9 | ZRH Safety Newsletter Discipline on the apron September 2013

ContentsEditorial

Case studiesIncidents at Zurich Airport

Safety BasicsMore discipline – fewer accidents

StatisticsIncorrect conduct results in accidents

Expert perspectives“Driving at the airport requires more discipline”

Reporting system

Accidents and incidentsOccurrences at international airports

Safety dates

Quiz

Occurrence Reporting

Editorial

Dear Reader

I am pleased to present you with the new issue of the ZRH Safety Newsletter. This issue deals with discipline on the apron and which types of conduct, i.e. good discipline, are required in order to avoid incidents and accidents in flight operations.

Are you disciplined? Do you know how to act in a disciplined manner? We will look at these questions with you in this issue.

In addition to current case examples, this Safety Newsletter also contains interesting sta-tistics and an interview with an expert. There is also a competition where you have a chance of winning an airport voucher worth CHF 50. I hope you enjoy reading the news-letter and remain, Yours sincerely

Steffi BaumgartenSafety ExpertFlughafen Zürich AG

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Incidents at Zurich Airport

A Current case examples at Zurich Airport

The following incidents could have been avoided with disciplined conduct:

A1 Airbus A346 collides with a high loader

An Airbus A346 arriving at stand E57 collided with an incorrectly parked high loader, which was standing by for handling. The ground crew noticed the incorrectly parked vehicle shortly before the collision. Unfortunately, it was no longer possible to correct the position of the high loader, and the engine of the Airbus A340-600 col-lided with the vehicle and was damaged. The passengers were able to disembark as usual via the passenger loading bridge. Considerable damage was caused to the aircraft.

ConclusionBefore the aircraft arrives at the stand, please ensure that no ground service equipment is within the aircraft stand area (within the red stand safety lines).

A2 De-icing vehicle damages winglet during de-icing

The left winglet of an Airbus A319 was damaged during de-icing in February. While manoeuvering, the driver of the vehicle concentrated on objects that were in the aircraft stand area. In doing so he failed to notice that he had touched the machine’s winglet.

ConclusionKeep aircraft stands free during de-icing. Caution is required when manoeuvering around the aircraft.

A3 A truck and a limousine collideA truck travelling to an aircraft stand had to halt in order to allow an aircraft to pass. However, the truck only came to a stop in the danger zone, and the driver wanted to reverse a few metres. He failed to notice that a limousine had arrived behind the truck. While reversing, the truck collided with the limousine.

ConclusionKeep an eye on the right-of-way for aircraft and make sure you can see them at all times. Pay special attention when reversing. If your field of vision is restricted, ask for assistance.

ZRH Safety Newsletter | Case studies In this section we look at concrete examples of safety incidents relating to our focus topic, investigating the background to them and highlighting the lessons to be learned.

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ZRH Safety Newsletter | Safety Basics

More discipline – fewer accidents

B DisciplineIn order to guarantee safety for flight oper-ations at Zurich Airport, certain rules have to be respected by all drivers.

Following the Ground Traffic Regulations (GTR) of Zurich Airport ensures that acci-dents and incidents in flight operations are avoided.

All drivers at Zurich Airport are required to exercise the necessary discipline and to respect the GTR.

B1 Incorrect conduct and deviation from procedures

1236 incidents were recorded in the Safety Office database between January and July 2013. They include incorrect conduct and deviations from procedures (including vio-lations of the GTR). This constitutes the largest category in terms of all reported incidents. This category includes breaches of the GTR, vehicles that were incorrectly parked or which were blocking the taxiway and other deviations from the GTR.

B2 What does discipline mean?Would you rate yourself as disciplined? How does one define discipline exactly?

According to the dictionary, discipline means a system of rules for behaviour. The most important document here at Zurich Airport is the GTR.

B3 The Ground Traffic RegulationsThe Ground Traffic Regulations (GTR) govern vehicle and pedestrian traffic in the non-public area of Zurich Airport. Drivers of vehicles must have a personal permit issued by Flughafen Zürich AG. Violations of the GTR are punished by means of a points system.

The latest version of the GTR is available on the website of Flughafen Zürich AG: www.flughafen-zuerich.ch/ rampsafety

C A selection of rulesThe following is a selection of articles from the GTR:

C1 PrincipleArt. 12: Everyone is required to act in such a way so as not to hinder or endan-ger others during regular use of the traffic areas or to impact negatively on air traffic.

C2 Right of way for aircraftArt. 30: Aircraft always have the right of way over all other traffic. This also applies to motor vehicles towing or guiding air-craft.

“Safety basics” is the section in each Safety Newsletter where we provide key information on the rules, regulations and procedures for the safety item we’re focusing on.

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ZRH Safety Newsletter | Safety Basics

C3 Right of way for motor vehiclesArt. 34: The right of way is regulated as follows in descending order:1. Motor vehicles with illuminated blue

danger lights and two-tone horn2. Motor vehicles with illuminated yellow

danger lights3. Winter service vehicles during

snow-clearing operations4. Motor vehicles in traffic lanes

C4 ReversingArt. 35 bis: Vehicles must always reverse at walking pace. Vehicles with no visual reversing aid and with limited visibility must be assisted when reversing.

C5 Speed limitArt. 33 para. 1: Unless otherwise indicated, the maximum speed is 30 km/hr.

C7 Driving onto aircraft standsArt. 20 para. 4: When the docking guidance system is activated, no traffic, pedestrians or objects are allowed onto the stands. The exceptions are tractors with towed aircraft and motor vehicles of Flughafen Zürich AG guiding an aircraft.

D Safety Office tips• Please observe the GTR rules.• Act prudently.• Adapt your driving to the circum-

stances (construction sites, traffic lanes, knowledge of the vehicle).

• Allow sufficient time.• In-depth knowledge of the vehicle• Learn from the mistakes of others so that

the same errors are not repeated.• Drive defensively.

Driving defensively means:• paying attention to traffic• being in control of the vehicle at

all times• identifying dangerous situations at

all times• minimising the risk of collisions

by braking

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Incorrect conduct results in accidents

Just the tip of the icebergVery often one only sees the tip of the ice-berg. The part below the surface is usually not adequately perceived. And yet this is what often causes accidents.

As part of the Safety Management System, violations of the GTR are considered to be incorrect conduct or incidents with consid-erable potential for damage, depending on their seriousness.

The adjacent statistics from 1 January 2012 until 31 July 2013 show that of the 693 cases of incorrect conduct, 352 were inci-dents with high potential for damage, 210 were incidents involving collisions with vehicles and buildings, and 65 involved damage to aircraft. In terms of incorrect conduct alone, the result is a ratio of 1:10. In other words, the less discipline, the more damage is caused to aircraft.

People are often unaware of incorrect conductMistakes occur wherever people work. Employees who perform the same work over a lengthy period develop a routine over time. This can be a positive thing, as processes are automated and run almost by themselves. However, it can also hap-pen that incorrect conduct occurs without an employee noticing.

Disciplined conduct can help to avoid such situations and ultimately also accidents.

65Damage to aircraft

Collision with vehicles and buildings

Incidents with considerablepotential for damage

Incorrect conduct

210

352

693

Damage to aircraft• Stationary aircraft (e.g. passenger loading bridges)• Aircraft loading equipment• Aircraft servicing equipment• Taxiing traffic (e.g. towing/push-back vehicles)• Parked vehicles

Collision between vehicles and buildings/vehicles • Accidents involving vehicles• Accidents involving equipment• Accidents involving buildings

Incidents with considerable potential for damage • Foreign objects on taxiways and runways• Near-collisions on traffic areas

Incorrect conduct • Incidents in flight operations• Deviations from procedures during ground handling

ZRH Safety Newsletter | StatisticsIn this section we present the data that have been collected on accidents and incidents at Zurich Airport in graphic and diagram form. These visual interpretations should also help raise our readers’ awareness of the current hazards and risks.

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“Driving at the airport requires more discipline”

Jürg Hug began his career in 1994 at Flughafen Direktion Zürich (later Unique AG and now Flughafen Zürich AG) in the bus service. In 2004 he moved to Ramp Safety and is now, among other things, the process owner for driving instruction and driving permits. Before working at the airport in Zurich he worked as a driving instructor.

Mr Hug, what do you understand by discipline in terms of driving and traffic? A lot (laughs). I understand it to mean observing the rules and being fair when driving. Without discipline, traffic wouldn’t function and would become a free-for-all. Being considerate of others is also part of discipline. For me this is very important as without rules – which are discipline in a broader sense – safe driving is not pos-sible. Drivers’ own interpretations of traf-fic-related conduct are useless. Discipline implies that everyone should act in the same way. Traffic rules serve to eliminate misunderstandings.

Do you find driving on an airport site more demanding? Does it require more discipline than in regular traffic?Yes, it does require more discipline. On the airport site one has to make clearer and more independent decisions, because in public traffic everything is indicated and regulated. Roads are clearly marked by pavements, meadows, etc. At the airport there are fewer reference points such as those we are familiar with in regular traffic. Also, in regular traffic, one does not have to deal with taxiing aircraft.

In what way are you confronted with discipline?I am confronted with it several times a day. I act in a disciplined manner in order to be a good role model. On the other hand, in the course of my work I am sometimes confronted with the undisciplined conduct of other drivers.

Has discipline improved over the years?That is difficult to say. Because we carry out more checks and have more people in these roles we can see more deviations than we did some years ago. On the other hand, more violations were seen then as checks were shorter and less frequent. So it’s difficult to generalise.

How do you teach disciplined conduct during your driving lessons?I try to make the trainees aware of the risks and their consequences. Proportionately the damage to an aircraft is 100 times greater than with a regular vehicle. In addi-tion, it is possible to promote safe conduct by passing on tips.

The expertJürg HugRamp SafetyFlughafen Zürich AG

ZRH Safety Newsletter | Expert perspectives In this section we present the views and experiences of various people at Zurich Airport on our focus topic.

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Can disciplined conduct be learned?Certainly. One way to do this is by ques-tioning one’s own behaviour. For example: Did I assess this traffic situation correctly? Did I observe the rules? By constantly asking questions one can train oneself: “Knowing oneself is good discipline”.

What tips would you give all drivers on the apron to avoid incidents and accidents?Observe correctly and drive defensively. Be aware of other drivers and always con-sider where the other driver is going. Think about where you can stop and wait in order to give someone else the right of way and to observe the rules. Learn the cor-rect behaviour patterns and use them con-sistently and correctly. Defensive driving in particular helps to avoid dangerous situations.

One danger is that drivers act with an exaggerated sense of routine and thus underestimate the situation. Is discipline lost as a result of routine?Yes. Routine gives rise to a lack of atten-tion, and actions are no longer carried out consciously. In a way, respect is lost. One allows oneself to be distracted by things that are unimportant and thus enters into risks. Dangers are then underestimated or not even perceived.

What types of violations occur most frequently?This is difficult to answer (thinks). Proba-bly not observing the warning lights when pushing back. The drivers often say that they saw them too late or not at all. This proves that people make their decisions on the basis of visual perception. So looking ahead is very important.

What does the airport expect of drivers?Disciplined, correct and error-free driving and also consideration for one’s partners.

ZRH Safety Newsletter | Expert perspectives

Reporting system

What contribution can I make?Safety enhancement information helps to improve safety at the airport and is a clear sign of a positive safety culture. It is thus all the more important that employ-ees report apparent or probable unsafe circumstances.

The following are examples of safety enhancement information and safety measures. These examples illustrate the seriousness of clarifying safety enhance-ment information and are intended to motivate employees to report information aimed at increasing safety to the Safety Office.

Information markings on taxiway YANKEE Pilots report to Apron Control that the information markings on taxiway YANKEE are missing. Apron Control realises that some crews did not notice the taxiway YANKEE and continue taxiing on the taxi-way ALPHA.

The Safety Office looks into the matter and observes the situation on the apron. It turns out that the renewal of the markings had been planned and communicated but that the information had not reached the apron traffic manager on duty.

Winter OPSDuring the winter, the Safety Office repeat-edly receives safety enhancement infor-mation about conduct on the ramp during winter service operations (e.g. snow-clear-ing), especially with regard to speeds that are not adapted, failure to give the right of way to snow-clearing and de-icing vehi-cles and passing in front of winter service equipment.

To date, no serious accidents have occurred, as the winter service vehicles managed to brake or avoid other vehicles.

ConclusionBe aware that accidents involving win-ter service vehicles could result in con-siderable damage to both people and property. Therefore please make sure you act in a disciplined manner during winter service operations in particular.

ZRH Safety Newsletter | Reporting system

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ZRH Safety Newsletter | Reporting system

Unsafe conditions and near accidents should not go unnoticed. We encourage all employees at Zurich Airport to report safety enhancement information and observations to the Safety Office. There are various ways in which you can report safety enhancement information:

By telephoneWe will be pleased to receive your information by telephone: Tel. +41 (0)43 816 75 42

OnlineYou can find the electronic reporting form on the airport website at: www.flughafen-zuerich.ch/ sicherheitshinweis

Safety & Security BoxThe Safety & Security Box is used to deliver your safety enhancement information either before or after your shift. The Safety & Security Boxes with the reporting forms are located at each door/entrance to the operational areas. The information may also be submitted anonymously.

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Occurrences at international airports

A Boeing B772 landed too early, broke up and went up in flames.An Asiana Airlines Boeing B777-200 en route from Seoul, South Korea, to San Francisco with 307 passengers on board landed too soon on runway 28L. The tail fin, the chassis and the engines were sepa-rated from the aircraft. The aircraft rotated almost 360 degrees before coming to a standstill around 460 metres from the run-way and burst into flames. Three passen-gers died, while the remaining 304 were able to leave the aircraft with either slight or medium injuries. The American aviation accident investigation authority NTSB initi-ated an investigation.

You can find information about interna-tional incidents and accidents at:• www.ntsb.gov/investigations/

reports.html • www.avherald.com• www.bfu-web.de

Unmanned towing vehicle collides with Boeing B733A Southwest Airlines Boeing B733 was struck by a tug while pushing back in Los Angeles, USA. The driver left his seat with the engine still running and wanted to load two suitcases. He lifted the first suit-case onto the passenger seat in the driver’s cabin. When he turned round to load the second suitcase, the vehicle moved on its own until it collided with the Boeing B733. The driver was unable to jump onto the vehicle. That same evening the operating company announced that the first suitcase had fallen from the seat onto the accelera-tor and had set the vehicle in motion. The NTSB report stated that the seat switch, which turns off the engine if the driver’s seat is empty, was not working. The air-craft sustained damage to the fuselage and the right engine. The passengers were flown to Tucson, Arizona, in a replacement aircraft and with a delay of two hours.

Safety dates

2013 Date Time PlaceRunway Safety Team meeting 01.10.2013 13.00–16.00 Prime Center ZurichAirport Safety Committee meeting 04.10.2013 08.30–11.30 Prime Center ZurichSwiss Aviation Safety Conference 29.10.2013 09.00–16.00 Kursaal, BerneRamp Safety Culture Zurich meeting 05.11.2013 13.30–15.30 Prime Center, ZurichRunway Safety Team meeting 04.03.2014 13.00–16.00 Prime Center, ZurichAirport Safety Committee meeting 07.03.2014 08.30–11.30 Prime Center, Zurich

ZRH Safety Newsletter | Accidents and incidents/ Upcoming safety dates

The ZRH Safety Newsletter is intended to sensitize readers to the potential dangers inherent in all operations at Zurich Airport. To this end, every issue includes a section reporting on recent occurrences at Zurich and worldwide. Not all these occurrences are necessarily related to the current focus issue.

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Quiz

Win one of three airport shopping vouchers each worth CHF 50Decide whether the following statements are true or false and deposit your slip in

one of the 12 Safety & Security Boxes at Zurich Airport (deadline for entries is 30 November 2013).

ZRH Safety Newsletter | Quiz

No. Statement True False1. The Aerodrome Manual is only a recommendation and implementing it is not mandatory.2. The points system is used in the case of GTR violations.3. Crossing vacant stands is allowed in order to increase efficiency as this saves time.4. As long as the vehicle is parked with the wheels inside

the white lines it is parked correctly.

5. I act in a disciplined manner on the apron because that’s what my boss wants.

This has nothing to do with safety.6. Discipline means observing a set of rules.7. The handling agent must ensure that the stand is free of equipment before the aircraft is parked.8. I pick up any loose objects on the taxiways or stands and place them in the nearest FOD bin.9. As long as I am faster than the others, I have the right of way.

10. If the service road is blocked I can always use the taxiway.11. By acting in a disciplined manner I can contribute to safe flight operations.12. There must not be any ground service equipment on the stand before the aircraft is parked.

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Publishing details

Editorial team:Flughafen Zürich AG

Printed by:RTK, Kloten

© Flughafen Zürich AGP.O. Box, CH-8058 Zurich Airport

www.zurich-airport.com

Contributors to this issue:Steffi Baumgarten, Alexander Burger

The ZRH Safety Newsletter provides regular information and updates on safety issues at

and around Zurich Airport. If you have any contributions or suggestions of your own,

the Safety Office will be pleased to hear from you at safetyoffice@zurich-airport.com

ZRH Safety Newsletter | Occurrence Reporting

By postYou can also submit your report to the Safety Office directly, using the paper form below.

Occurrence Reporting Formular Zurich Airport

1. Occurrence Identification

DateTime  day  night  dawn  duskWeather  clear  cloudy  ovc  rain  fogWeather/Visibility  snow  hail  good  med  poorSurface condition  dry  wet  snow  slush  ice

Location

2. Description of occurrence (What happened?)

3. Causal factors (What do you think caused this incident?)

4. Suggestions for corrective actions (What measures could prevent this occurrence from happening again?)

5. Your occurrence assessmenta. In your opinion, what is the likelihood b. What do you consider could be the of a similar occurrence happening again? worst possible consequence if this occurrence did happen again?rare likely insignificant catastrophic

 1    2    3    4    5  1    2    3    4    5

The information supplied in this form will only be used to enhance safety. You may choose to not provide your name. If you do provide your name, upon receipt of this form your name and position will be removed and dis-carded. Under no circumstances will your identity be disclosed to any person in the airport or to any other organ-isation, agency or person without your expressed permission. When you have completed your part of the form, it should be given to the Safety Office either by post, mail or fax:Flughafen Zürich AG, Safety Office, P.O. Box, 8058 Zurich Airport, occurrence@zurich-airport.com or Fax +41 43 816 83 63.

Name (Optional)

Company/Position (Optional)

Thank you in advance for playing your own active part in keeping our airport safe.