Find an Aircraft accident Topic and present it in 5 Model, Swiss Cheese Model, and SHELL model.

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Find an Aircraft accident Topic and present it in 5 Model, Swiss Cheese Model, and SHELL model.

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Here I attach an example of the way the project has to be done in 5 models, but the other two models have to be more creative depends of the information of the aircraft accident.

On 31 Oct 2000, Singapore Airlines Flight 006, a Boeing 747-400 aircraft, scheduled for Taipei to Los Angeles, took off on the wrong runway 05R (that was closed for maintenance works and parallel to runway 05L which they had intended to take off) in bad meteorological conditions. Whilst on the take-off roll, the aircraft collided with construction equipment and crashed, resulting in 83 out 179 people being killed.

Analysis using 5-M Model/ Swiss Cheese Model/ SHELL Model

FINDINGS

Man

Qualification and Flying Record of the Crew

• The primary flying crew consisted of the Pilot and Co-pilot. The aircraft captain had been a Captain for the Boeing 747-400 fleet since 1998 and had a total of 11235 hours of flying time.

• The Co-pilot had been a First Officer since 2000 and had a total of 2442 hours of flying time.

Currency and Proficiency

• From the aircrew records, both pilots were qualified and current for their flight. They were also current in simulator training. From interviews, both involved were assessed to be confident in carrying out their assigned duties.

Medical Status

• Both pilot and co-pilot were physically well at the time of the flight. On review of past medical records, both pilots did not have any significant medical conditions of note. Both pilots reported that they had not consumed any medications or intoxicating beverage 72 and 48 hrs prior to the flight. There was no evidence to suggest alcohol or drugs were factors in the accident.

Physiological and Psychological Fitness

• Both pilot and co-pilot were assessed to be psychologically and physiologically fit for the flight. The 2 crew had adequate sleep for the past 72 hrs prior, and were not fatigued on the day of the flight.

Machine

Aircraft Damage

• The Aft fuselage separated from the remainder of the fuselage and was generally intact. The mid and forward fuselage suffered extreme fire damage. The left and right wing were heavily damaged by fire.

Aircraft History

• The incident aircraft was serviceable on the day of the accident and the last maintenance performance was the A check at 17838 hrs, on 29 Oct 2000. The current airframe hours is 18459 hrs, 621 hrs since last service. A review of the maintenance logbooks revealed no related defects in the 30 days of Tech Log entries and showed no evidence that the aircraft was not airworthy.

Medium

Weather

• Taiwan was affected by north-east monsoon flow and typhoon “Xangsane”. The Taipei Meteorological Service issued a SIGMET for cumulonimbus, together with several gale and typhoon warnings which was applicable to the airport at the time of the accident.

• Surface Weather observations at the time of the accident varied with winds at 020 degrees, 30 kts gusting to 61 kts, visibility was 450m, RVR was 450m, there was heavy rain, with broken clouds at 200ft and overcast at 500ft.

Airfield Lightings/ Markings/ Signages

• The green taxiway lights immediately after 05R entry point into 05L were not serviceable and the following lights leading to 05L were degraded and dim.

• There were no runway guard lights to depict that they the active runway way was ahead.

• Taxiway centre line markings did not extend all the way down to the runway 05L threshold marking with interruption stops before the 05R threshold marking.

• No runway markings to indicate that runway 05R was closed.

• No visual warning/ signages or physical barriers to indicate maintenance works was in progress to prevent aircraft from lining up on wrong runway.

• Due to heavy winds and rain, concrete barriers instead of frangible ones with red obstruction lights (that were not visible in low visibility) were used to demarcate the construction areas.