Air Crash Investigation: Flight 191

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24/7/2012 “FLIGHT ENGINE DOWN” Air Travel Most effective and safest forms of transport < 1 for every 2 x 109 personmiles flown Air crash – One of worst situation Team Members: Seran Karikalan 1002764 Sivaguru S/O Sivagnanam 1003260 Ng Aiting 1067138 DARE 3B 24 Number of lives it takes with it Human Error Manufacturers to Engineers No one wishes for air crashes Synopsis On 25th May 1979, 15:00Hrs A McDonnell Douglas (MD) DC-10 American Airlines Took-off from Chicago O’Hare Int. airport Yet, 70% is caused by Human errors “That wouldn’t happen to me” Is main cause for such errors Just before lift off Lost power from No.1 engine Synopsis Suddenly rolled heavily to left Smoke gushing out Introduction…show more content…
4 24/7/2012 Rules & Regulations Aircraft Maintenance Manual (AMM) should be followed closely • Unless there is no procedure for a certain job Risk assessment of new procedure should be evaluated Improve on DC-10 Design Introduce slat-locking mechanism on DC-10 • Prevent unintended slat Improve on Communication Error report to reach authority effectively Top management monitor the performance of engineers closely Improve training quality for engineers retraction Improve on accessibility of the emergency power supply • Located somewhere within the reach or be made automatic Conclusion • • • Series of errors caused the accident Continental Airlines not informing FAA about damage flange Altering Procedures 5 24/7/2012 Conclusion • • Conclusion • • • • • Communication Human factor is a success only when a there is a top level commitment Consequence of Everyone 's actions Cutting corners and company norms Top management must ensure AMM are followed Communication Human factor is a success only when a there is a top level commitment Bibliography and References Earl L. Wiener and David C. Nagel, 1988. Human
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