Confidential Human Factors

Incident Reporting Programme

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The Charity

Aviation

Maritime

The Charity

Aviation

Maritime

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Punished for mistakes

Initial Report

I was forced to sign for an inspection that I did not carry out because the [Authorised Manager] had missed a duplicate inspection and had issued a Form 1 on the component. Months later I assembled a component incorrectly, which resulted in removal of my Inspector authorisation, a CV review, and being called useless and unskilled while being expected to carry out the same level of work and supervise. Any mistakes made in this hangar result in complete ridicule and aggression.

CAA Comment

CHIRP Comment

The reporter’s Quality/Compliance Manager was contacted with the reporter’s consent. The organisation took these matters very seriously and reported back to CHIRP that senior staff changes were pending when their investigations were concluded. It is gratifying that the report progressed to a satisfactory conclusion, no doubt improving the organisation’s safety culture, but a little disheartening that there are still some individuals in our industry that struggle to grasp the fundamentals of Human Factors, a Just Culture and open and transparent reporting. The work of CHIRP is never done and we all must play our part in identifying and highlighting unsafe old-fashioned cultures.