ICAO European Regional Runway Safety Seminar Amsterdam, The Netherlands 8 March 2012 ir. Job Brüggen, LVNL safety manager The global voice of ATM

Quiz: where are you? CANSO Safety Standing Committee (SSC) SSC Runway Safety Focus in 2012 CANSO Products

CANSO Safety Standing Committee (SSC) Very important part of CANSO The CANSO SSC: Leads data collection, trending, and analysis efforts Organises, facilitates and contributes to international and regional safety events Develops and publishes a variety of products and documentation to support global harmonisation of safety metrics and reporting mechanisms Encourages and provides tools to measure and improve the overall safety performance and culture of its members

CANSO Products Risk assessment tools, including the industry adaptation of the Bow Tie Model Second edition of the ‘Unstable Approach – ATC Considerations’ booklet SMS Evolution Guide Updated SMS Standard of Excellence to include fatigue management work CANSO Safety Performance Benchmarking Report, which will serve as the first Annual CANSO Safety Report

Bow Tie Model BEFORE AFTER PREVENTION RECOVERY Threat Consequence Hazardous Event Top Event Threat Top Event Consequence Potential Causes Potential Outcomes Threat Consequence The Bow Tie Model creates diagrams that show the relationship between hazardous events, their causes and consequences and the way that the event is controlled. The model has been in use since the late 1970s in the petro-chemical, mining and rail industries. It is a visual risk communication tool that helps develop a top-level model of risk situation. It supplements existing risk techniques, stimulates discussion amongst key stakeholders and provides clarity for complex risk situations. Proactive Controls Reactive Controls 5

Runway Excursion on Landing Bow Tie Model

Runway Surface Conditions A Closer Look Runway Surface Conditions THREAT ATC timely and accurate notification of runway conditions, including ATIS update ATC selects active runway appropriate to runway conditions ATC notify Flight Crew of runway condition

Unstable Approach Threat Line ATC and Flight Crew apply ICAO-compliant phraseology and communication practices Flight Crew monitors ATIS info Flight Crew follows published approach procedures Flight Crew applies stabilised approach procedures (SOPs) Flight Crew rejects clearance Flight Crew initiates go- around Flight Crew assessment and cross-check of info to ensure good decision-making (CRM) ATC provides accurate and timely weather info, including ATIS updates ATC provides accurate and timely track distance info from touchdown ATC applies speed control instructions consistent with aircraft performance capability ATC Considerations: It is crucial to understand the complexity of operations, as well as how ATC actions may increase that complexity and the risk of an unstable approach. The performance of ATC actions should be scrutinised using checks and in simulation. Data collection/analysis are necessary to understand causal factors and identify systemic risks in order to target initiatives to mitigate the risk of unstable approaches. Normal Operations Safety Survey: NOSS is designed to complement existing safety data collection sources by providing data not driven by occurrence, as most of the existing mechanisms. NOSS is a proactive safety management tool in that organisations can act on the outcome of a NOSS before safety issues manifest themselves through occurrences. Those ANSPs that have a NOSS programme should ensure that ATC actions during approach and landing are explicitly covered, and then analyse the results. ATC provides appropriate vectoring for final approach profile

2012 SSC Runway Safety Focus Support the development of common runway safety definitions and metrics (i.e., incursion, excursion). Expand and mature the Bow Tie Model. Expand and mature the runway incursion metric to collect data to support risk-based causal factor analysis.

Thank you for your attention CANSO Safety Standing Committee CANSO means Global Partnership cross-industry collaboration, data-sharing and performance measurement Runway Safety Focus www.canso.org/safety