1. Development of voluntary reporting system of aviation safety information in Japan Satoshi ISHIDA Aviation Safety and Security Promotion Division, JCAB JAPAN Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia 13-17 June 2011

2. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 ３． Establishment of voluntary information system （③） under Non-punitive circumstances ３． Establishment of voluntary information system （③） under Non-punitive circumstances １． Definition and framework of State Safety Programme (SSP) （①） ２． Equalized statement of Safety Management System (SMS) framework （②） １． Definition and framework of State Safety Programme (SSP) （①） ２． Equalized statement of Safety Management System (SMS) framework （②） Annex 1 Annex 6- Ⅰ Annex 6- Ⅲ Annex 8Annex 11Annex 13Annex 14 Personnel Licensing Operation of Aircraft -Commercial Aeroplanes Operation of Aircraft -Helicopters Airworthiness of Aircraft Air Traffic Services Aircraft Accident And Incident Investigation Aerodromes SSP Definitions SMS Framework ① SSP Definitions SMS Framework SSP Definitions SMS Framework ①① SSP Definitions SMS Framework ① SSP Definitions ① SSP Definitions SSP Definitions SMS Framework ① SSP Framework Attachment C SSP Framework Attachment J Attachment AAttachment DAttachment F SSP Framework SSP Framework SSP Framework SSP Framework Attachment C SSP Framework Appendix 4 Appendix 7 Appendix 4 Appendix 6 Appendix 7 ②②②②② Voluntary reporting system ① ③ ①①①①①①① 2 Amendment of Annexes to the Chicago Convention (effective date: 11/2010)

3. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Transition to new management system of aviation safety in Japan 3 FY2010FY2011FY2012FY2013 ICAO USOAP SSP implementation Development of Voluntary Reporting System Framework for implementation Performance-based SMS ALOS SPI Research and Examination Coordination with affiliates Improvement of legal system CSATransition to CMACMA

4. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Japan’s current reporting system : ASI-NET (Aviation Safety Information Network) Operated by a foundation since 1999 Reporting system aimed only at flight crew Collected data: de-identified, not disclosed Government ensures protection of safety information by its inaccessibility to the reporting system No immunity from administrative sanction or criminal prosecution 4

5. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Reporting system of aviation safety information 5 Mandatory reporting system by pilot in command CAA #76, 76-2 Injury Accident Major Incident which may cause accident Minor incident which may affect safe operation Mandatory reporting system by operator CAA #111-4 Pilots Other Unsafe Operation / Condition No access by JCAB to the information reported through this system CAA : Civil Aeronautics Act of Japan ASI-NET （ operated by the third party ） Airlines / Cargos Voluntary reporting system by operator

6. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Key points at issue for the development of voluntary reporting system 6 Annex13, Chapter8, item8.3 “A voluntary incident reporting system shall be non-punitive and afford protection to the sources of the information.” 1. ICAO standard requires “Non-Punitive” 1 voluntary incident reporting system ASI-NET is intended only for air operators: A voluntary reporting system for all parties involved in aviation including ATC, CNS and airport operation is necessary Exploratory committee meetings were held this year to discuss toward effective implementation This presentation shows points at issue and opinions delivered at the exploratory committee

7. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Case study US: Aviation Safety reporting System (ASRS) since 1976 –Operated by NASA UK: Confidential Human Factors Incident Reporting Program (CHIRP) since 1982 –Operated by the CHIRP Charitable Trust EU: Directive 2003/42/EU  Based on the concept of “Just Culture”  Willful misconduct and gross negligence are not covered  Collected data: de-identified  Disclosed in public (ASRS) / Not disclosed except summary report (CHIRP)  Immunity: –Judicial proceedings not instituted for collected data –Mitigation of administrative sanction 7

8. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Scope of the voluntary reporting system Information to be collected –Handling of speculation/hearsay –Reporting format that promotes reporters to suggest improvements Reporters considered –Passengers, employees involved in non-aviation field –Reporting through SMS operated by industry is preferred rather than individual reporting in order to avoid bypassing organizational reporting systems and duplicated reports 8

9. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Operator of the voluntary reporting system Non-punitiveness and confidentiality of safety information are eventually achieved in ASI-NET, but not ensured by enforcement policy In the case that non-governmental institutions collect data reported by the government- operated fields (ATC, CNS, operation of some airports), information security must be considered 9

10. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 How to ensure Non-punitive circumstances Common understanding is needed for all parties involved in the aviation field Incentive is necessary to promote voluntary reporting Reviewed in light of personnel affairs, administrative guidance/sanction and criminal prosecution 10

11. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Personnel View Objective: aviation sector operated by the government in addition to private enterprises –ATC, CNS, operation of some airports Incident reported through voluntary reporting system should not be noted in the personnel record Impact on career may be considered 11

12. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Administrative View Administrative guidance should be considered non-punitive as a measure for ensuring safety –e.g. Letter of notice/warning Possible ways for reduction/exemption from administrative sanction: –Stipulation of waiver on enforcement policy –Segregation of collected data from the government 12

13. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Penal View Voluntary reporting system should not apply to accidents and major incidents with injury which are subject to the penal code As the cultural background, victims’ sentiment is valued rather than the importance of investigation of the cause of accident Further discussion is necessary based on particular cases collected through the voluntary reporting system for considering protection of reporters from criminal prosecution 13

14. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Securing confidentiality of the source of information Information of the reporter must be confidential and protected from regulatory/judicial authorities in a proper manner As with most voluntary reporting systems, reporter’s personal data is de-identified by using “confidential report” Personal information contained in the report should soon be deleted from the database 14

15. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Future discussion of enforcement policy Role models were reviewed in the exploratory committee Further study is necessary for establishment of clear criteria for execution of administrative sanctions Development of effective and feasible enforcement policy along with administrative operation is needed 15

16. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 Conclusion A voluntary reporting system is now in the process of development in Japan Research and discussion of diverse aspects was conducted in the exploratory committee Discussion on the Non-punitive circumstances is focused on personnel affairs and administrative guidance/sanctions Further discussion is necessary for introducing an effective and feasible enforcement policy 16

17. TPT-WG34, Brisbane, Australia Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia, 13-17 June 2011 FIY: Safety Information Protection Task Force (SIP TF) The establishment of SIP TF is recommended in HLSC2010 and authorized in A37 Scope: Making findings and recommendation for development/amendment of relevant ICAO SARPs and guidance materials A kick-off meeting was held on May 4-5, and working groups were established for further research and discussion 17

18. Thirty Fourth APEC Transportation Working Group Meeting, Brisbane, Australia 13-17 June 2011 Thank you