Safety

         Hazard Reporting System (HAZREP)

         One of the most important and fundamental elements of a robust Safety Management System (SMS) is a clearly understandable and user-friendly Hazard Reporting System (HAZREP).

         The purpose of the HAZREP system is to identify hazards, evaluate their severity and mitigate them in a timely manner. This in turn allows us to isolate and deal with hazards rather than allowing them to reoccur. Every employee from the custodian to the department head should be familiar and comfortable with filing a HAZREP. They should be utilized for any condition, either ground or flight related, that poses a hazard to personnel or property. The mindset of, “if you see something, say something” should be fostered. Although HAZREP’s should never take the place of filling out an aircraft discrepancy, they can be used to supplement and enhance a squawk. The benefit of formally addressing hazards with a system is that it allows them to be evaluated for their severity, communicated with all employees and corrected as appropriate. An added benefit of the HAZREP system is that it empowers employees and demonstrates that their input is encouraged and taken seriously. This in turn promotes an active safety culture within your organization rather than just the appearance of giving “lip service” to safety. The SMS systematic approach also provides for trend analysis to determine if there are gaps or weaknesses in your SOP’s or processes that are resulting in similar type or recurring HAZREP’s.

         With regard to audits conducted of your flight department by external entities, some department managers feel the lack of hazard reports indicates a safe operation to the auditor. The opposite is actually true. What an auditor wants to see are a stream of HAZREP’s and how they were handled. This is evidence of a healthy SMS with “buy in” from staff and management.

         The method of filing a HAZREP can vary according to the level of sophistication your department desires. This can range from a form filed out and placed in the “HAZREP Box” to utilizing off the shelf customizable SMS software programs that allow you to file a HAZREP right from your smartphone or tablet. Whatever method is used, it should be user-friendly and not any more complicated than necessary. Although enough information should be solicited to properly evaluate the hazard, you want to make this process as painless as possible so members are not deterred form filing HAZREPS when needed. Most SMS software based HAZREP reporting tools are a good combination information gathering and simplicity. All hazard reporting systems should offer the reporter the opportunity of remaining anonymous, however it is usually better to know the reporter to gather additional information and to communicate actions taken and results.

         The next step is getting the report to the decision makers for evaluation and action. Usually any HAZREP filed should be sent immediately to the department/unit Safety Committee. This is typically comprised of: The Director of Safety, Chief Pilot, Director of Operations, Director of Maintenance and the department head. When using SMS software, the system can be set to automatically send these notifications. The committee should review the report and determine the severity of the HAZREP and set a “closure” time for the HAZREP as well as an action plan. The “Severity/Probability Matrix is a useful tool in determining this. The matrix determines the level of risk present by taking in to account how serious the hazard is and how likely is it to occur or reoccur. The figure below is an example:

         The “triaging” of potential hazards will help managers decide the speed in which an action plan must be deployed, and also determine the deadline for a HAZREP to be closed.  Depending on the severity of outcome posed by the hazard, this time frame may range from immediate action to 7 days, 30 days, or the next quarter.  In some cases, the committee may even choose to deem the hazard very low risk and simply accept it and monitor it as appropriate.

         The next step is diligent and timely communication with the reporter and the associated department in general. The reporter should be advised that the report has been received and is being evaluated by the Safety Committee. They should also be kept updated as to subsequent actions and decisions. This step is vital to give the reporter a sense that their report is being taken seriously and their input as a team member is valued. There is nothing more counterproductive to an SMS than for an employee to not receive feedback and in turn question the legitimacy of the entire system.

         The following are some actual HAZREP’s that I have dealt with over the years. When reading them, ask yourself how would you categorize them with regard to severity, how long would you allow to correct the hazard and what type of corrective action would you recommend?

    1. Dumpster on ramp adjacent to helicopter landing area left open causing trash to scatter from downwash causing a FOD hazard
    2. The crew lifejackets normally secured to the underneath of seats have repeatedly been found on aircraft floor unsecured. The elastic bands that secure them appear to have worn.
    3. Portable radios/cell phones worn on flight crew belts repeatedly are snagged by seatbelt buckle causing an egress hazard.
    4. Ground personnel walked in front of taxiing aircraft and was not visible in the dark until a near collision.
    5. Several S-76 inadvertent float deployments have occurred by former B-412 pilots. Possible negative habit transfer suspected.
    6. On two occasions tools discovered on transmission deck and in landing gear compartment during pilot preflight.
    7. Precautionary landing made due to partial power loss. Possible fuel contamination.
    8. On two occasions aircraft fuel cap left on aircraft step after fueling, lost during flight.
    9. Helicopter dolly surface slippery when wet due to years of oil/fuel soaking.
    10. Helicopter dolly’s black paint makes it difficult to see during night operations.
    11. Pitot/static system taped for aircraft washing. Preflight by crew discovered tape was never removed prior to putting aircraft back in service.

         Give these some thought, they will be reviewed and discussed at the ERHC General Meeting May 8th. Be prepared to offer your severity assessment and recommendations at the meeting.

         As with most elements of a functioning SMS, the nuts and bolts of a HAZREP system are actually less complicated than initially perceived. The challenge stems from having a safety culture in place that encourages reports and appropriately acts on them; the net result being a safer operation both in the air and on the ground.

         Fly Smart, Fly Safe. Glenn

     


    Glenn Daley
    ERHC Safety Chair