maintenance sms manual.docx

7/27/2019 Maintenance SMS Manual.docx

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SAFETY MANAGEMENT SYSTEM FOR

MAINTENANCE ORGANIZATION____________________________________________________________________________________________________________

Issue: 01 Rev 00 June 2010 Page No.1

1.0 Safety Management Plan

1.1 Purpose, Scope and App l icabi l ity

This Safety Management System (SMS-P) Manual has been developed to describethe requirements for Agni Air maintenance organizations Safety Management

System. This safety management system is denoted as SMS-P, to indicate that itapplies to a producer or provider of services and shall be part of Agni Air SMS

Manual.

Introduces the concept of a safety management system (SMS) to aviationmaintenance organization. A safety management system applies quality management

concepts to human organizational aspects of production and support processes toachieve safety goals.

The Maintenance Procedure Manual describes the companys organizationalstructure, scope of maintenance, responsibility, general company rules & procedures

used in the maintenance of the companys aircraft and associated equipment.

While the CAA NEPAL encourages each aviation maintenance organization todevelop and implement an SMS, these systems in no way substitute for regulatory

compliance of other certificate requirements, where applicable.

This manual is intended to address aviation safety related operational and supportprocesses and activities rather than occupational safety, environmental protection, orcustomer service quality.

1.2 Safety Po licyAll levels of management are accountable for safety performance and are committed toproviding safe, healthy, secure work conditions and attitudes with the objective of having

an accident-free workplace. Making safety excellence part of all activities strengthens the

organization. The organizations leader is committed to:

Ongoing pursuit of an accident-free workplace, including no harm to people, nodamage to equipment, the environment or property.

A culture of open reporting of all safety hazards in which management will notinitiate disciplinary action against any personnel who, in good faith, discloses a

hazard or safety occurrence due to unintentional conduct.

Regular and ongoing support for safety training and awareness programs. Regular audits of safety policies, procedures and practices are conducted. Monitoring industry activity to ensure best safety practices are incorporated in to the

organization.

Providing and promoting the necessary resources to support this policy. Requiring all employees to be responsible for maintaining a safe work environment

through adherence to approved policies, procedures and training.


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personnel as they impactflight safety.

The chief of maintenance is responsible for: understand applicable regulatory requirements,

standards, and organization safety policies and procedures.

achieve safe maintenanceoperations.

and supervisingmaintenance personnel.

personnel performance compliance with organizationalgoals, objectives and regulatory requirements.

personnel as they impactflight safety.

1.5 Comp l iance w ith Standards

All personnel have the duty to comply with approved standards including organizationpolicy and procedures, aircraft manufacturers operating procedures, and limitations, and

government regulations. Research shows that once you start deviating from the rules, you

are almost twice as likely to commit an error with serious consequences.

Breaking the rules usually does not result in an accident; however, it always results in

greater risk for the operation, and the organization supports the principle of, NEVER

take unnecessary risks.

1.6 Intent ional non -compl iance with standards

Behavior is a function of consequences. Management is committed to identifying

deviations from standards and taking immediate corrective action. Corrective action caninclude counseling, training, discipline, grounding or removal. Corrective action must be

consistent and fair.

Organization management makes a clear distinction between honest mistakes and

intentional non-compliance with standards. Honest mistakes occur, and they are

addressed through counseling and training.

Research has shown that most accidents involve some form of flawed decision-making.

This most often involves non-compliance with known standards. Non-compliance rarelyresults in an accident; however, it always results in greater risk for the operation.

1.7 Rewarding People

This organization is committed to the principle that people are rewarded for normal,positive performance of their duties that comply with organization standards.


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Personnel will not be rewarded for accomplishing the mission by breaking the rules.

Reinforced bad behavior breeds continued bad behavior. This is unacceptable.

1.8 Safety Promotion

Safety is promoted as a core value within the organization. Procedures, practices andallocation of resources and training clearly demonstrate the organizations commitment to

safety. The following methods are used to promote safety:

Post the Safety Policy in prominent locations around the base of operations. Start meetings with a comment or review about safety issues. Have a safety bulletin board. Have an employee safety feedback process.1.9 Documentat ion and record s management Technical libraries shall be kept current (for such things as technical publication,

airworthiness directives and service bulletins).

Maintenance defects and work completed shall be recorded in detail. Operational data shall be monitored for reliability analysis. Corporate safety policies, objectives and goals shall be formally documented and

distributed.

Records on certifying staff on training, qualification and currency, etc. shall be kept. Information on Inspection status, component history, life, etc. shall be kept.1.10 Hazard Identi f ic ation & Risk Management

The systematic identification and control of all major hazards is foundational. The

success of the organization depends on the effectiveness of the Hazard ManagementProgram. Hazards are identified through employee reporting, safety meetings, audits and

inspections.

When a major change in operations, equipment or services is anticipated, themanagement of change process includes hazard identification and risk management

processes.

Risk management is the identification and control of risk. It is the responsibility of everymember of the organization. The first goal of risk management is to avoid the hazard.

The organization establishes sufficient independent and effective barriers, controls andrecovery measures to manage the risk posed by hazards to a level as low as practicable.These barriers, controls and recovery measures can be equipment, work processes,

standard operating procedures, training or other similar means to prevent the release of

hazards and limit their consequences should they be released.

The organization ensures that all individuals responsible for safety critical barriers,

controls, and recovery measures are aware of their responsibilities and competent to carry


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them out. The organization establishes who is doing what to manage key risks and

ensures that these people and the things they do are up to the task.

1.11 Occurrenc e & Hazard Reportin g

All occurrences and hazards identified by an employee in the maintenance organization

will be reported to the safety officer using the Event Reporting Form.

Occurr ence - Defin iti on

An occurrence is defined as any unplanned safety related event. This would include

accidents and incidents that could impact the safety of guests, passengers, organizationpersonnel, equipment, property or the environment.

HazardDefinition

A hazard is defined as something that has the potential to cause harm to people and/or theloss of or damage to equipment, property or the environment.

Occurrences

Personnel who report are treated fairly and justly, without punitive action from

management except in the case of known reckless disregard for regulations andstandards, or repeated substandardperformance. The Just Culture process is used when

deciding if disciplinary action is appropriate.

1.12 Emergency Preparedness & Response

The detail of the crisis management and emergency response plan is contained in the

Company SMS Manual.2.0 SMS in A ircraf t Maintenance

2.1. Mainten ance Safety

2.1.1. Maint enanc e Safety General Maintenance and inspection errors are cited as a factor in a number of accidents and

serious incidents worldwide each year.

The safety of flight is dependent on the airworthiness of the aircraft. Safetymanagement in the areas of maintenance, inspection, repair and overhaul aretherefore vital to flight safety. Maintenance organizations need to follow the same

disciplined approach to safety management as is required for flight operations.

Conditions for maintenance-related failures may be set in place long before aneventual failure. For example, an undetected fatigue crack may take years to progress

to the point of failure.


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Shortcomings in the provision of timely, accurate, understandable discrepancy reportsby flight crews, etc.

Human F actors in maintenance:

Organizational and working conditions (as described above). Environmental factors (e.g. temperature, lighting and noise). Individual factors (e.g. workload, physical demands and maintenance). Scheduling (e.g. shift work, night work and overtime) versus adequacy of rest

periods.

Appropriateness of SOPs (e.g. correctness, understandability and usability). Quality of supervision. Proper use of job cards, etc. Adequacy of formal training, on-the-job training (OJT), recurrent training and Human

Factors training.

Adequacy of handovers at shift changes and record keeping. Boredom and cultural factors (e.g. AMEs professionalism and openness to report

errors and hazards).

2.2. Quali ty Po licy

Top management will ensure that the organizations quality policy is consistent with theSMS.

2.3. Safety Management in Maintenan ce

All levels of management are accountable for safety performance and are committed to

providing safe, healthy, secure work conditions and attitudes with the objective of having

an accident-free workplace. Making safety excellence part of all activities strengthens the

organization.

Resour ce Al location

To protect against losses due to an accident, resources shall be allocated for:

Personnel with expertise to design and implement the maintenance safety system. Training in safety management for all staff. Information management systems to store safety data, and expertise to analyze the

data.

Safety Culture:


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An organizations culture consists of its values, beliefs, legends, rituals, mission goals,

performance measures, and sense of responsibility to its employees, customers, and the

community.

A poor safety culture in a maintenance organization can lead to unsafe work practices not

being corrected; possibly creating latent unsafe conditions that may not cause a problemfor years. Agni Air Management is committed to foster a positive safety culture by honest

implementation of SMS.

2.4 Pr incipal tools for safety management in m aintenance

Effective operation of an SMS for maintenance builds upon risk-based decision-making,a concept that has long been integral to maintenance practices. For example, maintenance

cycles are built upon probabilities that systems and components would not fail for theperiod of the cycle. Components are often replaced because they are time expired, eventhough they may remain functionally serviceable. Based on knowledge and experience,

risks of unexpected failure are reduced to acceptable levels.

Some of the principal tools for operating an SMS for the maintenance function that AgniAir shall follow include:

Clearly defined and enforced Maintenance Exposition Manual. Risk-based resource allocations. Hazard and incident reporting systems. Flight data analysis programs. Reliability Analysis. Competent investigation of maintenance-related occurrences. Training in safety management. Communication and feedback systems (including information exchange and safety

promotion).

2.5 Safety o versight and prog ram evaluat ion

As with any system, feedback is required to ensure that the individual elements of themaintenance SMS are functioning as intended. Continuing high standards of safety in amaintenance organization imply regular monitoring and surveillance of all maintenance

activities. This is especially so at the interfaces between workers (such as between

maintenance personnel and flight crews, between personnel of different trades, orbetween staff on changing work shifts) to avoid problems falling through thecracks.

Change is inevitable in the aviation industry, and the maintenance area is no exception.

The Director of Engineering may require that a safety assessment be carried out inrespect of any significant changes in the maintenance organization. Circumstances that

might warrant a safety assessment include a corporate merger, and introduction of a new


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fleet, equipment, systems or facilities. Consequently, the need for any adjustments can be

identified and corrected.

The maintenance SMS shall be regularly evaluated to ensure that expected results are

being achieved. The areas to be evaluated are:

To what extent has management succeeded in establishing a positive safety culture? What are the trends in hazard and incident reporting (by technical trade, by aircraft

fleet, etc.)?

Are hazards being identified and resolved? Have adequate resources been provided for the maintenance SMS?3.0 Managing Proc edural Deviations in Maintenance

3.1 General

The maintenance system includes not only the Maintenance personnel on the shopfloor but also all the other technicians, engineers, planners, managers, stores keepersand other persons that contribute to the maintenance process. In such a broad system,

procedural deviations and errors in maintenance are inevitable and pervasive.

Accidents and incidents attributable to maintenance are more likely to be caused bythe actions of humans than by mechanical failure. Often, they involve a deviationfrom established procedures and practices. Even mechanical failures may reflect

errors in observing (or reporting) minor defects before they progress to the point of

failure.

Maintenance errors are often facilitated by factors beyond the control of themaintenance staff.

Safe maintenance organizations foster the conscientious reporting of maintenanceerrors, especially those that jeopardize airworthiness, so that effective action can betaken. This requires a culture in which staff feels comfortable reporting errors to their

supervisor once the errors are recognized.

Agni Air shall follow Maintenance Error Decision Aid (MEDA) developed by theBoeing Company for managing procedural deviations in maintenance. It provides the

first line supervisor and the Safety manager with a structured method for analyzing

and tracking the factors leading to maintenance errors and for recommending errorprevention strategies.

3.2 Maintenance Error Decision Aid (MEDA)

MEDA F ive Basic Steps

1. Event;Following an event, it is the responsibility of the maintenance organization to

select the error caused aspects that will be investigated.


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2. Decision;After fixing the problem and returning the aircraft to service, the operator

decides if the event was maintenance-related. If yes, the operator performs a MEDA

investigation.3. Investigation;Following a structured form (specifically designed for MEDA), the

operator carries out an investigation. The investigator records general information with

respect to the aircraft, when the maintenance and the event occurred, the event thatprecipitated the investigation, the error that caused the event, the factors that contributed

to the error and possible prevention strategies.4. Prevention Strategies;Management reviews, prioritizes, implements and then tracks

prevention strategies (process improvements) in order to avoid or reduce the likelihood ofsimilar errors occurring in the future.

5. Feedback is provided to the maintenance workforce in order for Maintenance

personnel to know that changes have been made to the maintenance system as a result of

the MEDA process. Management is responsible for affirming the effectiveness ofemployees participation and validating their contribution to the MEDA process by

sharing investigation results with them.

Definitions

An error is a human action (or human behavior) that unintentionally deviates fromthe expected action (or behavior).

A violation is a human action (or human behavior) that intentionally deviates from theexpected action (or behavior).

A contributing factor is anything that affects how a maintenance technician or inspectordoes his/her job.

It is easier to understand the concept of contributing factor using a model:

MEDA Event Model


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In this simple model, a contributing factor causes an error that causes an event.

Above model shows explicitly that there is a probabilistic relationship between

contributing factors and an error and between an error and an event. But based onresearch and experience, there are typically three to five contributing factors to each

error. In fact, there are contributing factors to the contributing factors.

This leads to a more refined model as shown above that is Enhanced MEDA Error

Model. We also know that there are contributing factors to contributing factors and this

leads to Further Enhanced MEDA Error Model as shown below:


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In some cases the violation itself leads directly to the event rather than to an error that

leads to an event.

There is one other way in which a violation can contribute to an event.

Of course, both types of violations can contribute to a single event. This is shown below incombined Error and Violation Model


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Thus all of these models put together leads to a final event causation model that includes

errors and violations known as Final MEDA Event Model as shown below:

The MEDA Phil osophy

The MEDA philosophy is based on this event model. The fundamental philosophy behindMEDA is:

A maintenance-related event can be caused by an error, by a violation, or by anerror/violation combination.


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Maintenance errors are not made on purpose. Maintenance errors are caused by a series of contributing factors. Violations, while intentional, are also caused by contributing factors Most of these error or violation contributing factors are part of an airline process, and,

therefore, can be improved so that they do not contribute to future, similar events.

The MEDA I nvestigation Process

The traditional approach in following up on maintenance errors was all too often toidentify the event caused by a maintenance error and then to administer discipline to

whoever made that error. The MEDA process goes much further (without the disciplinaryfollow-up unless there has been a deliberate violation of procedures). Having investigated

the event caused by a maintenance error and identifying who made the error, MEDA

facilitates the following actions: determining those factors which contributed to the error; interviewing the responsible persons (and others if necessary) to obtain all the

pertinent information;

identifying those organizational or system barriers which failed to prevent the error(and the contributing factors as to why they failed);

gathering ideas for process improvement from the responsible persons (and others asapplicable);

maintaining a maintenance error database; analyzing patterns in maintenance errors;

implementing process improvements based on error investigations and analyses; providing feedback to all employees affected by these process improvements;


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MEDA Resul ts FormThe MEDA Results Form consists of six sections:

Section IGeneral Information Section IIEvent Section IIIMaintenance System Failure Section IVContributing Factors Checklist Section VError Prevention Strategies Section VISummary of Contributing Factors, Error, and Event

MEDA Checklist

MEDA checklists facilitate the interview process (i.e. data acquisition) and data storage

in a maintenance error database. With a view to understanding the context in whichmaintenance errors are committed, listed below are ten areas where data should be

collected:

a) Inf ormation. This category includes work cards, maintenance procedures manuals,

service bulletins, engineering orders, illustrated parts catalogues and any other written or

computerized information provided either internally or by the manufacturer that isconsidered necessary for the fulfillment of the AMEs job.


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Some of the contributing factors as to why the information was problematic or was not

used include:

understandability (including format, level of detail, use of language, clarity ofillustrations and

completeness); availability and accessibility; accuracy, validity and currency; conflicting information;b) Equipment/tools. This category includes all the tools and materials necessary for the

correct completion of the maintenance or inspection task. In addition to routine drills,

wrenches, screwdrivers, etc., it includes non-destructive test equipment, work-stands, testboxes and special tools identified in the maintenance procedures.

Some of the contributing factors as to how equipment or tools can compromise theperformance of the AME include:

unsafe for use by the AME (e.g. protective devices missing or unstable); unreliable, damaged or worn out; poor layout of controls or displays; mis-calibrated or incorrect scale readings; unsuitable for task; unavailable; cannot be used in intended environment (e.g. space limitations or presence of

moisture);

instructions missing; too complicated;c) Air craft design/configuration/parts. This category includes those aspects of individual

aircraft design or configuration which limit the AMEs access for maintenance. Inaddition, it includes replacement parts that are either incorrectly labeled or not available,

leading to the use of substitute parts.

Contributing factors here that may lead to errors by the AME include:

complexity of installation or test procedures; bulk or weight of component; inaccessibility; configuration variability (e.g. due to different models of the same aircraft type ormodifications); parts not available or incorrectly labeled; easy to install incorrectly (e.g. due to inadequate feedback, absence of orientation or

flow direction indicators, or identical connectors);

d) Job/task. This category covers the nature of the work to be completed including the

combination and sequence of the various tasks comprising the job.


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Some of the contributing factors conducive to facilitating maintenance errors in this area

include:

repetitive or monotonous task; complex or confusing task (e.g. long procedure with multiple or concurrent tasks, and

exceptional mental or physical effort required);

new or changed task; task or procedure varies by aircraft model or maintenance location;e) Technical knowledge/ski ll s. This category includes the operator process knowledge,

aircraft system knowledge and maintenance task knowledge, as well as the technical

skills to perform the assigned tasks or sub-tasks without error.

Some of the related contributing factors compromising job performance are:

inadequate skills in spite of training, trouble with memory items, or poor decision-making;

inadequate task knowledge due to insufficient training or practice; inadequate task planning leading to interrupted procedures or too many scheduled

tasks for time available (e.g. failure to get all necessary tools and materials first);

inadequate operator process knowledge, perhaps due to inadequate training andorientation (e.g. failure to order necessary parts on time);

inadequate aircraft system knowledge (e.g. incomplete post-installation test and faultisolation);

f) Individual factors. This category includes the factors affecting individual job

performance that vary from person to person, such as those things brought to the job by

the individual (e.g. body size/strength, health and personal events), as well as thosecaused by interpersonal or organizational factors (e.g. peer pressure, time constraints, and

fatigue due to the job itself, scheduling or shift work).

The following possible factors contributing to maintenance errors:

physical health, including sensory acuity, pre-existing disease or injury, chronic pain,medications, and drug or alcohol abuse;

fatigue due to task saturation, workload, shift scheduling, lack of sleep or personalfactors;

time constraints due to fast work pace, resource availability for assigned workload,pressures to meet aircraft gate time, etc.;

peer pressures to follow groups unsafe practices, disregard for written information,etc.;

complacency (e.g. due to over familiarity with repetitive task, or hazardous attitudesof invulnerability or overconfidence);

body size or strength not suitable for reach or strength requirements (e.g. in confinedspaces);

personal events such as a death of a family member, marital problems, and a changein financial well-being;


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workplace distractions (e.g. due to interruptions in a dynamically changing workenvironment);

g) Environment/facil iti es. This category includes all those factors which can not only

affect the comfort of the AME but also create health or safety concerns which may

become a distraction to the AME.Some of the environmental factors as being potentially contributory to maintenance

errors include:

high noise levels that compromise communications or feedback, affect concentration,etc.;

excessive heat affecting the AMEs ability to physically handle parts or equipment, orcausing personal fatigue;

prolonged cold that affects the sense of touch or smell; humidity or rain that affects aircraft, part or tool surfaces, including use of paper

documents;

precipitation affecting visibility or necessitating bulky protective clothing; insufficient lighting for reading instructions or placards, conducting visual inspections

or performing tasks;

wind affecting ability to hear or communicate, or irritating eyes, ears, nose or throat; vibrations making instrument reading difficult or inducing fatigue in hands or arms; cleanliness affecting ability to perform visual inspections, compromising footing or

grip, or reducing available workspace;

hazardous or toxic substances affecting sensory acuity, causing headaches, dizzinessor other discomfort, or requiring wearing of awkward protective clothing;

power sources that are inadequately protected or marked; inadequate ventilation causing personal discomfort or fatigue; workspace too crowded or inefficiently organized;h) Organizational factors. This category includes such factors as internal communication

with support organizations, the level of trust that is established between management and

Maintenance personnel, awareness and buy-in to managements goals, and unionactivities. All these factors can affect the quality of workand therefore the scope for

maintenance error. The following are some of the organizational factors as being

potentially contributory to maintenance errors:

quality of support from technical organizations that is inconsistent, late or otherwisepoor; company policies that are unfair or inconsistent in their application, inflexible in

considering special circumstances, etc.;

company work processes, including inappropriate SOPs, inadequate work inspectionsand outdated manuals;

union action that becomes a distraction;


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Between the flight crew and maintenance crew vague or incomplete logbookwrite-up; late notification of defect; aircraft communications addressing and reporting

system (ACARS)/data link not used;

4. References

This Manual is in accordance with the following documents:

Annex 6 to the Convention on International Civil Aviation, Operation of Aircraft International Civil Aviation Organization (ICAO) Document 9859, ICAO Safety

Management Manual

Maintenance Error Decision Aid (MEDA) Users Guide developed by Boeing5. Definit ion s

Accident an unplanned event or series of events that results in death, injury,occupational illness, damage to or loss of equipment or property, or damage to the

environment.

Analysis the process of identifying a question or issue to be addressed, modeling the

issue, investigating model results, interpreting the results, and possibly making a

recommendation. Analysis typically involves using scientific or mathematical methodsfor evaluation.

Assessmentprocess of measuring or judging the value or level of something.

Auditscheduled, formal reviews and verifications to evaluate compliance with policy,

standards, and/or contractual requirements. The starting point for an audit is themanagement and operations of the organization, and it moves outward to the

organization's activities and products/services.

Internal auditan audit conducted by, or on behalf of, the organization being audited.

External audit an audit conducted by an entity outside of the organization being

audited.

Aviation system the functional operation/production system used by the serviceprovider to produce the product/service (see Figure 1).

Complete nothing has been omitted and the attributes stated are essential and

appropriate to the level of detail.

Continuous monitoringuninterrupted watchfulness over the system.

Corrective action action to eliminate or mitigate the cause or reduce the effects of a

detected nonconformity or other undesirable situation.


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Correct accurately reflects the item with an absence of ambiguity or error in its

attributes.

Documentation information or meaningful data and its supporting medium (e.g.,paper, electronic, etc.). In this context it is distinct from records because it is the written

description of policies, processes, procedures, objectives, requirements, authorities,

responsibilities, or work instructions.

Evaluation a functionally independent review of company policies, procedures, andsystems. If accomplished by the company itself, the evaluation should be done by an

element of the company other than the one performing the function being evaluated. The

evaluation process builds on the concepts of auditing and inspection. An evaluation is an

anticipatory process, and is designed to identify and correct potential findings before theyoccur. An evaluation is synonymous with the term systems audit.

Hazard any existing or potential condition that can lead to injury, illness, or death topeople; damage to or loss of a system, equipment, or property; or damage to the

environment. A hazard is a condition that is a prerequisite to an accident or incident.

Incident a near miss episode with minor consequences that could have resulted ingreater loss. An unplanned event that could have resulted in an accident, or did result in

minor damage, and indicates the existence of, though may not define a hazard or

hazardous condition.

Lessons learned knowledge or understanding gained by experience, which may bepositive, such as a successful test or mission, or negative, such as a mishap or failure.

Lessons learned should be developed from information obtained from within, as well as

outside of, the organization and/or industry.

Likelihood the estimated probability or frequency, in quantitative or qualitative terms,of an occurrence related to the hazard.

Line managementmanagement structure that operates the aviation system.

Nonconformity non fulfillment of a requirement (ref. ISO 9000). This includes but is

not limited to noncompliance with Federal regulations. It also includes company

requirements, requirements of operator developed risk controls or operator specifiedpolicies and procedures.

Operational life cycle period of time spanning from implementation of a

product/service until it is no longer in use.Oversighta function that ensures the effective promulgation and implementation of the

safety-related standards, requirements, regulations, and associated procedures. Safetyoversight also ensures that the acceptable level of safety risk is not exceeded in the air

transportation system. Safety oversight in the context of the safety management system

will be conducted via oversights safety management system (SMS-O).

Preventive action action to eliminate or mitigate the cause or reduce the effects of a


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potential nonconformity or other undesirable situation.

Procedurespecified way to carry out an activity or a process.

Processset of interrelated or interacting activities which transform inputs into outputs.

Product/serviceanything that might satisfy a want or need, which is offered in, or canbe purchased in, the air transportation system. In this context, administrative or licensing

fees paid to the government do not constitute a purchase.

Product/service provider any entity that offers or sells a product/service to satisfy a

want or need in the air transportation system. In this context, administrative or licensing

fees paid to the government do not constitute a purchase. Examples of product/serviceproviders include: aircraft and aircraft parts manufacturers; aircraft operators; maintainers

of aircraft, avionics, and air traffic control equipment; educators in the air transportation

system; etc. (Note: any entity that is a direct consumer of air navigation services and oroperates in the U.S. airspace is included in this classification; examples include: general

aviation, military aviation, and public use aircraft operators.)

Records evidence of results achieved or activities performed. In this context it is

distinct from documentation because records are the documentation of SMS outputs.

Residual safety risk the remaining safety risk that exists after all control techniqueshave been implemented or exhausted, and all controls have been verified. Only verified

controls can be used for the assessment of residual safety risk.

Risk The composite of predicted severity and likelihood of the potential effect of a

hazard in the worst credible system state.

Risk Control refers to steps taken to eliminate hazards of to mitigate their effects byreducing severity and/or likelihood of risk associated with those hazards.

Safety assurance SMS process management functions that systematically provide

confidence that organizational products/services meet or exceed safety requirements.

Safety culturethe product of individual and group values, attitudes, competencies, and

patterns of behavior that determine the commitment to, and the style and proficiency of,the organization's management of safety. Organizations with a positive safety culture are

characterized by communications founded on mutual trust, by shared perceptions of the

importance of safety, and by confidence in the efficacy of preventive measures.

Safety Management System (SMS) the formal, top-down business-like approach tomanaging safety risk. It includes systematic procedures, practices, and policies for themanagement of safety (as described in this document it includes safety risk management,

safety policy, safety assurance, and safety promotion).

Product/Service Provider Safety Management System (SMS-P)the SMS owned and

operated by a product/service provider.

Oversight Safety Management System (SMS-O)the SMS owned and operated by an


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oversight entity.

Safety objectivessomething sought or aimed for, related to safety.

NOTE 1: Safety objectives are generally based on the organizations safety policy.

NOTE 2: Safety objectives are generally specified for relevant functions and levels in the organization.

Safety planning

part of safety management focused on setting safety objectives and

specifying necessary operational processes and related resources to fulfill the qualityobjectives.

Safety riskthe composite of predicted severity and likelihood of the potential effect ofa hazard.

Safety risk control anything that reduces or mitigates the safety risk of a hazard.

Safety risk controls must be written in requirements language, measurable, and monitored

to ensure effectiveness.

Safety risk management (SRM) a formal process within the SMS composed ofdescribing the system, identifying the hazards, assessing the risk, analyzing the risk, and

controlling the risk. The SRM process is embedded in the processes used to provide the

product/service; it is not a separate/distinct process.

Safety promotiona combination of safety culture, training, and data sharing activitiesthat support the implementation and operation of an SMS in an organization

Severitythe consequence or impact of a hazard in terms of degree of loss or harm.

Substitute riskrisk unintentionally created as a consequence of safety risk control(s).

Systeman integrated set of constituent elements that are combined in an operational or

support environment to accomplish a defined objective. These elements include people,hardware, software, firmware, information, procedures, facilities, services, and othersupport facets.

Top Management(ref. ISO 9000-2000 definition 3.2.7) the person or group of people

who directs and controls an organization.

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