Inquiries & Recommendations

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On 26 February 2025, the Commission recommended to the Director of Civil Aviation at the Civil Aviation Authority of New Zealand that they promote, through the appropriate International Civil Aviation Organization (ICAO) forum, consideration for the requirement and implementation for Vortex Ring State alerting systems to be installed in new helicopters.

Require Airways New Zealand to enhance its procedure for handling flight progress strips with the aim of increasing the time given to aerodrome controllers to assimilate the details of departing traffic.

Clarify the requirements for the application and securing of handbrakes on ADB and ADK cars, and ensure they are appropriately signposted.

On 26 March 2025, the Commission recommended that KiwiRail review and improve the automatic carriage alarm system (TMS) to ensure it alerts the crew to faults.

Introduce a system to ensure that the pilots who operate on the Manukau Harbour are sufficiently familiar and experienced with the harbour to undertake the pilotage.

He require training and checking organisations to adopt height margins beneath cloud as a topic for flight checks, such as those carried out in accordance with CA Regulation 76, where it is relevant and appropriate to the operation involved.

Advises all authorities of the circumstances of the Henderson accident to alert those which may have similar problems to the desirability of taking action with their local schools, Tranz Rail and other affected local groups to develop and implement locality specific action plans to reduce hazards.

Advise all New Zealand operators of the AlliedSignal (Lycoming) LTS101 engine to inspect and check tighten each 'B' nut that secures the Pr and Pg accumulators to their respective pressure line, inspect and check tighten the 'B' nut that secures the Py line to the over speed governor, and to report to the CAA any instances of loose fittings.

That legislation be introduced to enable Police and Civil Aviation Authority personnel to require a pilot suspected to be under the influence of alcohol or drugs to undergo the appropriate test to determine if this was so. The circumstances under which such tests may be requested should be based on similar considerations to those outlined in FAR91.11, but, at the least, tests should be conducted following an aircraft accident or incident where alcohol or drugs may be suspected as a contributing factor.

Ensure that appropriate rules and/or guidance is available to marine surveyors and vessel operators on the risk of having all life jackets stowed in one place that might not be accessible during foreseeable events.

Conduct an independent inspection of all commercial jet boats by suitably qualified persons, to assess the compliance with Rule Part 80 [Marine Craft Involved In Adventure Tourism] with regards to occupant protection in event of collision, and withdraw any operator's certificate of compliance where their boats do not comply.

Improve the resilience of the track warrant system to accommodate deviations from standard patterns, taking particular account of the need for: • an improved method of providing an LE with a continuous and conspicuous visual display of his track warrant limit. • introducing a system to identify the position of trains in track warrant territory which would increase the situational awareness of LEs as they approached the limit of their track warrant, and limit the possible consequence of any overrun which may occur.