Inquiries & Recommendations

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That a system be implemented whereby pilots gain an appropriate level of experience and expertise before being allowed to operate air transport flights, unsupervised into one-way airstrips such as Tangahoe.

When reviewing the design of the safety rails (or chains or strops as appropriate) take into account the spacing and layout of the safety rails, and the direction and magnitude of the loads which might be applied by passengers. [This safety recommendation was subsequently cancelled and replaced with safety recommendation 125/95.]

Reinforce the training and increase the compliance monitoring of remote control operators to ensure they are positioned and operate in such a manner that a combination of: range of vision normal operating distractions and shunting speed maintain an acceptable factor of safety with respect to possible collision.

implement procedures to ensure that the length of a protected site under Conditional Stop Protection, and the number of separate work groups within the protection, are adequately supported by the communication resources available, the procedures in place, and the known communication reception history of the area.

Incorporate in the helicopter training syllabus for PPL and CPL an item dealing with uncommanded yaw.

That the necessary steps be taken to convene a meeting or meetings to include representatives of local aviation operators, the Police, and local medical authorities, and any other appropriate persons, in order to discuss and develop suitable contingency plans in the event of an aviation accident or emergency in the Kaikoura area.

ensure that where a train control shift is extended beyond 8 hours a mandatory break of at least 15 minutes is available to the train controller as close as practicable to the start of the shift extension.

At the time of this incident KiwiRail’s safety system could not ensure that infrastructure staff were competent to perform their roles, and could not ensure that the appropriate safety observations and revalidations of current staff competency had been undertaken.

The adequacy of existing restraint systems installed in aerial work helicopters for the use of shooters be considered as a matter of urgency.

draft an amendment to Rule Part 40C.60 Design, Construction and Equipment - Non-Passenger Solas] for the consideration of the Minister to include an additional requirement that ships towing in pilotage operations must be fitted with either a towing hook that has a positive means of quick release or a towing winch that has means of rapidly paying out when under load, either of which must be controllable from the conning positions and at the hook or winch.

in conjunction with the operating companies and using Signalling and Interlocking diagrams as the standard, institute a policy for the agreement and adoption of appropriate siding names connected directly to the controlled network on the diagram

Undertake a hazard identification audit of his operation, with special regard to the particular risks associated with operating from a launching ramp close to a bridge, where strong river currents may be experienced.