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TOKAI (ver 3) Introduction Occurrence Investigation Process and TOOLS

TOKAI (ver 3) Introduction Occurrence Investigation Process and TOOLS. Background. 1. 2. 3. Need for harmonised analysis of ATM Safety Occurrences. Prerequisite for Safety Improvement - Lessons learned;. Safety Management - Harmonised approach;. Safety Regulation - Coherent data ;. 1.

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TOKAI (ver 3) Introduction Occurrence Investigation Process and TOOLS

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  1. TOKAI (ver 3) Introduction Occurrence Investigation Process and TOOLS

  2. Background

  3. 1 2 3 Need for harmonised analysis of ATM Safety Occurrences Prerequisite for Safety Improvement - Lessons learned; Safety Management - Harmonised approach; Safety Regulation - Coherent data;

  4. 1 2 3 4 5 Harmonised Analysis Implies Common Method or Technique - SOFIA; Shared Vocabulary - HEIDI; Common process structure - guidelines document; Support Tool - TOKAI; Data Exchange Tool - SHIELD;

  5. 2 1 3 4 5 ESARR2 compliance package Guidelines for Safety Occurrences Investigation in ATM ; Guidelines - Reporting Systems for ATM; SOFIA Tutorial Workbook; HEIDI Taxonomy; Support Tool - TOKAI;

  6. Tools Description

  7. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination SRU Guidelines for ATM Occurrence Investigation - support from University of Glasgow and SRU

  8. TOKAI existing functions

  9. Tool 1 Notification Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  10. Tool 1 ATS Occurrence Reporting Form APDSG form

  11. Notification Proposal: Include a check list that could be customised No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  12. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation No easy solution Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  13. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Tool 2 Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  14. Tool 2 Factual Information Gathering Tree • HEIDI Based, aligned with ICAO ADREP2000, includes • Help • Find function • Report printing

  15. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Covered by Data Gathering Tree printing function Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  16. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Tool 3 Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  17. Tool 3 Sequentially Outlining and Follow-up Integrated Analysis

  18. Notification No delay Requirement for immediate action Co-operation with ATSA Bulgaria 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed SOFIA Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  19. 1 4 2 3 5 6 SOFIA Developed to be compliant with ESARR2; Top-down + Bottom-up approach; Probabilistic + Deterministic approach; Events and Conditions; J.Reason model ; Sequential logic in time;

  20. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Tool 4 Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  21. Tool 4 Human ERror in ATM

  22. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Derives directly from SOFIA & HERA: Identified key points Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  23. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Tool 5 Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  24. Tool 5 NATS SSE - Safety Significance Evaluation Mark-sheet

  25. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Tool 6 Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  26. Tool 6 • Safety Recommendations functions: • at creation, verify existing (two way search)

  27. Tool 6 • Safety Recommendations functions: • at creation, verify existing (two way search)

  28. Tool 6 • Safety Recommendations functions: • at follow-up, monitor implementation

  29. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Covered by Data Gathering printing function Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  30. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay Covered by Safety Recommendations function As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  31. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Tool 7 Report and Exchange Lesson Dissemination

  32. Tool 7 • Configuration files permit to define for each recipient: • type of occurrences to be reported/exchanged • disable fields within selected occurrence files; or • disidentify fields within selected occurrence files

  33. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP AST Annual Summary Template Report and Exchange Lesson Dissemination

  34. SRU • AST module: • generates automatically the Annual Summary Template • provides for a means to verify if occurrence file is consistent with AST (and subsequently ESARR2) requirements

  35. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment • Lesson dissemination: • publication of reports are made available (covered by Data gathering printing function) Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  36. Help functions

  37. Help in all menus will provide for the HEIDI definition and comments/examples

  38. AVI files to recall the sequence of inputs required to operate a given function These can be called anytime when performing a function and swap back to actual use of the function can be made.

  39. System Management Functions

  40. Updating The HEIDI Taxonomy

  41. Customising the HEIDI Taxonomy

  42. Managing the Databases

  43. Current and Planned Validations

  44. Notification No delay Requirement for immediate action • Link with ASMT • Development of Technical Fault Report Form • Feedback link 96 hours maximum Assessment of need for investigation Factual Information Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  45. Notification No delay Requirement for immediate action 96 hours maximum Assessment of need for investigation Factual Information OTHER: • User access rights • Security of Data`(partially achieved) • Organisation system architecture • Web-site version (notification form) • Support for local languages • Support for statistical reports (priority 1) Preliminary Report IF prescribed Reconstruction Analysis Conclusions As quickly as practically possible IF prescribed Recommendations Severity Assessment Final report No delay As prescribed Follow-up ASAP Report and Exchange Lesson Dissemination

  46. Thank you for your attention !

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