Air Traffic Control
CHIRP continues to receive relatively few reports from ATCOs, FISOs and A/G Operators and it has not been possible to determine any particular themes. In the past, there have been concerns about equipment and procedural issues, and a number of reports that related to fatigue and task saturation on smaller units.
A confidential reporting system permits individuals who are working within the aviation system to report safety-related matters that they might not report through other âopenâ systems. Reporting directly to an organisation that is totally independent of the operational management and regulatory agencies allows reporters to describe the issue in their own words and ensures that reports are received without being filtered in any way. More importantly, the confidential process permits the non-attributable reporting of deficiencies and discrepancies that may result from, or cause, human errors without exposing the reporter or other individuals within the system to critical judgement or the attachment of blame.
On the other side of the coin, for companies and organisations, confidential reports provide a source of non-attributable safety information to safety management and regulatory agencies that otherwise would probably not be available. This type of information often provides organisations with early warning precursor alerts of potential problems, or substantiates other sources of information.
CHIRPâs Role
The CHIRP programme is an independent, confidential and voluntary way of reporting concerns that complements the existing mandatory reporting programmes recommended by the International Civil Aviation Organisation (ICAO) and the European Commission regulations as retained by the UK.
Our Purpose â To contribute to the enhancement of flight safety by providing an independent confidential reporting system for all individuals employed in or associated with the provision of ATC services to UK aviation.
Reporters (ATCOs, FISOs or A/G Operators) can submit reports to CHIRP using the âAir Traffic Controlâ process which can be accessed from the âSubmit a reportâ function on the CHIRP website homepage or the CHIRP App. Reports are then processed and disidentified by the CHIRP Director Aviation and, if appropriate, will then be reviewed by either the CHIRP Air Transport Advisory Board (ATAB) or General Aviation Adivisory Board (GAAB) (depending on applicability) to seek their counsel. If agreed by the reporter, CHIRP will also forward disidentified information to relevant organisations best able to investigate/address the reported issue. Once resolved, disidentified reports may then be included in the dedicated Air Transport or GA FEEDBACK newsletters if suitable.
Flight Crew (Commercial)
Although commercial air transport accident rates are extremely low, they have remained relatively constant over the past few decades and a major challenge for the air transport industry has been to develop effective processes to identify key causal factors that in some circumstances might lead to an accident, before the accident occurs. One element of this has been to improve the quality of feedback from the professional groups involved in air transport operations through not just the reporting of incidents but also the reporting of things that nearly happened (but were averted or didnât develop into a reportable incident) in order to provide additional important information related to contributory causal factors.
A confidential reporting system permits individuals who are working within the aviation system to report safety-related matters that they might not report through other âopenâ systems. Reporting directly to an organisation that is totally independent of the operational management and regulatory agencies allows reporters to describe the issue in their own words and ensures that reports are received without being filtered in any way. More importantly, the confidential process permits the non-attributable reporting of deficiencies and discrepancies that may result from, or cause, human errors without exposing the reporter or other individuals within the system to critical judgement or the attachment of blame.
On the other side of the coin, for companies and organisations, confidential reports provide a source of non-attributable safety information to safety management and regulatory agencies that otherwise would probably not be available. This type of information often provides organisations with early warning precursor alerts of potential problems, or substantiates other sources of information.
Crew rostering practices, fatigue and absence management policies regularly feature as safety issues reported by professional flight crew. Of these, companies pursuing maximum work-rate within flight-time limitation (FTL) regulations is often a prominent theme. FTL limitations are intended as an absolute maximum for use only under carefully considered and pro-active management; however, some companies adopt a policy that they are limits that can be routinely approached with impunity. As a result, CHIRP receives many submissions regarding cumulative fatigue from arduous rosters, which can often result in serious jetlag and associated performance degradation in reporters.
With regard to absence management, CHIRP has no remit to investigate contractual or industrial relations issues, but these can often be difficult to separate from safety concerns. CHIRP has also engaged with operators in the past to highlight the safety implications of some absence management policies that could be incompatible with pilotsâ licence obligations to fly only when fit to do so; unlike many other industries, the physiological effects of even minor ailments can render pilots unfit to operate.
Finally, commercial pressures and coercion to meet performance objectives can severely impact trust between flight crew and management. Associated poor perception of companiesâ Just Cultures can translate into reporting being focused on perceived poor safety cultures and inappropriate pressures to operate.
CHIRPâs Role
The CHIRP programme is an independent, confidential and voluntary way of reporting concerns that complements the existing mandatory reporting programmes recommended by the International Civil Aviation Organisation (ICAO) and the European Commission regulations as retained by the UK.
Our Purpose â To contribute to the enhancement of flight safety by providing an independent confidential reporting system for all individuals employed in or associated with UK Commercial Aviation.
Reporters can submit reports to CHIRP using the âFlight Crew (Commercial)â process which can be accessed from the âSubmit a reportâ function on the CHIRP website homepage or the CHIRP App. Reports are then processed and disidentified by the CHIRP Director aviation and, if appropriate, will then be reviewed by the CHIRP Air Transport Advisory Board (ATAB) to seek their counsel. If agreed by the reporter, CHIRP will also forward disidentified information to relevant organisations best able to investigate/address the reported issue. Once resolved, disidentified reports may then be included in the dedicated Air Transport FEEDBACK newsletter if suitable.
Cabin Crew
Although cabin crew are primarily expected to report safety issues to their operator, sometimes individuals might want to use an independent, confidential reporting programme to seek reassurance or guidance about their actions following an occurrence and/or they may wish to share an experience more widely than within just their airline so that others in the cabin crew community can learn from it. Individuals may also choose to use the CHIRP reporting programme if they fear retribution if they report to their employer, or they may also do so if they believe that their employer might not take their report to a satisfactory conclusion.
CHIRP is primarily concerned with safety-related reports about Human Factors and/or Just Culture/Reporting Culture issues. Such reports may include but are not confined to: human skills, performance and training; rules, procedures and regulations; the design and use of aircraft and equipment; communication; workplaces, manpower, organisation and management.
CHIRPâs Role
The fundamental principle underpinning CHIRP is that all reports are treated in absolute confidence in order that reportersâ identities are protected â any associated information and concerns or experiences are only communicated to external agencies and organisations with the agreement of the reporter and then only in a disidentified format to protect their anonymity. The CHIRP Cabin Crew programme was launched in July 2001 and now receives a higher volume of reports than any of the other CHIRP programmes.
Our Purpose â To contribute to the enhancement of flight safety by providing an independent confidential reporting system for all individuals employed as cabin crew.
Reporters can submit reports to CHIRP using the âCabin Crewâ process which can be accessed from the âSubmit a reportâ function on the CHIRP website homepage or the CHIRP App. Reports are then processed and disidentified by the CHIRP Cabin Crew Programme Manager and, if appropriate, will then be reviewed by the CHIRP Cabin Crew Advisory Board (CCAB) to seek their counsel. If agreed by the reporter, CHIRP will also forward disidentified information to relevant organisations best able to investigate/address the reported issue. Once resolved, disidentified reports may then be included in the dedicated Cabin Crew FEEDBACK newsletter if suitable.
Engineering
Engineering activity pervades all that we do in aviation and involves Production, Overhaul, Maintenance and Servicing of complete aircraft, major assemblies (both airframe and engines) and individual mechanical and electrical/electronic components. The maintenance and servicing environment can be especially diverse given the contrasts between Base Maintenance carried out in hangars and Line Maintenance mainly conducted outside at airfields (large, small and private facilities) that may be regular operator Line Stations or just one-off destinations. Understanding Human Factors is therefore integral to safety given that engineers can also be operating as part of a supervised team or individually depending on the circumstances.
Such Human Factors issues in engineering include the following (non-exhaustive) examples: aircraft design failings; individual staff knowledge, skills and ability; environmental issues with difficult weather conditions; plus issues that derive from the immediate working environment such as poor facilities, teamwork, management, peer and time pressure, poor planning, inadequate/incorrect procedures and inadequate (or lack of) organisational safety cultures.
CHIRPâs Role
Engineering reporting has always been part of CHIRP activity and complements the CAA Mandatory Occurrence Reporting system and other formal reporting systems operated by many UK organisations by providing a means by which individuals are able to raise safety-related issues of concern without being identified to their peer group, management or the Regulatory Authority. As always, we will ensure confidentiality is maintained by disidentifying the sources of the incoming reports, the individual reporterâs details, the company they work for and the operator and airfield involved.
Our Purpose â To contribute to the enhancement of flight safety by providing an independent confidential reporting system for all individuals employed in or associated with aircraft engineering.
Reporters can submit reports to CHIRP using the âEngineeringâ process which can be accessed from the âSubmit a reportâ function on the CHIRP website homepage or the CHIRP App. Reports are then processed and disidentified by the CHIRP Engineering Programme Manager and, if appropriate, will then be reviewed by either the CHIRP Air Transport Advisory Board (ATAB) or General Aviation Adivisory Board (GAAB) (depending on applicability) to seek their counsel. If agreed by the reporter, CHIRP will also forward disidentified information to relevant organisations best able to investigate/address the reported issue. Once resolved, disidentified reports may then be included in the dedicated Air Transport or GA FEEDBACK newsletters if suitable.
General Aviation
The majority of GA reports are mea culpa admissions of error or mistakes and/or requests for advice on better courses of action in the reported circumstances. It is commendable that so many pilots are prepared to altruistically share sometimes embarrassing experiences in the hope of preventing other pilots making similar errors. That this is an effective process is borne out by the number of comments received in response to publishing these reports.
Reports range from failures to follow procedures as a result of reduced currency, distraction and rustiness due to lack of flying; being insufficiently ready to fly; task overload; complacency; or poor airmanship often because of reduced spare capacity as pilots struggle with the task of flying itself to the expense of wider situational awareness. Problems in busier airspace such as the visual circuit or in encountering controlled airspace also tend to predominate, and there has also been a noticeable trend in pilots not taking full advantage of and/or understanding how their electronic planning systems function.
CHIRPâs Role
Broadly speaking, CHIRP provides a vital safety net as another route to promote change when all else fails, and for collecting reports that would otherwise have gone unwritten with associated safety concerns therefore not being reported. An element of our work involves whistleblowing with discretion and without direct regulator involvement for those who do not want the regulator to know their details. We often act as an âAgony Auntâ for those who seek our âwiseâ counsel and we often provide information and point people to the right sources/contact points for them to resolve their own issues. Depending on the issue and our resource availability, we also champion causes and act as an advocate or the âconscienceâ of industry and the regulator where we can.
Our Purpose â To contribute to the enhancement of flight safety by providing an independent confidential reporting system for all individuals involved in or associated with sport and recreational flying.
GA pilots often do not have the support of a safety system to guide their reporting and post-event actions and CHIRP also provides a means for them to seek assistance when they are unsure of what to report and to whom.
Reporters can submit reports to CHIRP using the âGeneral Aviationâ process which can be accessed from the âSubmit a reportâ function on the CHIRP website homepage or the CHIRP App. Reports are then processed and disidentified by the CHIRP Director Aviation and, if appropriate, will then be reviewed by the CHIRP General Aviation Adivisory Board (GAAB) to seek their counsel. If agreed by the reporter, CHIRP will also forward disidentified information to relevant organisations best able to investigate/address the reported issue. Once resolved, disidentified reports may then be included in the dedicated GA FEEDBACK newsletter if suitable.
Flying Display & Special Events
Investigations into many fatal air display accidents often reveal no technical cause, leading to the conclusion that the source could have been down to human factors. It is often the case that information is unearthed from pre-cursor incidents where causal factors were similar to those of the accident and which might have led to a similar outcome had it not been for the fact that one or more links in the ‘causal chain’ had been broken. Those pilots who have experienced a ‘close-call’ air display incident often take particular care to ensure that they subsequently allow a sufficient margin for error. In the particularly demanding environment of display flying, when the margin for error may be significantly reduced from that available in normal flight operations, it is extremely important to share experience as widely as possible. We are specifically inviting reports from Air Display participants with the objective of sharing this information, after disidentification, with other display pilots.
CHIRPâs Role
The CHIRP Programme exists to gather information on errors and âSafety lessons learnedâ and promulgate this as widely as possible for the benefit of other individuals. We are specifically inviting reports from Air Display participants with the objective of sharing this information, after disidentification, with other display pilots.
If you have had an air display flying experience, from which others might learn â write it down and send it in.
Our Purpose â To contribute to the enhancement of flight safety by providing an independent confidential reporting system for all individuals associated with display flying in the UK.Reporters (pilots, FCCs or FDDs) can submit reports to CHIRP using the âFlying Display & Special Eventsâ process which can be accessed from the âSubmit a reportâ function on the CHIRP website homepage or the CHIRP App. Reports are then processed and disidentified by the CHIRP Director Aviation and, if appropriate, will then be reviewed by the CHIRP General Aviation Adivisory Board (GAAB) to seek their counsel. If agreed by the reporter, CHIRP will also forward disidentified information to relevant organisations best able to investigate/address the reported issue. Once resolved, disidentified reports may then be included in the dedicated GA FEEDBACK newsletter if suitable
Ground Handling & Security
Ground Handling Operations are an essential activity in the aviation operational environment during aircraft arrivals departures and movements, and as such contributes to aircraft safety and airworthiness.
Some 8% of all safety occurrences reported to the CAA in the past five years have involved ground handling. The occurrences have been categorised and the most numerous reports fall in to six event types, two of which account for the greatest proportion of reports:
- Ground Damage which comprises mainly collisions between vehicles and ground servicing equipment and miscellaneous damage of unknown cause discovered on arrival in the UK; and
- Loading error comprising mainly unsecured loads in the aircraft hold and incorrect load distribution as a result of an incorrect load plan or the aircraft not being loaded in accordance with a correct load plan.
The remaining four event types, De-icing, Fuelling, Marshalling and Catering comprise of a lower number of reports. A significant proportion of these events would in fact be more correctly identified as ground damage.
There have been four common themes running throughout the six event categories – People and Training, Processes and Procedures, Business Pressure and Infrastructure and Equipment.
CHIRP’s Role
Including Ground Handling & Security operations through CHIRP across the UK will complement the CAA Mandatory Occurrence Reporting system and other formal reporting systems operated by many UK organisations, by providing a means by which individuals are able to raise safety-related issues of concern without being identified to their peer group, management or the Regulatory Authority. As always, we will ensure confidentiality is maintained by disidentifying the sources of the incoming reports, the individual reporterâs details, the company they work for and the operator and airport involved.
Our Purpose â To contribute to the enhancement of flight safety by providing an independent confidential reporting system for all individuals employed in or associated with UK Commercial and General Aviation Ground Handling & Security operations.
Reporters can submit reports to CHIRP using the âGround Handling & Securityâ process which can be accessed from the âSubmit a reportâ function on the CHIRP website homepage or the CHIRP App. Reports are then processed and disidentified by the CHIRP Ground Handling & Security Programme Manager and, if appropriate, will then be reviewed by either the CHIRP Air Transport Advisory Board (ATAB) or General Aviation Adivisory Board (GAAB) (depending on applicability) to seek their counsel. If agreed by the reporter, CHIRP will also forward disidentified information to relevant organisations best able to investigate/address the reported issue. Once resolved, disidentified reports may then be included in the dedicated Ground Handling & Security, Air Transport or GA FEEDBACK newsletters if suitable.
Drone/Unmanned Air Systems
Drone/UAS operators, who will have registered under the Civil Aviation Authorityâs DMARES system, are one of a number of airspace users and should be treated as just another sector of aviation. As such, safety/hazard reporting processes should mirror those used in manned aviation as closely as possible, and the CHIRP Drone/UAS safety reporting processes follow those used in our other aviation programmes.
Remote pilots and organisations are primarily expected to report safety issues to the relevant authorities as defined in CAP722 which outlines the associated mandatory and voluntary reporting processes for safety occurrences. However, sometimes individuals might want to use an independent, confidential reporting channel if they fear retribution if they report to their employer or, if in the Open category, they are unwilling to voluntarily report directly to the CAA.
Individuals may also choose to use the CHIRP reporting programme to seek reassurance or guidance about their actions following an occurrence, and/or for altruistic reasons of wishing to share an experience so that others can learn from it.
CHIRP’s Role
CHIRPâs role for drone operations is the same as performed for aircraft operators where the pilot is on board: to provide a safety net for reporters unwilling to use formal reporting systems.
Some remote pilots may not have a background in, or detailed knowledge of aviation, airmanship or reporting processes and so CHIRPâs role is also to guide and educate reporters to become âair-mindedâ. Reporters are encouraged to think of themselves as part of the national aviation community in which the processes, permissions and responsibilities are coherent throughout.
Our Purpose â To contribute to the enhancement of flight safety by providing an independent confidential reporting system for all individuals associated with unmanned air system operations in the UK.
Reporters can submit reports to CHIRP using the Drone/UAS reporting form which can be accessed from the âSubmit a reportâ function on the CHIRP website homepage or the CHIRP App. Reports are then assessed by the CHIRP Drone/UAS Advisory Board and included in the dedicated Drone/UAS FEEDBACK newsletter if suitable. CHIRP will, if appropriate and agreed by the reporter, also forward disidentified information to relevant organisations best able to investigate/address the reported issue.
NB:- CHIRP only provides a confidential reporting system for aviation safety occurrences, it does not act as a general conduit for members of the public wishing to report drones as a nuisance, concern, invasion of privacy etc. These concerns should be reported to the local police on 101.