United pilots contract, Section 19 — Flight Safety Programs
19-A Introduction
19-A-1 Safety is the number one priority at the Company. All Pilots employed by the Company view the safe operation of our aircraft as their primary function. Both the Company and the Association view safety as the overriding principle in the conduct of our operations.
19-A-2 To effectively manage threats to safety, the parties have adopted a Safety Management System (“SMS”). This system seeks to mitigate risk through threat risk assessments and analysis of collected data, followed by corrective actions, and subsequent reassessments. The basic premise of SMS is acceptance of safety principles and collaboration with parties at all levels of the Company.
19-A-3 The Vice President of Safety (“VP of Safety”) and the United Airlines ALPA Master Executive Council Central Air Safety Committee Chairman (“CASC Chairman”) shall collaborate regarding the application and administration of the programs described in this Section 19. It is the responsibility of the VP of Safety to ensure the effective application and administration of the programs referred to in this Section 19. To effectively administer these programs a level of trust and clear, open, and honest communication is required. Members of the Safety Action Council (“SAC”) shall make themselves available to hear and discuss concerns of either the Association or the Company.
19-A-4 The Company shall indemnify the CASC Chairman and any other Pilot member of the programs in this Section 19, or his estate, and provide defense against any claims, whether by third parties or by fellow employees, arising out of such Pilot's good faith performance of his duties with the Company as a member of the programs in this Section 19 unless such claims arise from the willful misconduct of the Pilot.
19-B Safety Program Integration
19-B-1 Partnership Safety Programs covered by this Section 19 are:
Fatigue Risk Management System (“FRMS”)
Flight Operations Quality Assurance (“FOQA”)
Flight Safety Action Program (“FSAP”)
Flight Safety Investigations (“FSI”)
Line Oriented Safety Audit (“LOSA”)
These programs produce data and information that may be sensitive in nature to both the Company and the Association. This Section 19 sets forth the agreement between the Company and the Association regarding how the above mentioned programs, as well as Flight Data Recorders, Voice Recorders, and the ALPA Accident and Incident Go-Teams, may be integrated to allow a more comprehensive assessment of the entire operation.
19-B-2 Safety Action Council
The SAC, consisting of the VP of Safety and the CASC Chairman, administers the programs defined in this Section 19. The SAC may consult appropriate Subject Matter Experts (“SMEs”).
19-B-3 Delegation to Designated Alternates
If the responsibilities of any member of the programs in this Section 19 are delegated, the designated alternate shall be vested with the authority and responsibility to make the required decision(s) in support of the program and shall carry the full weight of the position they are fulfilling.
19-C Administration of Data/Information
19-C-1 Data collected for the programs described in this Section 19 shall be used to enhance the safety, comfort, reliability, and efficiency of flight operations.
19-C-2 Data collected for the programs described in this Section 19 shall not be used by any party for the purpose of discipline or action against any individual or entity, including the CASC Chairman and Association volunteers in any program in this Section 19. Any restrictions regarding the use of this data shall be defined within this Section 19. The VP of Safety shall be responsible for the release of any data as required by law, regulation, court order, or legally binding directives of responsible government agencies. When data for the programs described in this Section 19 is released to an external source as required by law, the VP of Safety shall advise the senior-most flight-qualified Vice-President in charge of Flight Operations and the CASC Chairman.
19-C-3 The administration of data and response to information requests in the above mentioned programs shall be handled by the person or committee designated in each of the programs. Consensus must be reached between the Company and the designated person or committee to grant any information requests. If consensus is not reached the request shall be immediately referred to the SAC. The SAC shall either reach consensus or the request shall be denied.
19-C-4 Special Studies
A special study is a study that either includes data from more than one Partnership Safety Program or is outside the normal processing of data/information. The SAC shall agree on the appropriateness of the request, the defined objectives, the scope of the distribution, and the data/information to be included and shall notify the appropriate person or committee (e.g., Gatekeeper for the FOQA program, the UAL MEC FSAP Chairman for the FSAP program) regarding the study. Further, the SAC shall agree how the data is to be collected, and which departments to collaborate with in the data gathering phase. At the completion of the study, the SAC shall confirm that the output of the study is consistent with the objective(s).
19-D Remediation
19-D-1 Unless otherwise provided below, disputes over a potential violation of the programs in this Section 19 shall be referred to the SAC for resolution and shall not be delegated. The program in question shall be held in abeyance until the SAC resolves the dispute, including any findings regarding a cause and implementation of a remedy.
19-D-2 If a program is held in abeyance, data may still be collected, but analysis and output to end-users shall stop. If a time-critical safety issue is identified during the period of abeyance, the appropriate data to continue safe operations shall be provided to the necessary persons and/or entities.
19-E ALPA Accident/Incident Go-Team
19-E-1 The Company shall place the CASC Chairman, the UALMEC Chief Accident Investigator, and the UALMEC Chairman or his designee on its roster for notification of safety accidents or incidents, including Dispatch Notable Flight Log and FODM messages. Any non-safety related information provided to the UALMEC members shall be treated confidentially and may not be used or shared for any purpose. In addition, safety related information provided pursuant to the terms of this Section 19 to Association members shall be treated confidentially and may be used or shared only in conjunction with carrying out their safety responsibilities.
19-E-2 The Association shall designate up to fifteen (15) members of the UAL Central Air Safety and ALPA Accident Investigation Committee (“Committee”) as an Accident or Incident Response “Go-Team.” The Association shall provide the Manager Flight Safety Investigations with a list of the Go-Team members. In the event of a Company accident or incident, the CASC Chairman, or the UALMEC Chief Accident Investigator or their designee shall notify the Flight Safety Investigator In Charge which Go-Team members need to be released from their schedules and dispatched to an accident or incident site. The number of necessary members of the Go-Team who need in their good faith judgment to be released shall be determined at the discretion of the CASC Chairman and the UALMEC Chief Accident Investigator. The request shall normally be less than fifteen (15) and should not result in a flight cancellation or significant delay, except in a major accident or incident.
19-E-3 The Company shall provide the Go-Team members with positive space must-ride travel where service is provided by the Company or make any respective arrangements with partner airlines in order to go to and from an accident or major incident site.
19-E-4 The Company shall not request Go-Team members to return to line flying following an accident or incident investigation until they are released by the CASC Chairman or the UALMEC Chief Accident Investigator (but such release shall not be unreasonably withheld). Once released, the Pilot shall not be required to return to line flying until approved by a joint review of the Managing Director of Flight Operations and a Critical Incident Response Program representative.
19-E-5 The CASC Chairman and the UALMEC Chief Accident Investigator or their designee shall be released from duty to assist in investigations of other carrier accidents or incidents if requested by the Association. If additional Go-Team members are required in an investigation of another carrier, their release from duty shall be on a case-by-case basis and only after mutual agreement between the Company and the Association.
19-F Data Recorders and Flight Deck Voice Recorders
19-F-1 Definitions
19-F-1-a “Data Recorder” is any device, equipment or system which transmits for the purpose of recording or collecting data and/or records and/or collects data on an aircraft or flight simulator that monitors Pilot, aircraft component, or aircraft performance.
19-F-1-b “Cockpit Voice Recorder” (“CVR”) is any device, equipment or system which monitors or records a Pilot’s voice while he is on an aircraft or flight simulator.
19-F-1-c “Recorded Data” has the same meaning as Information as defined in Section 19-G- 1-e.
19-F-2 Cockpit Voice Recorders
19-F-2-a Data from a CVR shall only be removed from an aircraft following an accident or incident in accordance with law, regulation or court order, or legally binding directives of responsible government agencies.
19-F-2-b No later than twenty-four (24) hours after removal, the Company shall notify the flight crew involved and the CASC Chairman that data from the CVR was removed for analysis. Unless otherwise required by law, regulation or court order, or legally binding directives of responsible government agencies, the Pilot(s) and the CASC Chairman shall be given advance notice of a time and place for a review of the recording, and shall be given an opportunity to attend.
19-F-2-c Voice recordings which have been removed from the aircraft and transcriptions thereof shall not be retained in an identifiable form for more than seven (7) days unless (1) required by law, regulation or court order, or legally binding directives of responsible government agencies, (2) by mutual consent of the Company and the Association or 3) an active safety investigation is in progress.
19-F-2-d Only the senior-most flight-qualified Vice-President in charge of Flight Operations or the VP of Safety may authorize the removal and review of the CVR. If unavailable, their designated alternate may authorize the removal (but not review or analysis) of the CVR.
19-F-3 Data Recorders
19-F-3-a Except as otherwise provided herein, Information shall be used strictly (1) for engineering analysis, (2) in conjunction with an accident or incident investigation, or (3) as authorized by the FOQA program.
19-F-3-b Removal and analysis of an aircraft Data Recorder may only be authorized by the senior-most flight-qualified Vice-President in charge of Flight Operations or the Vice President of Corporate Safety, or for the purposes of engineering analysis only, at the direction of the senior-most flight-qualified Vice-President in charge of Maintenance or Vice President of Engineering. If unavailable, their designated alternate may authorize the removal (but not review or analysis) of the Data Recorder.
19-F-3-c If information from a Data Recorder has been retrieved from his flight for any reason other than routine engineering analysis or as part of the FOQA program, the Company shall notify the Pilot(s) involved and the CASC Chairman within forty-eight (48) hours.
19-F-3-d A Pilot, and/or his representative, if desired, shall be allowed to review data retrieved by the Company from his flight unless restricted by statute. The Company shall provide a Flight Safety staff member with appropriate expertise to explain the meaning of the Recorded Data.
19-F-3-e Recorded Data or Information shall not be used by the Company in any legal or administrative proceeding (including any Grievance or System Board of Adjustment proceeding) against a Pilot(s) involving discipline, discharge, FAR violation, civil liability or criminal penalty nor shall it be used by the Company to investigate or initiate discipline, or against the Association in any legal or administrative proceeding. The Company shall not monitor individual performance or compliance with policy, legally binding directives or
regulations with such data. Current routine uses of ACARS data may be continued. Such routine uses shall not include either use in any legal or administrative proceeding against a Pilot(s) involving discipline, discharge, FAR violation, civil liability or criminal penalty or use by the Company to investigate or initiate discipline.
19-F-4 General
19-F-4-a The Company shall notify the Association no later than ninety (90) days prior to any future installations on aircraft or flight simulators of Data Recorders or other recording devices or methods.
19-F-4-b Except as required by law, regulation, court order or legally binding directives of responsible government agencies, neither the Company nor the Association shall release any Recorded Data to a third party without the express written consent of the other party.
19-F-4-c Information obtained from a Data Recorder or CVR shall not be used for individual line checks.
19-G Flight Operational Quality Assurance (“FOQA”)
19-G-1 Definitions
19-G-1-a “FOQA program” is a Flight Operational Quality Assurance (“FOQA”) program to improve flight safety by providing more Information about, and greater insight into, the total flight operations environment through selective automated recording and analysis of data generated during flight operations.
19-G-1-b “Identifying Data” is any data or combination of data that allows collected data to be associated with a specific crewmember.
19-G-1-c “FOQA Data” is Information collected from an aircraft or flight simulator used for analysis in the FOQA program. Data associated with AQP is not FOQA Data.
19-G-1-d “Identified Data” is any collected data prior to removal of all Identifying Data.
19-G-1-e “Information” is any data transmitted for the purpose of recording or collecting data, or data recorded or collected by use of a Data Recorder, CVR or any other recording device on an aircraft or flight simulator that monitors Pilot, aircraft component, or aircraft performance. Information shall also include tapes, transcripts, reports, papers, memos, statements, studies, charts, graphs or any other description, analysis or compilation of data/information collected by any such equipment or Gatekeeper interview. Information shall be handled in accordance with the data de-identification and sharing process established in the FOQA program, except for already de-identified Information otherwise collected in the normal course of business and routine uses of Information as agreed to herein or by the SAC.
19-G-1-f “FOQA Monitoring Team” (“FMT”) is comprised of an equal number of Association and Company representatives, and includes: The Sr. Manager – FOQA and Technical Data, Sr. FOQA Analyst(s), Association Gatekeeper(s), FOQA/FSAP Committee Chairman. The FMT is responsible for the development of formal procedures required to implement and maintain the FOQA program. The FMT also conducts reviews of aggregate trend data to identify safety recommendations to stakeholders.
19-G-1-g “Operational Exceedance Event” is an event in which an aircraft is operated, as determined by FOQA Data, outside of mutually agreed upon tolerances developed by the FMT.
19-G-1-h “Operational Routine Event” is an event in routine operation of statistical interest, such as time into operation when flaps are retracted.
19-G-1-i “Gatekeeper” is the FMT representative who is primarily responsible for the security of Identified Data. The Gatekeeper can link FOQA Data to an individual flight or crewmember. The Gatekeepers shall be Pilots appointed by the CASC Chairman, who are empowered to identify and interview crewmembers.
19-G-2 FOQA Program
19-G-2-a The design, implementation, and operation of a FOQA program shall be by mutual agreement between the Company and the Association. Any variation from the agreed upon FOQA program shall require the mutual agreement of the parties prior to implementation.
19-G-2-b The FMT shall oversee the day-to-day operations of the FOQA program and establish necessary policies and procedures to ensure compliance with the provisions of this Section 19.
19-G-2-c The design of the FOQA program shall ensure the confidentiality and ultimate anonymity of individual crewmembers.
19-G-2-d Any violation of the requirements of the FOQA program shall cause the FOQA program to be held in abeyance (data gathered but not processed) until the infraction is resolved by the SAC.
19-G-2-e The Company shall bear the full cost of the FOQA program to include Pilot expenses (e.g., hotel, per diem, conference fees, transportation) incurred when performing FOQA- associated duties.
19-G-2-f The Company shall provide for a minimum of one (1) Gatekeeper for each business day in the FOQA Lab pursuant to the Company required meeting provisions of LOA 12-14. Any future staffing needs shall be addressed by the SAC.
19-G-2-g Sufficient de-identified data shall be maintained to fulfill the requirements of the agreed-upon FOQA program. All de-identified data, and analyses of such data, shall be made available to the Company and the Association.
19-G-2-h The FMT shall establish exceedance values. The exceedance values shall be continually evaluated and any changes/additions/deletions shall require approval of the FMT.
19-G-3 Data Retention/Security
19-G-3-a FOQA program Information (identified or de-identified) shall not be released to any third party without SAC approval. The Federal Aviation Administration (“FAA”) may view de- identified data on Company property.
19-G-3-b Identifying Data shall be removed from Identified Data as soon as possible, but no later than thirty (30) days from the date of acquisition of the data by the Company.
19-G-3-c Any employee/agent who has contact with any Identified Data used in a FOQA program shall be prohibited from divulging any Identifying Data to any individual other than a Gatekeeper except as required by law, regulation, court order or legally binding directives of responsible government agencies. Any violation of the aforementioned process could result in the employee/agent being removed from the FOQA program.
19-G-3-d The SAC shall determine the access level for the FMT members and Gatekeepers, and shall also determine the parameters for validation. The parameter validation process may be delegated to the FMT.
19-G-3-e The release of Information, except as authorized in this Section 19, without expressed written consent of both parties is strictly prohibited. If either party discovers an unauthorized release they shall immediately notify the other party. The unauthorized release shall be immediately investigated and corrective action taken to protect all crewmembers, the Company, and to prevent additional release of data and/or information. It is expressly understood that the investigation of the unauthorized release of data as set forth in this Section 19 shall be conducted prior to either party's exercise of their rights under Section 19- G-2-d.
19-G-4 Data Use
19-G-4-a Only the specific designated Gatekeeper shall be authorized to identify/contact the individual crewmembers associated with any specific data.
19-G-4-b Any notes, memoranda, or other documents used by the designated Gatekeeper in any contact with any crew member concerning a specific FOQA event shall be considered Identified Data for purposes of this Section 19 and the FOQA program and shall be de- identified in accordance with Section 19-G-3-b. De-identified notes, memoranda, or other documents may be stored in a database for the purpose of tracking trends and root cause.
19-G-4-c At a minimum, the FOQA program may be used for evaluation of the following areas: Safety Aircraft performance Aircraft system performance Crew performance Company procedures Training programs Training effectiveness Aircraft design ATC system Airport issues Meteorological issues Any other area mutually agreed to by the SAC
19-G-4-d Data Use for Training
19-G-4-d-(1) The SAC may approve procedures and use of collected FOQA Data for the purpose of enhancing Pilot training.
19-G-4-d-(2) De-identified aggregate FOQA Data may also be used for training purposes if approved by the SAC.
19-H Flight Safety Action Program (“FSAP”)
19-H-1 FSAP shall be administered in accordance with the FSAP Memorandum of Understanding (“FSAP MOU”) between the Association, the Company, and the FAA.
19-H-2 Any Pilot who has submitted an FSAP report that is accepted into the FSAP that results in his being removed from his schedule by the Company shall not have his PTC, or MPG reduced by such removal provided the Pilot continues to participate in the FSAP.
19-H-3 If the Company fails to file a NASA ASRS report for an incident reported by a Pilot to the FSAP, and a resulting FAA enforcement action over that incident results in the Pilot suffering a loss of flight pay, the Company shall make the Pilot whole.
19-I Flight Safety Investigation (“FSI”)
19-I-1 General
19-I-1-a FSI is the method for reviewing any incident involving a Pilot that resulted in or had the potential to result in personal injury or property damage. As part of this review, a formal Pilot debriefing may be initiated at the discretion of the assigned Investigator-In-Charge (“IIC”), and if so, shall be initiated as soon as possible following the incident.
19-I-1-b The debriefing should determine the factors which contributed to the incident.
19-I-2 Coordination with FSAP
19-I-2-a Information obtained from the FSI process may be used to support FSAP’s Event Review Committee (“ERC”) investigation. Specific FSI roles and responsibilities are:
19-I-2-a-(1) To obtain all information required by the Company, the FAA and the National Transportation Safety Board (“NTSB”).
19-I-2-a-(2) To establish a standardized debriefing procedure for all crew debriefings to include specific roles and responsibilities.
19-I-2-a-(3) To ensure a consistency in the quality of the debriefings fostered by a checklist identifying a broad array of questions.
19-I-2-a-(4) To set consistent expectations as to the investigation objectives, conduct, documentation and actions taken to reduce or eliminate the risk of reoccurrence.
19-I-2-b ERC as used in Section 19-I includes only Company and Association participants.
19-I-3 Responsibilities
19-I-3-a Aviation Safety is the only Company representative to NTSB and foreign accident/incident authorities under ICAO Annex 13.
19-I-3-b Aviation Safety is responsible for:
19-I-3-b-(1) Determining if a Flight Safety debriefing is warranted. That determination shall not prevent the initiation of a Flight Safety Investigation nor shall it preclude the Chief Pilots’ Office (“CPO”) or Fleet management from performing a follow-up inquiry after learning that a Flight Safety debriefing is not scheduled.
19-I-3-b-(2) Assigning an IIC to coordinate the Pilot debriefing, provide direction to participants, and control the conduct of the debriefing. The IIC shall coordinate an Incident Review Conference (“IRC”) as described in Section 19-I-5 following completion of the Pilot debriefing.
19-I-3-b-(3) Providing required information to the NTSB.
19-I-3-b-(4) Preparing a written investigation summary and NTSB report if required and determining appropriate distribution.
19-I-3-b-(5) Augmenting Flight Safety staff with Quality Assurance investigators as required.
19-I-3-c Flight Standards’ responsibility is to:
19-I-3-c-(1) Provide technical and procedural expertise to the IIC.
19-I-3-c-(2) Provide the primary debriefing team member who is the Flight Standards, Fleet Technical Manager for the particular fleet type.
19-I-3-c-(3) Consult with the Chief Pilot if follow-up training is recommended.
19-I-3-c-(4) Interface with FAA/POI on developing appropriate procedural changes to address pertinent issues related to the incident as required.
19-I-3-c-(5) Provide feedback to the IIC on any planned changes to the Flight Manual and/or Flight Operations Manual.
19-I-3-d Flight Training’s responsibility is to:
19-I-3-d-(1) Provide a debriefing team member for the particular fleet type (if the Flight Standards FTM is not available) who may be either the Program Manager of Flight Operations Fleet Training or a Training Center Standards Captain.
19-I-3-d-(2) Provide appropriate training guidance to the IIC.
19-I-3-d-(3) Consult with the Chief Pilot if follow-up training is recommended.
19-I-3-d-(4) Interface with FAA/POI on developing an appropriate training syllabus to address pertinent issues related to the incident as required.
19-I-3-d-(5) Provide feedback to the IIC on any planned changes to the training program.
19-I-3-e The CPO’s responsibility is to:
19-I-3-e-(1) Determine if the crew should be placed on “NF” (no-fly status - paid) or remain in active flight status. A determination to place the crew in “NF” status is in no way a punitive or disciplinary action. “NF” status is determined by using the “Removal of Pilot
From Schedule Criteria” and the “Human Factors Post Incident Evaluation” listed in the Flight Operations Business Manual.
19-I-3-e-(2) Consult with Flight Training, Flight Standards and the ERC, to determine if training is warranted following an incident involving flight safety.
19-I-3-f The CASC Chairman is responsible for:
19-I-3-f-(1) Providing an ERC debriefing team member, preferably one qualified in the same aircraft type (if unavailable a fleet coordinator or a fleet coordinator-qualified officer of the committee).
19-I-3-f-(2) Assisting the IIC in coordinating the Pilot debriefing and communicating the process to the crew.
19-I-3-f-(3) Guiding and representing the Pilots through the FSI process. In the event of an NTSB or FAA investigation, the CASC Chairman shall coordinate with Association Legal as required to ensure the Pilot’s right to legal representation is ensured.
19-I-3-f-(4) Monitoring the FSI process, identifying safety hazards and providing other inputs into the Company's safety risk management and safety assurance processes.
19-I-4 Debriefing Procedure
19-I-4-a The IIC is responsible for debriefing coordination, notification and control.
19-I-4-b The debriefing shall be accomplished only after the involved Pilots’ FSAP reports have been accepted by the ERC. This may require the IIC to request the convening of a special ERC to address only the FSAP reports related to the investigation to support the timing of the debriefing.
19-I-4-c For Pilots who were not removed from schedule, the debriefing shall occur during periods when the Pilots are not on an active Trip, unless agreed to by the Pilots. Debriefs should be mutually convenient for all participants.
19-I-4-d Flight Safety debriefings shall usually be completed by a three (3) member (nonsupervisory) debriefing team comprised of the IIC (who shall lead the debriefing), a Fleet Management representative, and the CASC Fleet Coordinator or the CASC Chairman’s designee.
19-I-4-e The ERC shall be afforded the opportunity to participate in the debriefing. The ERC may submit questions prior to the debriefing in lieu of attendance. If the ERC does attend, the participants shall be adjusted accordingly. Example: If the ERC Association representative attends, the CASC Fleet Coordinator shall not attend. (Should circumstances warrant, an Association attorney, and/or the CASC Chairman may opt to participate in the debriefing.)
19-I-4-f Subject matter experts may be included at the IIC's discretion. Experts may include, but are not limited to, Fleet specific engineering expert, Senior Staff Investigator - Cabin Safety, Ground Safety Representative, and Company Air Traffic Control Representative.
19-I-4-g The IIC shall notify the Association CASC Chairman and debriefing team members of the debriefing time and provide a toll free conference call number for the debriefing. The IIC
debrief shall not occur without an appropriate Association representative. In the event an appropriate Association representative cannot be contacted and/or when a significant event has occurred, the IIC shall notify the CASC Chairman or designee of the planned debriefing, in sufficient time to allow a CASC representative to be present at the debriefing.
19-I-4-h The debriefing shall be conducted in a non-confrontational seminar atmosphere. All debriefing team members have full opportunity to participate. Pilots shall be encouraged to participate in identifying methods to prevent reoccurrence. All Pilot accounts and notes of such accounts shall be considered an extended part of the FSAP report itself and afforded all the limits and protections of the original report.
19-I-4-i Every attempt shall be made to debrief the Pilots only once. Flight Safety reserves the right to conduct a second debriefing in exceptional circumstances when additional information surfaces regarding a specific incident. In these cases, every attempt shall be made to debrief with the original debriefing team. In appropriate cases, as an alternate means to learn additional information, the IIC may submit questions to the Pilots through the CASC representative in lieu of coordinating a second formal debriefing.
19-I-5 Incident Review Conference (“IRC”)
19-I-5-a Following the crew debriefing, the IIC shall initiate a call for the IRC to provide factual information related to the investigation. Unless previously agreed to by mutual consent, the following individuals shall be present on the IRC call:
Managing Director Aviation Safety or designated alternate
Chief Pilot or designated alternate
Managing Director of Flight Standards or designated alternate
Applicable Senior Manager Training or designated alternate
FAA Aircrew Program Manager (APM)
The FSAP ERC
Association Training Committee Chairman or designated alternate
CASC Chairman or designated alternate
19-I-5-b During the IRC call, the IIC shall provide a review of the crew debriefing. In addition, the IIC shall provide any additional factual details that may have surfaced and have been verified since the time the debriefing was completed. The IIC shall answer any questions regarding factual information to help ensure that participants have a complete understanding of the incident.
NOTE: The presentation of the current facts surrounding the incident by the IIC only indicates the beginning of the FSI process and in no way should be construed as the completion of the investigation.
19-I-6 Incident Follow-up Actions
19-I-6-a The Chief Pilot shall determine whether follow-up training is required for the Pilot(s). Following the completion of the IRC, the following actions shall occur in sequence to ensure timely resolution:
19-I-6-a-(1) The Chief Pilot shall consult with the Managing Director of Flight Standards, the Managing Director of Training, the APM, and the Association MEC Training Committee Chairman to decide if training deficiencies were identified in the FSI.
19-I-6-a-(2) In the event that the Chief Pilot determines that action is required, the Chief Pilot shall forward that recommendation to the FSAP ERC.
19-I-6-a-(3) The ERC is responsible to ensure that any such recommendations adhere to principles outlined in the FSAP MOU.
19-I-6-a-(4) The ERC shall either approve or modify the recommendation of the Chief Pilot. The ERC shall give every consideration to the Chief Pilot’s recommendations.
19-I-6-a-(5) The Chief Pilot shall await the ERC's approval before acting on any proposed training.
19-I-6-a-(6) The Association ERC Representative shall notify the crew of the corrective actions from the IRC call before the Chief Pilot contacts the crew.
19-I-6-b Corrective action sessions are training, not testing or checking. Corrective action sessions shall not be used for disciplinary or punitive actions. Corrective training is not a punitive action. No record of the corrective action sessions shall be recorded. Flight Safety shall not participate in the decision making process, but shall be advised by the Chief Pilot of the actions taken, if any. The Association CASC Representative, and when appropriate the LEC officers and or Association attorneys, shall represent the flight crew until all follow-up issues are resolved.
19-I-7 Incident Documentation
The IIC shall work closely with the debriefing team members and the responsible Division Representatives to identify all necessary corrective actions and the responsible Division shall implement prevention strategies as soon as practical. When the investigation is completed, the IIC shall document the complete investigation in accordance with the Aviation Safety Manual.
19-J Line Operations Safety Audit (“LOSA”)
19-J-1 Definitions
19-J-1-a The “LOSA program” is a recurring program that requires expert and highly trained observers to ride the flight deck jumpseat during regularly scheduled flights to collect safety related data on environmental conditions, operational complexity, and flight crew performance. Confidentiality of data and non-jeopardy assurance for Pilots are fundamental to the program.
19-J-1-b The “LOSA Committee” shall consist of the senior-most flight-qualified Vice-President in charge of Flight Operations, the VP of Safety or their designated alternates, and two representatives designated by the Association CASC Chairman. Any necessary subject matter experts may be included with the agreement of the LOSA Committee.
19-J-1-c The “LOSA Coordinator” shall be appointed by the LOSA Committee and shall be responsible for day-to-day oversight of the LOSA program and LOSA Observers.
19-J-1-d The “LOSA Training program” is a training program for training LOSA Observers that must be approved by the LOSA Committee.
19-J-1-e The “LOSA Observers” shall be selected by the Chief Pilot’s Office, approved by the respective Association LEC, and then validated by the LOSA Coordinator. LOSA Observers shall observe line crews on regularly scheduled flights. Selected individuals shall be trained under the direction of the LOSA Committee. At a minimum, LOSA Observer training shall consist of an approved training program. LOSA Observers shall be fully trained on LOSA ethics, Threat, Error and Undesired Aircraft State (“UAS”) Management concepts, observational coding and narrative write-up for contextual support, etiquette and rationale, and use of any forms and recording tools to include the protection of Identified Data (flight number/date, crew names, observer names, etc.).
19-J-2 LOSA Program
19-J-2-a The design, implementation, and operation of the LOSA program shall be determined by the LOSA Committee. Any variation from the agreed upon LOSA program shall require the mutual agreement of the parties prior to implementation.
19-J-2-b The LOSA Coordinator shall oversee the day-to-day operations of the LOSA program and establish necessary procedures to ensure compliance with the provisions of the LOSA program and this Section 19.
19-J-2-c The design of the LOSA program shall ensure the confidentiality and ultimate anonymity of individual crewmembers to the maximum extent possible.
19-J-2-d Data collected from the LOSA program shall be considered Information and comply with all the provisions of the LOSA program and this Section 19.
19-J-2-e All information derived from the LOSA program shall be shared among all members of the LOSA Committee.
19-J-2-f Any claimed infraction of the requirements of the terms of the LOSA program shall be promptly reviewed and investigated by the LOSA Committee. If an infraction is found, the LOSA Committee may suspend the LOSA program until the infraction is resolved to its satisfaction.
19-J-2-g The LOSA program shall be a voluntary, peer-to-peer observation of normal line operations, where crew participation is optional. Before conducting LOSA observations, LOSA Observers shall first ask the flight crew for permission to be observed. If any crewmember declines, the LOSA Observer shall not conduct the observation.
19-J-2-h The LOSA program shall include the following elements:
19-J-2-h-(1) LOSA observations shall be limited to regularly scheduled flights. Line checks, initial operating experience or other training flights shall not be used as LOSA observation flights.
19-J-2-h-(2) LOSA Observers are prohibited from recording names, flight numbers, dates, or any other information that can identify a crew or individual. LOSA Observers shall sign a confidentiality agreement with these stipulations. The purpose of the LOSA program is to collect safety data. LOSA data can never be used for disciplinary reasons. No observed Pilot shall be subject to any instruction, checking, discipline, discharge or enforcement action by the Company during or as a result of their participation in the LOSA program.
19-J-2-h-(3) A standard form shall be approved by the LOSA Committee for use during observation rides. No other notes or records of any kind shall be kept.
19-J-2-h-(4) In order to maintain confidentiality, the LOSA Committee shall maintain a trusted data repository. Absent approval of the LOSA Committee, only the LOSA Committee's final analysis, which shall not identify individual observations, shall be disseminated outside the LOSA Committee. Storage and access arrangements, including the identity of those who have access at any time to the records and/or data, must be agreed to in advance by the LOSA Committee. Any use of LOSA raw data or the “LOSA Data Query and Reporting Tool” software (or similar) shall remain under the exclusive control of the LOSA Committee and requires mutual agreement by the Company and Association members of the LOSA Committee.
19-J-2-h-(5) The final product of the LOSA program is data derived targets for enhancement based on emergent patterns in the data. It is then up to the LOSA Committee to develop an action plan based on these targets.
19-J-2-h-(6) Data Cleaning Roundtables shall include one Flight Standards representative, one designated Association representative, and one Instructor/Evaluator. Selection of Roundtable participants shall be by consensus of the LOSA Committee. In order to ensure data security the following provisions shall be implemented for the Roundtables:
19-J-2-h-(6)-(a) All members of the Roundtables shall sign a confidentiality agreement and shall be briefed regarding the restrictions on divulging LOSA data or information outside the LOSA Committee.
19-J-2-h-(6)-(b) LOSA reports shall not be distributed to or retained by members of the Roundtable.
19-J-2-h-(6)-(c) The LOSA Coordinator shall attend the Roundtables to ensure compliance with these restrictions.
19-J-3 Information Security and Use
19-J-3-a Any special studies or evaluations require approval by the LOSA Committee.
19-J-3-b No data derived from the LOSA program shall be shared with any government agencies, including any FAA personnel, unless required by law, regulation, court order, or legally binding directives of responsible government agencies or unless expressly agreed to in writing by the Association. Government agencies may be given access to de-identified data on Company property if expressly agreed to in writing by the Association, or if otherwise required by law, regulation, court order or directive.
19-J-3-c Any information that could be used to identify the crew shall not be recorded.
19-J-3-d LOSA participants, including the Company, the Association, and vendors shall enter into confidentiality agreements prior to their participation in the LOSA program. Any individual who has contact with any Identifying Data used in the LOSA program shall be prohibited from divulging any Identifying Data outside the LOSA Committee, except as required by law.
19-J-4 General
19-J-4-a The Association members of the LOSA Committee, the LOSA Coordinator, and any other Association LOSA participants shall be paid per the Company-required meeting provisions of LOA 12-14.
19-J-4-b A LOSA Observer who has conducted a LOSA observation in the ninety (90) days prior to the date he lapses currency shall not be subject to the provisions of Section 20-R.
19-J-4-c LOSA observers shall be boarded as jumpseaters after Company Pilots.
19-K Fatigue Risk Management System (“FRMS”)
The FRMS shall be administered in accordance with the FRMS Letter of Agreement between the Association and the Company.