  affecting flight safety
- Apply that knowledge
- Take note of the safety notices, measures, and procedures
- Report events and issues that may increase the risk of incidents

5  SMS in Practice

The SMS is composed of hazard identification, risk recognition, safety training and promotion, and event management. Upon identification of hazards, an analysis of the biggest dangers and resultant risks in the sport is proactively made. The goal is to get insight into the frequency and impact of an incident. On that basis, areas of attention are determined for the upcoming season.

Safety promotion is aimed at increasing knowledge about safety, procedures and measures, but above all at stimulating a safety culture.

Event management is a reactive process where a continuous process is completed, from event reporting and analysis, implementation of measures to prevent the same event, to reviewing of the effectiveness of measures.

Hazard identification involves a number of operational experts. Therefore, at the initiative of the SC and before the beginning of the flight season, the section holds each year a meeting with the SMs of the clubs and schools and some of the most experienced members and/or (expert) instructors. In a brainstorming session during this meeting, the top three risks are identified, taking into account the probability that an incident may occur, and how serious its consequences are. In annex is a method by which this can be done in a systematic manner.

5.1 Safety Promotion and Training

Safety promotion and training are aimed at knowledge transfer regarding flight safety, both on a technical level and to create a safety culture. On a technical level, pilots should be aware of laws and regulations, flying technique, procedures and other flight technical matters. Aspects like talking to each other about behaviour and readiness to report are covered by the safety culture.

An important aspect here is that not only measures and procedures are applied, but it is also explained why and how they increase flight safety. People who know the reason of certain safety procedures will be more inclined to adhere to them. When people know that their reports result in measures, this leads them to report.

- Safety promotion and training's goal is that everybody (members, students,
  instructors and others) has current knowledge of flying technique, meteorology,
  aviation regulations, aerodynamics, PG and HG rules, navigation if relevant, and
  other information affecting flight safety.
- The above is applied consistently.
- Everyone knows what is expected of her or him regarding the safety policy.
- The improvement measures and other important decisions taken are known, like
  their follow-up.
- The reasons of certain measures taken are known, and everyone knows why certain
  safety procedures are introduced or changed.

5.1.1 Methods

Safety promotion and training takes place both at the clubs and schools level and at the section level. During the instruction period in the schools, through practice and theory among others, a detailed attention is paid to flying technique, legislation and procedures, with the objective that (future) pilots learn responsible use of airspace. However, the SMS is also aimed at keeping on refining flying technique after the licence is achieved, in the clubs.

To pay attention in a structured way to the promotion of flight safety among members and students, an annual day of instructors or schools is organised by the section board. This is to share knowledge and experiences and to create uniformity in the way safety is handled. Another aspect at the section level is the development of policy and instruction material for the theory examinations.

5.2 Event Management

Event management takes mainly place at the level of clubs and schools. Only in case of serious accidents, an investigation is made by the section board. Event management includes the following components:
- Event reporting
- Analysis and registration
- Implementation of improvement measures
- Assessment of improvement measures

5.2.1 Event Reporting

The members are encouraged to report events. The form to use can be found in annex. Some examples of events to report:
- (Near) collision with another aircraft
- Hitting obstacle upon take-off or landing
- Rescue throw due to non flying equipment
- Faintness of pilot during flight
- Damage to material
- Injuries (to oneself/others)
- Unsafe situations, like bystanders at launch, poor launch, landing and flying
  technique

All incidents are reported using the form on the section website. There are roughly two situations in which events take place:
1) In school/federation, whether accompanied by an instructor or not
2) All other incidents where individual pilots are involved

In the first case, the relevant SM presents a factual report on the incident. In addition, the SM interviews as many people involved and witnesses as possible. The factual report is submitted to the SC via the incident reporting system. The SM receives a copy, uses it for internal analysis and submits the possible feedback to the SC.

In the second case, the individual pilot presents a factual report and interviews also any persons involved and witnesses. The report is submitted to the SC via the incident reporting system on the section website.

In both cases, it is advisable to support the reports with available photo and video material, which can be presented separately to the SC.

5.3 Analysis and Registration

The research taking place after each report focuses on the causes of the event and the underlying hazards. The contribution of the organisation, procedures, environmental and individual factors are included. Based on that study, the SM determines the findings, adds them to the factual report, and draws improvement measures/proposals.

The event reports are added by the SC in the register, where the files are kept for at least 5 years. The incident register, attached as an annex, makes a trend analysis possible.

5.4 Implementation of Improvement Measures

Working together with the club board or school owner, the SM establishes improvement measures and ensures that they are communicated to the members, students and instructors. Shortly after improvement measures have been implemented, it is necessary to check whether they have lowered the risk level.

5.5 Assessment of Measures

At least once a year are the occurred events discussed within the club or school. Here are also discussed the situations or outcomes of the researches, and which measures have been and/or are being taken to prevent recurrence. In the schools, it can take place during the annual refresher course which they provide for their (help) instructors. In the clubs, it can be an agenda item at their meeting.

The central questions in the review of measures taken are the following:
- Are the measures working as they are supposed to?
- Do they still have the desired effect on the risk?
- Is the risk that these measures limit still at the same level?
- Have the measures introduced new hazards?

5.6 Communication Tools

Communication occurs among others by means of briefings on the flying day, via the website (of the club, school or section), club and members' magazine, and mailing lists/forums within the sections (e-line/chat...). Here can a distinction be made between two types of information, and the mode of communication depends on their type: critical information that must be known before the next flight or as soon as possible, and information where the time factor is less critical.

6  Annex 1 Risk Identification

Hazard identification is as follows:
The experts write, individually, their top three potential hazards and assign to them, in a comprehensive manner, their most serious and most likely effects.
All hazards with their effects are compiled and the corresponding hazards are merged.
The experts examine then all possible effects written down, and from there decide together which effects are actually the most serious, most probable ones.
Then is examined for each hazard how likely it is to happen and how big its effects are. This is again done separately by each of the experts, using the following tables:

 Chance  Definition  Value
 Often  Several times a season 5
 Regularly  A few times a season/probable 4
 Sometimes  Once a season or two seasons/possible 3
 Rarely  Not known to have happened before, once in five years/small 2
 Very rarely  Almost inconceivable that it will ever happen/unlikely 1

 Effect
 Definition
 Value
 Very big  Fatality/destroyed material A
 Big  Safety margins hugely affected, major injuries/damage B
 Serious  Safety margins affected, serious injuries/incidents/damage C
 Small  Emergency, aircraft limitations exceeded, minor issues D
 Very small  Few effects E

Then the values of the results "Chance" and "Effect" are combined and it is examined in a discussion among the experts whether an agreement can be reached between the different results related to the outcome (risk). In case of agreement, this table is used:

 Chance \ Effects  Very big  Big  Serious  Small  Very small
 Often 5A 5B 5C 5D 5E
 Regularly 4A 4B 4C 4D 4E
 Sometimes 3A 3B 3C 3D 3E
 Rarely 2A 2B 2C 2D 2E
 Very rarely 1A 1B 1C 1D 1E


The outcome of the above table is used as input to the next table and it is examined whether measures are needed to reduce the risk:

 Outcome combination  Criteria
 5A, 5B, 5C, 4A, 4B, 3A

 Unacceptable risk under current circumstances,
 measures needed to bring the risk down
 5D, 5E, 4C, 4D, 4E, 3B, 3C, 3D,
 2A, 2B, 2C
 Tolerable risk, the board may require measures
 still needed, risk growth monitored
 3E, 2D, 2E, 1A, 1B, 1C, 1D, 1E  Acceptable risk, risk growth monitored


For the top three threats with the highest points numbers, measures are now formulated.

7  Annex 2 Event Reporting

The federation facilitates the recording of events. For this purpose, an event registration system is set up where anyone can report an event. Events can be reported via the website of the section. Event reports are treated strictly confidentially by the SC.

Risk Assessment

Safety Management System provides tools to improve safety at the organisation level (manufacturer, school, club), but the pilots need something more basic for their everyday's pratice. The purpose of the Risk Assessment table is to provide a "safety Swiss knife" to be used while making decision. It can be downloaded here:

  rc ic.gb     rc ic.ru     rc ic.f                                                                                             

Risks can be defined mathematically in a rather simple way, as the likelihood of hazards multiplied by their consequences. To the question "Am I going to hurt myself?", instead of "It should be OK, let's go!", this table is a more structured answer. We are all different at assessing risks, some have a strong preservation instinct, some are self-confident and like thrill. This tool helps taking time, stepping back and watching calmly the situation. It simplifies the hazard identification process of the SMS, making it easy to know by heart and use in an instant, before or during a flight.

Hazards                                   
 ________________________________________________________________ 

Chance  \  Effects Catastrophic Manageable Negligible
Probable High High Serious
Occasional High Serious Low
Improbable Serious Low Low

                                       ___________________________________________
                                                             Risks

The green zone represents where flying looks reasonable, the conservative approach. In the yellow zone, other factors should be assessed: personal worries (divorce, unemployment), "currency" (first flight of season, new equipment), pressure (short on time), fitness (tiredness), weather... One may enter this zone, but staying aware that the odds are higher. The red zone gives access to the statistics. "Is this flight worth my life, the catastrophy for my family, the mourning of my friends and club, the bad impact on my sport?" The decision should be just not to fly. Some examples: aerobatics cannot be green as an adverse outcome is at least possible, cliff or towed launches cannot either as the effects can be catastrophic.

More generally, being a weather expert is considered as normal for pilots. They should have the same expertise in launch and landing skills, psychology and safety knowledge, especially about the human factor. Meanwhile, let us remind the traffic light: "Am I going to fly in the green zone, or in the yellow or red one?" Let us enjoy the green!

                                                                                 Raymond Caux (2015)

CIVL Safety

rc eagle

"Every system is perfectly designed to achieve exactly the results it gets."
                                                                                                   Donald Berwick

Here is the common section. The documents to start with are marked in red.

Project & Resources

rc noluck

Former updates

The 2011 Plenary split Training out and created a Safety Committee, the 2012 Autumn Bureau Meeting replaced it by a Safety Officer, the 2015 Plenary chose two of them.

Safety Articles

rc lilienthal

"The human component is the least reliable component of any system."
                                                                                                  Rollin Fairbanks

Why Can't We Get a Handle on this Safety Thing?
Reducing Your Risk
Recommendations for Preventing Omission Errors
The Long Haul
How to Survive Gliding?
Fighting Tunnel Vision
Some Brain's Biases
Self Distrust
Mike Meier (USA) 1998
Greg Hamerton (ZA) 2001
David O'Hare (NZ) 2004
Brian Germain (USA) 2004
Bert Willing (CH) 2008
Vic Napier (USA) 2011
Raymond Caux (F) 2013
Raymond Caux (F) 2013

More Articles

rc clouds

"If you fail to plan, you are planning to fail."                           Benjamin Franklin

Luck, Longevity and the Limits of Skills
Human Factors in Soaring
An Alternate View - Risk Management
Do Skydivers Care About Safety?
Risk Management in Paragliding
Human Factors Engineering
Pilot Error
Happened Recently on an Airfield
Glider Accident

John Halle (USA) 1995
Ian Oldaker (CDN) 1999
Bob Weien (USA) 1999
Bill Booth (USA) 2003
Irène Revenko (F) 2006
Rollin Fairbanks (USA) 2007
Ryan Voight (USA) 2009
Martin Feeg (D) 2010
Peter Kelly (USA) 2012

Safety Network

What?rc globe

This Network is a list of National Safety Officers plus some professionals. Only the names are published, the email addresses are in a separated mailing list. Please send the updated name and email of your contact person to the CIVL Safety Officer (R. Caux) to register and help keeping this list accurate.

Why?

It has happened that people died only because an available equipment failure information had not reached them. The aim of this Network is to avoid that. (members using explicitly a Safety Management System are marked in green)

National Safety Officers

Argentina
Australia
Azerbaijan
Belgium
Brazil
Bosnia & Herzegovina
Bulgaria
Canada
China
Colombia
Croatia
Czechia
Denmark
France
Germany
Great Britain
Greece
Guatemala
Hong Kong
Hungary
Iceland
India
Ireland
Israel
Italy
Japan
Liechtenstein
Lithuania
Macedonia
Malaysia
Mongolia
Morocco
Netherlands
New Zealand
Norway
Pakistan
Poland
Portugal
Serbia
Slovakia
Slovenia
South Africa
Switzerland
Taiwan
Ukraine
United States of America

Juan Ramon Castillo
John Twomey
Emin Afandiyev
Jean Solon
Chico Santos
Mirvad Zenuni
Michael Yankov & Daniel Dimov
Suzanne Francœur & George Martin
Zhaofang Han
Mayer Zapata
Zlatko Vukicevic & Radoslav Ostermann
Dan Vyhnalik & Klara Beranova
Michael Hasselgaard
Claude Bredat
Karl Slezak
Angus Pinkerton
Lillian LeBlanc & Ioannis Myrianthopoulos
Alejandro Toralla
Trevor Gribble
László Szöllösi
Robert Bragason
Ramakant Sharma
Philip Lardner
Miki Weiss
Rodolfo Saccani
Toshiyuki Katsura
Siegfried Herzog
Justinas Pleikys & Jevgenij Blokha
Goran Dimiskovski
Nasarudin Baker
Shijir Buyandelger
Ahmed Lahmidi
Araldo van de Kraats & Henry Lemmen
(Nicky Hamill)
Runar Halling
Sajjad Shah & Jabbar Bhatti
Zbigniew Gotkiewicz & Mariusz Nowacki
Artur Osório
Zeljko Ovuka
Milan Bohuš
Igor Eržen
Egmont van Dijk & Hans Fokkens
Beni Stocker
Elsa Mai
Evgeniy Bublik
Greg Kelley

Professionals

Hang Glider Manufacturers Association
Paraglider Manufacturers Association
Cross Country Magazine
Oz Report
Sport Aviation Publications
Mike Meier
Hans Bausenwein & David Humphrey
Ed Ewing
Davis Straub
Dennis Pagen

Not yet in

Albania
Algeria
Austria
Belarus
Cyprus
Egypt
Finland
Indonesia
Kazakhstan
Korea
Korea PR
Lebanon
Luxemburg

Mexico
Montenegro
Mozambique
Philippines
Romania
Russia
Spain
Sweden
Thailand
Turkey
United Arab Emirates
Venezuela

 

Incidents Types

rc direct 

This incidents types list is a synthesis of syntheses of several national overall practice incidents databases, running over several decades. Some sources have been lost, however the synthesis remains. Sorting the categories and especially the solution proposals are subjective (R. Caux). The list is of course open. Fly safe.

 

issues

proposals

physiology
hypoxia
dehydration
hypoglycemia
cold
sun
lack of sleeping, tiredness, jetlag
bad physical shape
alcohol, cannabis
need to pee

visual flaw (midair path)
white dots on retina
airsick
wounds on ground
scubadiving less than 12h before flight
fly down, oxygen set
drink, camelback
eat
weather check, gloves, cothes
sunglasses, sunscreen, clothes, drink
give up
give up
give up
learn technique

red tape, FLARM
good sunglasses
training

(fitness) training
give up
psychology
lack of experience
start of season
fear, carelessness, complacency
personal worries, feeling "beside"
nervous,
anger, "testosterone"
distraction (camcorder...), speeding up
forgetting to hook in
forgetting legloops
run stop in tandem launch
student without guidance
risk taking with weather, aerology
unavailability, overload, panic
training
learn human factor
learn human factor
give up

delay
delay
1. hook in 2. put on harness
close legloops 1st
improve pedagogy
improve pedagogy
learn human factor
tuned equipment, simplified pedagogy, training
harness
impossible/difficult direct connection
forgetting to hook in
forgetting legloops, waist strap

forgetting chest strap
impossible/difficult stand up
impossible/difficult lying
zipper failure

main suspension rope break
tilt cord break

main riser break
backplate break, separation

forgotten hook-in
impossible wanted reserve opening


unwanted reserve opening
separation on reserve opening
legs injuries
spine injuries
front opening harness?
direct connection & automatic backup
Fourment legloops-chest strap link, upper zipper closing from bottom?
external chest strap
proper rail length, tuned legloops
centered rail, tuned riser-footplate cord
zipper on velcro sandwich

riser sliding on metal rod
removable tilt cord, properly routed

riser properly sewn & linked to safety frame
freefall tested plate linked to safety frame

1. let go 2. turn back onto slope
direct pod handle reached by both hands, 2 reserves
faired & fitted pod handle

bridle connected to harness safety frame
ballast suited to pilot
deployable airbag
equipment
face wounds by glasses
loosing helmet
"neck breaker"
brain rotational wounds
snagging cord on launch or glider

difficult reserve opening
pilot chute break
difficult pod opening
pod opened before throwing

reserve burst in terminal velocity opening
injuries upon landing under reserve
lockout on tow

drogue chute line break, torsion
interference drogue chute-keel
unavoidable crash upon landing
drowning upon water landing
glasses with round rim
tested geometry, strong chin strap
minimal fairing behind helmet
MIPS helmet technology
tethers only by cow hitches or quick links, inner radio wire, no external strings
pilot chute on pod
freefall tested pilot chute
bungees regularly changed (prevent hardening)
protected closing loop, lines stowed on pod

freefall tested sail
size suited to gross weight
harness pitch set & 1/3 VG, pull in upon control, "hands on bar" release, dual bridle, fin
proper bridle possibly on harness axis
short bridle
let glider absorb energy, wrap around 1 downtube
1. exit to trailing edge 2. open harness
glider

forgetting pin with top closing A-frame
A-frame top bolt fatigue failure
weak A-frame top bolt through keel
cable folding base bar, fatigue
base bar break
torn cast fittings upon downtube bend/break
side wires fatigue break

forgetting haulback swan neck pin
folded leading edge mylar inserts
corrosion hidden by painting
forgetting/loosing nose cone
forgetting to close sprogs/keel zippers
hang loop
snagging VG cord

rectangular carbon spars break by complex forces
keel break
weak push-out upon landing
tiring, loss of interest

rigids control wires/spoilers/flaps disconnected in flight
rigids stabiliser lost in flight
rigids D-tubes delamination

base closing A-frame
right quality/size
short bolt in craddle under keel
articulated folding base bar
base bar inner backup wire
milled fittings

Cheney bottom fittings, right sized wires, eye swage terminals?
ring/shackle haulback, backup
inserts adjusted in leading edge pockets
anodised aluminium tubes
nose cone binding by cord or return velcro
"remove before flight" tags?
easy harness clip-in to dingle dangle/kingpost
stowing bungee on downtube base

wound spars

keel inner backup wire
A-frame top behind main riser
advertised glider tuning procedure: VG loose 1. symmetry 2. trim, VG tight 3. symmetry 4. pitch
pin secured wires/spoilers/flaps

pin secured stabiliser, reinforced craddle
control during preflight check
environment
protruding nail on ramp
pitch change on slope change

low pitch on cart, tug lifts off 1st
high pitch on cart, stall
tumble out of cart
dragging cart on launch
nose AoA velcro limiter
steep launch on winch tow, stall upon line break
weak link break on launch
face injuries on line break
snagging tow line

impossible release upon lock out
midair with winch tow line
obstacles on landing
surfacing
start run less than 1m before slope change (except cliff without wind)
tunable keel support, 20° (rigids 10°)
pitch angle: base bar ~ flight position
push while rolling & hold hoses
base bar cradles for all bars
glider/harness dual bridle
restricted tension below 50m, operator's training

stronger weak links, regularly replaced
simple, light & compact release
base bar central part clear of instruments, sheathed line

no cord loops imitating metal rings
winch towing activity on air maps
cut fences, trees
control

launch with low AoA, glider overtaking
launch with high AoA, slow lift off, stall

loss of control on cart
blown launch, lockout on tow
hitting the ridge
midair
unwanted reserve opening
tumble
drogue chute thrown over base bar/snagged on wheel/skid
spin close to ground
loss of control close to ground
poor approach, low turn
gradient, lee of obstacles
obstacles on landing
poor landing

launch AoA 20° (rigids 10°)
progressive acceleration, let fly
specific reversed control on cart
wings level, active control
crabb toward the valley
learn rules, continuous 360° watch, anticipate
equipment preparation
sprogs/twist tuned, VG loose in turbulence
throw at trim speed, right away

wings level, VG loose/flaps on for final
transition to low half of downtubes before final
long straight final
jugde & anticipate
anticipate, watch free zone
"listen" to trim
competition
overcrowded launch
overcrowded start gate

midair
high altitude
lost pilots
hazardous task line/final glide

overcrowded landing
low stress setup/launch system (priority set up)
adapt lapse beween launch opening and 1st start, ex. 1 to 2h
continuous 360° watch, FLARM
oxygen sets
mobile phone on, live tracker, SPOT
flight corridor over landable & in aerologically sane zones
daily turn direction for landing
principles

mental training: visualise problems & emergency procedures
aware of consequences (aviation's hardest = ground)
aware of own (changing) limits: adrenalin, visual flaws, no cheating
fit & awake
ability to renounce: maturity
use logic more than lists learned by heart
simplify procedures to lower work load
anticipate worsening situation, have an alternate
rely on anticipation more than luck
safety scale (green: fly, yellow: watch ground, red: land)
anticipate human mistake, humbleness, listen to critics
step in when hazard or incompetence
declare incidents for common knowledge
putting stress on little mistakes (almost accident)

 

lack of oxygen
dehydration
hypoglycemia
cold
sun
need to pee
white dots on retina
visual flaw (midair path)
airsick
scubadiving less than 12 hours before flight
bad physical shape
lack of sleeping
tiredness
alcohol
cannabis
wounds on ground

Incidents Types

rc tbar 

This incidents types list is a synthesis of syntheses of several national overall practice incidents databases, running over several decades. Some sources have been lost, however the synthesis remains. Sorting the categories and especially the solution proposals are subjective (R. Caux). The list is of course open. Fly safe.

 

issues

proposals

physiology
hypoxia
dehydration
hypoglycemia
cold
sun
lack of sleeping, tiredness, jetlag
bad physical shape
alcohol, cannabis
need to pee
visual flaw (midair path)
white dots on retina
airsick
wounds on ground
scubadiving less than 12h before flight
centrifugated, no reserve opening
fly down, oxygen set
drink, camelback
eat
weather check, gloves, cothes
sunglasses, sunscreen, clothes, drink
give up
give up
give up
learn technique
red tape, FLARM
good sunglasses
training
(fitness) training
give up
learn Gs dangers, G-trainer, drogue chute
psychology
lack of experience
start of season
fear, carelessness, complacency

personal worries, feeling "beside"

nervous, anger, "testosterone"
distraction (camcorder...), speeding up
forgetting legloops
run stop in tandem launch
student without guidance
risk taking with weather, aerology
unavailability, overload, panic
training
learn human factor
learn human factor
give up

delay
delay
close legloops 1st
improve pedagogy
improve pedagogy
learn human factor
tuned equipment, simplified pedagogy, training
harness
forgetting legloops, waist strap

impossible wanted reserve opening

unwanted reserve opening
separation upon reserve opening
legs injuries
spine injuries
EN 1651, Safe-T-Bar, legloops-shoulder straps links
direct handle reached by both hands or 2 reserves
faired & fitted pod handle
bridle connected to harness safety frame

ballast suited to pilot

deployable airbag
equipment
face wounds by glasses
loosing helmet
"neck breaker"
brain rotational wounds
snagging cord on launch or glider

difficult reserve opening
pilot chute break
difficult pod opening
pod opened before throwing

reserve burst in terminal velocity opening
injuries upon landing under reserve
drowning upon water landing
glasses with round rim
tested geometry, strong chin strap
minimal fairing behind helmet
MIPS helmet technology
tethers only by cow hitches or quick links, inner radio wire, no external strings
pilot chute on pod
freefall tested pilot chute
bungees regularly changed (prevent hardening)
protected closing loop, lines stowed on pod

EN 12491, freefall tested sail
size suited to gross weight
floating harness, 1. brake sail 2. open harness
glider
loss of control during launch, dragged
collapses, low AoA,
cravats

cutting or fatigue line break
spiral stability
easy sail behaviour, Rose system
max speed limitation, more lines in upper front pyramid?
proper size lines
design, drogue chute
environment
protruding nail on ramp
steep launch on winch tow, stall upon line break
face injuries upon line break
impossible release upon lock out
midair with winch tow line
obstacles on landing
surface
restricted tension below 50m, operator's training

simple, light & compact release

no cord loops imitating metal rings
winch tow activity on airmaps
cut fences, trees
control

spinaker effect, poor sail rising control
launch with line mix, low AoA, gust
passenger/pilot hindrance upon launch
blown launch, lockout on tow
hitting the ridge
collapse, surge, stall, parachutal, spin

midair
unwanted reserve opening

pilot wrapped up in sail
high wind
poor approach, low turn
gradient, collapse due to obstacles
obstacles on landing
no braking

training
training
improve briefing
anticipate, active control, "hands free" release
crabb toward the valley

training, SIV
learn rules, continuous 360° watch, anticipate

equipment preparation

read on aerobatics & risk management
improve wind analysis & anticipate
long straight final
judge & anticipate
anticipate, watch free zone
pedagogy, training

competition
overcrowded start gate

midair
collapses
lost pilots
hazardous task line/final glide

overcrowded landing
adapt lapse between launch opening & 1st start, ex. 1 to 2h
continuous 360° watch, FLARM
reduce speed by task design
mobile phone on, live tracker, SPOT
flight corridor over landable & in aerologically sane zones
daily turn direction for landing
principles

mental training: visualise problems & emergency procedures
aware of consequences (aviation's hardest = ground)
aware of own (changing) limits: adrenalin, visual flaws, no cheating
fit & awake
ability to renounce: maturity
use logic more than lists learned by heart
simplify procedures to lower work load
anticipate worsening situation, have an alternate
rely on anticipation more than luck
safety scale (green: fly, yellow: watch ground, red: land)
anticipate human mistake, humbleness, listen to critics
step in when hazard or incompetence
declare incidents for common knowledge
putting stress on little mistakes (almost accident)