David Fisher is a senior reporter for the NZ Herald.

Safety issues repeatedly ignored: report

A leaked report by an experienced crash investigator found safety problems throughout the air force. Photo / APN
A leaked report by an experienced crash investigator found safety problems throughout the air force. Photo / APN

The air force has repeatedly failed to fix safety issues highlighted through its accident investigations - including changes which could have prevented the 2010 Anzac Day crash.

A leaked report by the Royal New Zealand Air Force's most experienced crash investigator found safety problems throughout the air force.

Squadron Leader Russell Kennedy - who has worked on 27 air accident inquiries - found the system designed to protect air force staff was broken.

He found the air force had failed to put in place 47 per cent of recommendations made through the Court of Inquiry process in the past 10 years.

The inquiry process is the air force's formal method of addressing safety issues and carries the force of an order from the Chief of Air Force. In the past five years, just 17 per cent of recommendations had been put in place.

The recommendations which had been ignored included:

* Safety changes which would have stopped the air force from shipping dangerous material on an Air New Zealand plane.

* Safety issues highlighted after near-fatal accidents in 2008 and 2009 which resulted in serious injury to a civilian and a police officer.

The failures were "essentially the same" as those causing the Anzac Day crash and were not dealt with again at a meeting five days before the fatal accident.

Squadron Leader Kennedy's Accident Analysis Report also found widespread safety issues in the air force. Some of the conclusions were "of sufficient gravity ... to warrant further investigation".

Defence Force commander Lieutenant-General Rhys Jones told the Herald no wider review had been conducted.

The Court of Inquiry also recommended: "The RNZAF investigate possible parallels between this accident and the reports of other Courts of Inquiry, flight safety issues and broader organisational issues that could be relevant to preventing future accidents."

Information released under the Official Information Act shows no work has begun on this and it is planned for early next year - three years after the accident.

The Accident Analysis Report highlighted near-fatal accidents from 2008 and 2009 which were discussed at a formal "airworthiness" meeting at 3 Squadron on April 20, 2010 - five days before the accident.

The cases involved a police officer who was seriously injured in a training accident who was rushed to hospital.

In another accident, a civilian "lost consciousness and ceased breathing" during a training exercise.

The report found neither accident had been dealt with according to air force safety rules, which aim to improve systems.

The numbers

81 safety recommendations in five years
12 the actual number put in place in five years
17% of recommendations put in place
3 months the length of time an investigation into a flight safety event is meant to take
14.3 months the length of time it actually takes to resolve a flight safety event

- NZ Herald

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