Inquiries & Recommendations

Ngā ketuketutanga me ngā tūtohunga

On 15 May 2025, the Commission recommended that the Secretary for Transport take steps to introduce a legislative change that would give the Director of Maritime New Zealand powers to ban substandard ships from New Zealand under appropriate criteria.

Investigate the practicability of introducing an intermediate speed aspect for the signals 12L and 6L at Te Kauwhata and other similar locations.

Review the requirements for the installation of Flight Data Recorders in aircraft to recognise the latest ICAO recommendations on this subject.

Maintain the requirement that the signal station operator informs masters of transiting ships of any unlit or temporarily lit beacons and also include a reminder to advise the signal station should any other beacons be discovered extinguished.

At night, and where wind conditions make it practicable, aircraft which are being loaded or unloaded should be parked so that optimum illumination from the apron floodlighting is available on the access side of the aircraft.

The continuing need for parties involved in importing overseas components to thoroughly scrutinise all available records in accordance with AC-001 to ensure the accuracy of the reported component service life.

Consider whether similar modifications to other Cessna aircraft seats would provide a similar improvement in crashworthiness.

He promote awareness to pilots and flight training organisations of the hazards associated with flying with only a small height margin beneath cloud, and of the parameters which may affect a safe height margin, by the development of educational material in his flight safety publications.

Ensure that masters and senior officers receive bridge resource management training and adopt the principles as part of company operational policy and procedure.

The findings from 2 separate inquiries show that general aviation maintenance practices in New Zealand are not always in accordance with Civil Aviation Rules or accepted industry practice. The findings show that non-compliance occurs in certificated maintenance organisations and by individual maintenance engineers exercising their individual licence privileges. This is an indication that the safety issue is not specific to just one sector of aviation maintenance. If left unchecked this situation is likely to have significant implications for aviation safety.

On 26 March 2025, the Commission recommended that KiwiRail include in its Operational Rules the processes and procedures to respond to a train parting because of a mechanical failure, to ensure the risk of injury to rail personnel and damage to rail vehicles is mitigated.

introduce alignment control procedures to ensure maintenance tamping does not result in an effective uncontrolled lowing of the neutral temperature of the rail. [SR repeated in report 02-104: 3 separate track buckle occurrences on the South Island coal route during the summer of 2001/2002.]