Modul 9 Kaynak
Modul 9 Kaynak
Human Factors in
Aircraft Maintenance
for
EASA Part-66
BT-A1-0900-LN
BT-B1.1-0900-LN
BT-B2-0900-LN Rev:02 – 01.12.2016
Revision and Amendment Status
These course notes have been produced in accordance with AMC 147.A.120, Part 66 and
AMC/GM Rev May 2012.
01 31.03.2016 Revised for format change including cover, header and footer. S. Güncan
02 01.12.016 Contents have been slightly improved and minor editorial changes have B.Bozok
been made and entirely issued by Turkish Technic Inc. Training
Directorate.
Level
Sub Rev.
09 HUMAN FACTORS Rev. Date Page(*)
Module Nbr.
A1 B1.1 B2
(*): This number indicates the page number of the digital PDF document.
Module 9
Human Factors
9.1 General
Intentionally Blank
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common words
and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate, typical
examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws describing
the subject.
The applicant should be able to read and understand sketches, drawings and schematics describing the
subject.
The applicant should be able to apply his knowledge in a practical manner using detailed procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and comprehensive
manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other subjects.
The applicant should be able to give a detailed description of the subject using theoretical fundamentals
and specific examples.
The applicant should understand and be able to use mathematical formulae related to the subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using manufacturer's
instructions.
The applicant should be able to interpret results from various sources and measurements and apply
corrective action where appropriate. Intentionally Blank
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
General 9.1 1 2 2 2
Aircraft maintenance is one of the most important components of the aviation industry.
The purpose of the "Human Factor in Aircraft Maintenance" course can be summarized as
to underlie the situations where human error emerges and the measures to reduce
them by attending the maintenance process with the “human” dimension, to facilitate
awareness creation among employees and to help familiarize themselves with all their
positive and negative aspects.
Brief History
The field of interest on human factor issues has gained momentum since the beginning
of last century; however, the very first significant studies, especially in the field of aviation,
were done on equipment design and human performance during World War 2. The
purpose of the many analyses and evaluations that emanate from the experiences gained
in the last 50 years on principal concepts of human factors is to ensure that the
employees perform their duties more effectively, more efficiently, safer and with less
stress, or in other words, better. Structural and mental flexibility and adaptability of
humankind has been the principal guidebook in aircraft designs. Technology and human
relationship, and the incompatibilities and limitations emerging at this point have come to
be attended scientifically:
While human factors were handled in this sense, the first target audience has been flight
crew and air traffic controllers.
Following the Aloha Airlines / B737-300 (1988) and British Airways / BAC1-111 (1990)
accidents, aircraft maintenance activities are also included in the application area of
human factors / human errors issues.
At the same time, within the scope of the EASA Part-66 ―Maintenance Certifying Staff
regulation, human factors topic is framed also as one of the compulsory courses that
constitutes the basic training and is required to be attended by the maintenance
approbatory staff (Aircraft Maintenance Basic Training - Module 9). The necessity of the
education in question is acknowledged by the International Civil Aviation Organization
ICAO and is deemed mandatory for all member states. ICAO Annex 1 “Personnel
Licencing”, Annex 6 “Operation of Aircraft” and Annex 13 “Accident Investigation” have
been revised in this direction.
Maximizing flight safety in terms of aircraft and to minimize the delays and disruptions
due to technical reasons are directly related to “human factors”.
It is very obvious that humans should recognize and familiar themselves with their
capacity, limitations, mental and physical abilities very well. In this course, we will also
investigate features and concepts such as the eye, ear, brain, emotional stress, the
body, fatigue, attention, sleep, nutrition, learning and forgetting that apply to aircraft
maintenance personnel as it does to all other human beings.
Additionally, dissemination of knowledge, training and equipment in use, facilities and work
environment, corporate culture, teamwork, production schedule, rewarding and advanced
technologies topics will be scrutinized.
Since thousands of years ago, humankind has been trying to increase work efficiency by
using tools. In ancient times, humans were also using their physical strength while using
the tools. At the point reached, however, advanced technology enables the ability to
perform many tasks with minimal physical strength.
Human factor and ergonomics, which deals with humankind and its environment in
terms of all anthropometric, biological, physical and medical aspects, are nested
concepts. Ergonomics is a Greek word; it is composed of ERGON (work) and NOMOS
(law) the words occur.
Nowadays, human factors and ergonomics issues are focused on human/ machine/
environment relations. The aim is to ensure the harmony between machines and
humans that use them.
- Human / machine harmony (Can the pilot reach the panel?)
- The dynamics of human perception (Do the continuously blinking lights draw attention?)
- Biological and physiological effects on the human (exhaustion, hot or cold environments)
Anthropometry
Anthropometry is the scientific measurement and collection of data about human physical
characteristics and the application (engineering anthropometry) of these data in the
design and evaluation of systems, equipment, manufactured products, human-made
environments, and facilities.
Using anthropometric design principles it is possible for a variety of people to find physical
comfort at a workstation. On the other hand, not taking these physical requirements into
consideration may create bad work postures leading to fatigue, loss of productivity, and
sometimes injury.
Anthropometry is not only a concern about appropriate working height, but also about how
the operator can easily access controls and input devices. In an airplane it should be
possible for a pilot to reach the controls in the cockpit while being held back by the
seatbelt. Similarly, the controls of machine tools must be easy to reach.
The basic approach to human factors considers the employees a part of the whole
system. People working on those issues especially focus on the relations between
human beings and other elements of the system. The crucial point in the system overview
here is the reality that, "human beings are inseparable from the other elements of the
system". This view is similar to the perspective of environmental scientists that suggests,
“All the elements of nature are in interaction with each other”. It is impossible that a
change we cause in the system will not affect the other elements of the system. Human
being has a complex structure. There are as many different human types and ways of
thinking as the number of people. With the disciplines of human factors, systems based
on the common features of these different structures are being developed.
First of all, let us remember a few general descriptions regarding the system:
- System is the constituent parts of a whole.
- System is the sum of the functional components.
- System is the sum of all kinds of elements that fulfill an objective.
- System is working together.
SHEL Model
The model, rules, procedures, traditions, habits, all kinds of information, symbols, and
other elements that determine how the system will function is included within the
"software" definition. Incorrect understanding of a procedure, its openness to
interpretation, maintenance manual that contains inaccurate information, an inadequate
check-list are factors that would cause errors.
All physical assets other than humans, aircraft and components, equipment, materials
and vehicles constitute "hardware" side of the system. Lack of equipment and materials,
poor design or faulty production are always causes of error.
"Liveware" defines human beings and the relationship between people. Lack of human
strength, control and supervision gaps, insufficient management support and low
motivation prepare the ground for errors.
Software
(maintenance procedures, AMM, checklist)
Hardware
(components, test equipment, aircraft, material)
Environment
(physical and social environment)
LiveWare
There are four elements in this model interacting with each other. The source of all the
errors and events are the system components in question and their interrelations. The
boundaries of these elements are not straight lines.
In order to prevent any possible damage, failure or accident, all the elements must be
operating compatibly with each other. Human is the most flexible element of the
system in terms of performance.
P stands for People (the humans in the system), with all our capabilities and limitations. It
includes senses such as vision and hearing; physical characteristics such as strength
and reach; as well as capabilities such as memory, communication styles, decision
making, supervision and teamwork skills (leadership/ followership etc.).
E stands for the Environment in which the work is done, not just the physical
environment, but also the organisation itself. The physical environment includes lighting,
temperature, noise level and time of day. The organisational environment covers issues
such as supervision, pressures, organisation and safety culture and existing
organisational norms and how these will affect individual and team performance and the
potential for error.
A represents the Actions people perform. Actions list the requirements of a job to help to
identify any specific areas that might increase the risk of error, such as ambiguous
information, or complex tasks that need specialist skills and knowledge.
R is for the Resources necessary to perform the work. Resources are the broadest
component of PEAR. They can be defined as anything that the maintenance engineer
needs to get the job done. Resources details both the tangible items required and
available, such as personnel, spares, technical manuals, tooling, and personnel
protective equipment (PPE), as well as less tangible (but equally important) elements
such as time and training availability.
Though there are many areas where human factor in aircraft maintenance exists but we
can evaluate these under three basic categories:
Today, more than 18,000 aircrafts provide service in all the airline fleets of the world. In
2016, this number is estimated to go beyond 26,000.
Despite the very low risk factor, when the causes of aircraft accidents were
investigated, most of the time it was found out that, "simple errors cause major
disasters”.
The table below demonstrates the Boeing statistics related to the causes of plane
crashes that occur in all jet fleets of airliners engaged in commercial air transport and
cause mortal damages.
Main causes of plane crashes that occurred between the years 1990-1999:
Looking at the table below, where the 476 accidents that occurred in the U.S. between
the years 1959-1986 and the 145 accidents that occurred between the years 1987-
1996 are analyzed, we observe that the accidents resulting from maintenance have
increased from 3% to 6%.
Three studies give an idea of the kind of maintenance problems that feature in
accidents and incidents. In 1992, the UK CAA listed the most common maintenance
errors found in occurrence reports:
When the facts are revealed, it becomes obvious that during the time of course until
the accident occurs, a stream of human errors that we can describe as chain of errors
go unnoticed. If we could break the chain of errors during maintenance, accidents
would not occur.
In the research conducted to determine the causes of accidents, more than one of
the factors causing the accident creates knock-on effect. In the event that one of the
aforementioned factors did not emerge, or the order of events changed, in other
words, if the chain of errors was broken at some point, the accident would not occur.
For this reason, all weak links should be identified for the sake of flight safety. (Reason
Model)
negligence
exhaustion
stress
time-pressure
norms
equipment deficit
Problems arising from the maintenance could be related to engine, landing gear,
systems, structural or components, or they could also emerge during ramp services.
One the one hand, errors can be the cause of fatal, seriously damaging accidents; on
the other hand, errors can cause damages that may result in the aircraft remaining
on the ground for a long time.
Aircraft maintenance personnel work with many boundaries, rules, possibilities, and
challenges and together with different people that have different tasks.
Human-Machine Relationship
The advancement of technology, clarification of maintenance methods, having
established standards and rules and establishing new monitoring/control systems have
caused a decline in machine-related (technical) errors over time.
There is a tendency among human beings towards complacency, the belief that an
accident will never happen to "me" or to "my company". This can be a major problem
when attempting to convince individuals or organizations of the need to look at human
factors issues, recognize their risks and implement improvements, rather than merely
paying "lip-service."
Never hesitate to ask questions about a topic you have encountered for the first time
and that is new to you. Do not learn by making mistakes. Remember the following
Murphy rule if you do have reservations about what you do:
“If there is an erroneous way of doing something, the path you will follow is that way
most of the time.”
While keeping in mind Murphy's Law may increase our awareness of potential incidents
and accidents, there are other human factors to consider that are based on the
limitations of the human body and mind.
Module 9
Human Factors
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common
words and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate,
typical examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws
describing the subject.
The applicant should be able to read and understand sketches, drawings and schematics
describing the subject.
The applicant should be able to apply his knowledge in a practical manner using detailed
procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and
comprehensive manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other subjects.
The applicant should be able to give a detailed description of the subject using theoretical
fundamentals and specific examples.
The applicant should understand and be able to use mathematical formulae related to the subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using manufacturer's
instructions.
The applicant should be able to interpret results from various sources and measurements and
apply corrective action where appropriate. Intentionally Blank
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
Vision; 9.2
Hearing; 9.2
Memory; 9.2
9.2.1 – General
Knowing human abilities and the limitations of those abilities, understanding human
capacity, and paying attention to those in every application constitute the basis of our
topic. Humans have strengths and weaknesses. Not taking human limitations into
account when assigning people to tasks makes errors inevitable. The correct
question is not “Can this job get done?”; but should be “Can this job get done
safely and properly by the relevant person?”.
Our work performance cannot be considered separately from our life performance.
When we consider our 24-hour life performance, we encounter biological rhythm.
Sleeping / wakefulness order is a determinant of this rhythm. Moreover, diet and
social life are also included in this rhythm. All of these are phenomena that a carried
over to work life. Persons have two types of performance, namely actual and ideal
performance. Actual performance is the sum of the effort and skills that can be
displayed under private life and work life conditions. Ideal performance, on the other
hand, is the sum of the effort and skills that we can be able to display when private
life and work life conditions can be controlled.
Achieving the ideal performance and ensuring its continuity begins with taking control
of the factors that influence our performance.
The vestibular system of the body is a system that regulates the balance and
movements that significantly affect the performance of the body. The brain enables
coordination through the synchronization of eyes and ear. In case of contradictory
information flow between the eyes and ear, orientation of the brain is impaired.
Because, understanding and comprehension begin with the eyes and ear. It is
worth remembering our visual and audible systems in order to ensure our
personal control.
Light enters the eye through the cornea, then passes through the iris and the lens
and falls on the retina. Here the light stimulates the light-sensitive cells on the
retina (rods and cones) and these pass small electrical impulses by way of the
optic nerveto the visual cortexin the brain.
The cornea is a clear ‘window’ at the very front of the eye. The cornea acts as a
fixed focusing device. The focusing is achieved by the shape of the cornea
bending the incoming light rays. The cornea is responsible for between 70% and
80% of the total focusing ability (refraction) of the eye.
Eye, has the ability to adapt to different levels of light, daylight and the darkness.
The iris (the coloured part of the eye) controls the amount of light that is allowed to
enter the eye. It does this by varying the size of the pupil (the dark area in the
centre of the iris). The pupil of the eye protects the retina, which is the part that is
sensitive to light, by growing / shrinking with the effect of the beams entering
the eye. When the person tries to see in darkness, the pupil grows; when the light
is bright, the pupil shrinks. In addition, the process that enables the coloring
begins. Rod cells become the main sensor in the dark. In the dark, vision is not
sharp and is colorless. The person only sees shades of gray. As the light intensity
decreases, the sensitivity of the eye against colors decreases.
In order for the objects to be seen from different distances, eye needs to focus
and the pupils need to zoom in on that object. It is the movement of the eye
muscles that arranges the vision of distant objects. The brain might interpret the
perceived visual messages with some confusion and hesitation due to past learning
and experiences. That is, the memory contains records. If there is a difference
between records and the vision, the eye might misapprehend.
Vision can be improved by increasing the lighting level, but only up to a point, as
the law of diminishing returns operates. Also, increased illumination could result in
increased glare. Older people are more affected by the glare of reflected light than
younger people. Moving from an extremely bright environment to a dimmer one
has the effect of vision being severely reduced until the eyes get used to less light
being available. This is because the eyes have become light adapted. If an
engineer works in a very dark environment for a long time, his eyes gradually
become dark adapted allowing better visual acuity. This can take about 7 minutes
for the cones and 30 minutes for the rods. As a consequence, moving between a
bright hanger (or the inside of an aircraft) to a dark apron area at night can mean
that the maintenance engineer must wait for his eyes to adjust (adapt).
Refractive Errors
The cornea and lens of your eye helps you focus. Refractive errors are vision
problems that happen when the shape of the eye keeps you from focusing well.
The cause could be the length of the eyeball (longer or shorter), changes in the
shape of the cornea, or aging of the lens.
The most common symptom is blurred vision. Other symptoms may include
double vision, haziness, glare or halos around bright lights, squinting,
headaches, or eye strain.
Glasses or contact lenses can usually correct refractive errors. Laser eye
surgery may also be a possibility.
Foreign Substances
Vision can be adversely affected by the use of certain drugs and medications,
alcohol, and smoking cigarettes. With smoking, carbon monoxide which builds up
in the bloodstream allows less oxygen to be carried in the blood to the eyes. This
is known as hypoxia and can impair rapidly the sensitivity of the rods.
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Turkish Technic Inc.
© Copyright 2016
Rev.02 – 01 Dec 2016 Training Purpose Only
Colour Blindness
Colour blindness, also known as color vision deficiency, is the decreased ability to
see color or differences in color.
Colour blindness is usually transmitted genetically, but can also be caused by
brain, eye or nerve damage. Inherited color blindness is caused by abnormal photo
pigments. These color-detecting molecules are located in cone cells.
There are three main kinds of color blindness, based on photo pigment defects in
the three different kinds of cones that respond to blue, green, and red light.
Red-green color blindness is the most common, followed by blue-yellow color
blindness. A complete absence of color vision —total color blindness – is rare.
Although not directly affecting visual acuity, inability to see particular colours can
be a problem for the aircraft maintenance engineer. Amongst other things good
colour vision for engineer. Amongst other things, good colourvision for
maintenance engineers is important for:
o Recognising components
o Distinguishing between wires
o Using various diagnostic tools
o Recognizing various lights on the aircraft (e.g. warning lights)
The person who is aware that he has such a disorder should ask for help from
other people around when he is uncertain.
Around 10% of the male population is affected by colour blindness, while less than
1% of the female population is affected.
Outer ear collects sound and composed of pinna, auditory canal and the
eardrum. Middle ear, which transmits the sound to the inner ear, is composed
of 3 small bones called the hammer, anvil and stirrup. At the same time, middle
ear opens to the nose and the throat. The pressure here is equalized with the
pressure of the external environment through swallowing, yawning or sneezing.
Unlike the middle ear, the inner ear is filled with fluid. The last of the ossicles in
the middle ear is connected to the cochlea. This contains a fine membrane (the
basilar membrane) covered in hair-like cells which are sensitive to movement in
the fluid. Any vibrations they detect cause neural impulses to be transmitted to the
brain via the auditory nerve.
In the inner ear, there are three semi-circular canals that are perpendicular to
each other that equilibrate and transmit information to the brain. The axis of
these canals is parallel to the axis of the aircraft. Bristles with the appearance
of fluid and hair are responsible for balance. The regulate acceleration and
speed. If the fluid inside the canal and the body move in the same direction, the
balance does not deteriorate as the bristles in the canal remain in an upright
position. Otherwise, the balance of the body is impaired. (When the person stops
suddenly or turns the head to the opposite direction after shaking or rotating the
head in the same direction). Inner ear is the main element of the vestibular
system, and transmits balance and movement information to the brain.
There are very diverse causes of hearing problems. For example, the blockage
of the connection between the middle ear and mouth / nose as a result of
catching cold decreases the hearing ability. Moreover, audio transmission is
restrained as a result of the calcification of the small bones in the middle ear or
due to accumulation of fluids, and again, the person might encounter hearing
problems. However, the most important reason is that the ear is exposed to high
volume of sounds for a long time. Permanent damage to the ear is inevitable in
this case. Disease conditions in the brain also affect hearing. The impairment of
hearing ability as inversely proportional to age is a natural consequence.
Employees should have annual hearing exams, if they work in a job with
consistent exposure to sound levels more than 85 dB.
Continued exposure to very loud noise leads to fatigue and therefore to a higher
potential for error.
Think about closing the hangar doors to remove external sources of noise, for
example, but if you cannot prevent the noise, ensure that appropriate personal
protective equipment (PPE) is used. In noisy environments, use appropriate
communication headsets where possible, bearing in mind that ear plugs and
headsets may restrict you from hearing warnings from other team members, or
being aware of approaching hazards.
Positive and negative many factors affect people in the process of gathering
information about the world around them (seeing, hearing, etc.), perceiving
(interpreting), evaluating and reacting.
To process this information, warning signals stimulate the person’s attention and
perception systems. Signals are sent to the brain. They are processed in the
brain. The result depends on the nature and structure of the received message.
Decision-making process begins with the shaping of the results of the stimulus.
Mobile feeding
Experience
& memory
Action of
the
technician
Visual feeding
Since our brain undertakes the most important duties, it would be appropriate to
mention the interesting facts about the brain that surfaced in recent years:
Rapid development of the brain that begins in the mother‟s womb continues until
the end of 20 years of age. However, during and after this development, if the
brain is not used enough (reading, writing, learning, playing sports etc.), and not
protected (balanced diet, foods that make vascular obstruction, avoidance of
smoking and alcohol etc.), building blocks of the brain, in other words, “neurons”
will disappear rapidly.
Ageing cannot be prevented, however, just like a well-maintained machine or
aircraft, there are simple but crucial things we can do for the brain in order to
have a healthy and happy life. Preventing obliviousness and strengthening the
memory is only possible through the use of the brain.
Our brain performs functions such as controlling and coordinating every organ of
our body, muscles, senses, emotions, memory, and our balance, and thinking,
information storage, speaking, hearing, seeing, paying attention, motivation,
moving, sleeping, rejoicing, worrying hoping, anxiety, fear, respiration, blood
circulation, decision making, learning, forgetting, and remembering.
o “Out-of-the-box” thinking
o Art, including the ability to draw, paint, sculpt, etc.
o Imaginative thinking
o Music, including the ability to play instruments with ease or to recognize a
song melody and play it back upon “hearing it”
o Language skills
(reading, writing, speaking)
o Math
o Logic and reasoning
o Science
Attention
It refers to the characteristic of a person to ignore irrelevant event and focus on
the issue of interest. It is always prevalent during the monitoring of the situation,
assessment of the acquired response and reaction to the response. A person
that continues his normal speech in a noisy environment constitutes an example
to this issue. It is the ability to focus on a source among many sources. On the
contrary, keeping track of more than one thing at the same time is considered as
fragmented or scattered attention.
Perception
The structure that should be the basis for normal functioning of the brain is the
correct and regular perception. Five sense organs inform the brain regarding
what is happening outside. Perception refers to the awareness of objects, attributes
or events that stimulate sense organs. Perception is influenced by the
environments, emotional experiences, personal feelings, attitudes, goals, and
urges.
2.20 Module 9.2 Human Performance and Limitations Turkish Technic Inc.
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9.2.6 – Memory
The ability to recall is an important stage of the information process. Even the
simplest system cannot function without the memory. Human memory is a limited
resource that is also is linked to education. Disciplines that would prevent the
overload of the memory when designing any kind of system must be considered.
The materials and tools to be used are brought from storage in the shop and held
on the workbench so that they can be easily reached during construction. Similarly,
working memory is our mental workbench where new information can be combined
with material already in long-term memory to form a new product.
Some people learn faster visually. For them, information and messages that are
perceived visually are more permanent.
Some people, on the contrary, find learning by listening a more effective. For
them, it is the words they remember that makes learning more long lasting. Yet
others learn better through direct application. The knowledge they receive this
way becomes permanent. “Learning” method that combines all three methods,
however, speeds up the learning process and makes it permanent. The order
information that is transmitted during a presentation is important, such that last
information provided is the one that is best memorable one. Information that is
provided in-between is the least memorable one.
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The fact that a person has received education on any subject and has proved his
knowledge does not necessarily mean that he would have the same knowledge
five years later. Sometimes we can face situations that we can refer to as the
negative impact of education. For instance, if the new things we learn are similar
to the information that is located in our long-term memory, in practice we might
make mistakes by mixing old and new information. Therefore, when dealing with
similar yet not exactly the same things, we should make more detailed controls.
The important thing to keep in memory the things that we should not forget.
Everyone has to develop his own technique to improve memory. In other words,
everyone has his own form of learning. Some techniques to remember, to improve
memory, or to learn easily are summarized below:
- Repeating vocally
- Note-taking
- Summarizing
- Preparing check list
- Using abbreviations
- Linking subjects together
- Reproducing meaningful words with initial letters
- Establish relations between numbers
- Observing during implementation or implementing directly
We all have both anxiety and fear. This is natural. However, when the degree of
fear reaches a level that hampers the person’s daily life and hinders his normal
functioning, it becomes abnormal. In that case we speak of phobias.
One of the most prominent features of phobias is that its source is unconscious.
According to Freud's approach, the source of phobias is unresolved dilemmas in
the subconscious. Without resolving those dilemmas, it would inadequate and
meaningless to seek to eliminate the phobia alone. Because the dilemma will be
unresolved, the person may adopt another phobia.
Claustrophobia is defined as the fear of closed spaces. In the aircraft, fuel tanks,
cargo, tail sections, sections of ventilation systems are narrow, dark and
distressing places. Working in such places may trigger such discomfort; people
with claustrophobia prefer to be close to exits from closed spaces. These people
should at least not work alone; work plans should be prepared taking this factor
into consideration.
Acrophobia is the fear of the height. For example, a technician with the phobia
may feel discomfort when working on the wing or tail of the aircraft. His inability
to focus fully on the task increases the likelihood of making a mistake. In this kind
of operating conditions, seat belts and appropriate platform / dock should be
used in order to prevent the occurrence of phobic symptoms.
Managers are required to take this situation into consideration when assigning
tasks to staff.
2.24 Module 9.2 Human Performance and Limitations Turkish Technic Inc.
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Rev.02 – 01 Dec 2016 Training Purpose Only
European Aviation Safety Agency (EASA)
Module 9
Human Factors
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common
words and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate,
typical examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws
describing the subject.
The applicant should be able to read and understand sketches, drawings and schematics
describing the subject.
The applicant should be able to apply his knowledge in a practical manner using detailed
procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and
comprehensive manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other
subjects.
The applicant should be able to give a detailed description of the subject using theoretical
fundamentals and specific examples.
The applicant should understand and be able to use mathematical formulae related to the subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using manufacturer's
instructions.
The applicant should be able to interpret results from various sources and measurements and
apply corrective action where appropriate. Intentionally Blank
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
9.3.1 – General
We can define social psychology as a field that scrutinizes how we think, feel and
move in social environments, and how social environments influence our thoughts,
emotions and actions.
Social psychology highlights that human behavior is a function of both the individual
and the group. Every individual knows the existence of many other individual and
thinks that the burden of responsibility does not belong to him alone. He may
think that “Somebody must have done something or somebody else will definitely
intervene”. The presence of others distributes the responsibility to take action. The
individual behaves according to the requirements of the social system he is a part of.
Aircraft maintenance technician is a also part of the system. The system is treated
in 6 stages:
o At the core of the system is the technician himself with his knowledge, training,
skills, abilities, and all other characteristics.
o The second ring is his immediate surroundings. Hangar, workplace, external
environment, aircraft, components, equipment, materials, time pressure,
teamwork, and shift order are included in this context.
o The third ring includes planning, control, OJT, directions, priorities, performance,
and management stages.
o The fourth ring is the organization. It includes concepts such as policies,
strategies, vision, mission, and personnel selection, processes, procedures,
training and quality assurance.
o The fifth ring is defined as the rules. Safety rules their implementation, the
command of the senior management are included here.
o The sixth and last in the ring is the extended environment. It includes the
economic situation, the society’s perception about the institution, and social
relations.
Company position, organizational structure and the type of management directly
affect the employees. Similarly, the economic situation, perception of outsiders,
relationships, collaborations, and staff turnover is closely related to incidents and
accidents caused by human factor.
Peer Pressure
Peer pressure is influence on a peer group, observers or individual exerts that
encourages others to change their attitudes, values, or behaviors to conform to
groups. Social groups affected include membership groups, in which individuals
are "formally" members (such as political parties and trade unions), or social
cliquesin which membership is not clearly defined. A person affected by peer
pressure may or may not want to belong to these groups. They may also
recognize dissociative groups with which they would not wish to associate, and
thus they behave adversely concerning that group's behaviors.
An organisation with a positive safety culture, for example, will exert pressure on
newcomers to operate with a professional and positive attitude to safety. However,
an organisation where shortcuts and non-compliance (violations) to achieve
unrealistic goals are commonplace will have a negative influence on the behaviour
of individuals. If individuals are expected to cut corners to get the job done, peer
pressure can influence others to do the same.
In a group you are more likely to agree with the majority, rather than disagree, or
rock the boat (think back to peer pressure). The desire to reach unanimous
agreement can result in what is known as group think, and may override any
individual desire to put forward an alternative view. It is human nature to want to fit
in with the group, but you must be prepared to challenge the group if you believe
actions are irresponsible or unsafe.
Obedience to Authority
The most important difference that separates obedience with compliance is that
obedience occurs unconditionally and without any questioning. Sometimes
compliance may confront us as a social necessity. Obedience, however, is more
of an obligation than choice against the authority. When the society is
traditional, authority is instigated and, hence, social compliance takes the form
of obedience. According to the instructions given by the authority, i.e. through
violation of the rules, one can find himself in a situation of infringement of written
instructions. Written rules must absolutely be adhered to and recorded.
Polarization
Polarization occurs as the individuals forming the society take sides and, at a
more advanced stage, to defend his side in a way to cause conflicts. It destroys
common values such as participation, communion and production in the society.
A technician that is stuck between different decisions is extremely inclined to
make mistakes.
Norms that emerge from many factors such as overconfidence, pressure and lack
of resources have the potential to cause errors.
Social norms are unspoken rules and expectations regarding how we should
think and act. Social norms tell us to look forward when stepping in an elevator
and not to sit next to a stranger in an uncrowded bus or train. Moreover, social
norms create and maintain all racial discrimination or gender discrimination
ideology in a society.
Unsafe norms are non-productive or detract from the productivity of the group.
Taking shortcuts in aircraft maintenance, working from memory, or not following
procedures are examples of unsafe norms. Newcomers are better able to identify
these unsafe norms than long-standing members of the group. On the other hand,
the newcomer’s credibility depends on his or her assimilation into the group. The
newcomer’s assimilation, however, depends on adherence to the group norms.
Everyone should be aware of the perceptiveness of newcomers in identifying
unhealthy norms and develop a positive attitude toward the possibility that norms
may need to be changed. Finally, as newcomers become assimilated into the
group structure, they build credibility with others. Once this has been done, a
relative newcomer may begin to institute change within the group.
Leadership Types
Designated – Leadership with authority, rank, or title (Official / permanent)
Functional - Leadership with the knowledge and experience (informal/ temporary)
Leader Responsibilities
Directing and coordinating team activities
Delegating tasks to team members. Ensuring that the team apprehends his
expectations. Drawing attention to critical aspects of the team. Providing the team
with the mission information.
Questioning the team’s knowledge about the mission
Providing feedback to the team members on their performance
Creating and maintaining a professional atmosphere
Motivation is one of the main parameters of psychology. It is derived from the Latin
word “movare” which means movement. Motive is any condition that effects the
preparation to begin or continue certain behavior. Motives are the reasons and
processes that push the organisms to behave in a certain way and give direction to
these behaviors. Motivated behavior is directed towards a goal and has a purpose.
Therefore, motivation is a process that allows the person to move forward towards
the goal.
Although it seems that the most important factor that creates motivation is to
desire/want success, it is just as important to believe that the effort will result in
success. For example, if a person does not believe that he can win the reward, even
if he is longing for the reward, he will not make the necessary effort.
From a different perspective, together with skills, motivation determines
performance. Therefore, lack of motivation decreases the performance. That is to
say, the performance of a person that has average skills and yet high motivation
may be better than the performance of a person that has superior skills and yet
low motivation.
One of the most important factors of motivation is that the person feels
belongingness to a group. However, due to some factors that are either way related
to the character of the person or related to undesirable life experiences, factors such
as stress, negative impact on the environment, failures and bad events, the person
might be demotivated. In other words, lack of motivation can be experienced. (Such
as not desiring anything, decrease in movement, and underperformance).
The group of factors leading to satisfaction is called motivators. These are topics
such as “challenge at work”, “responsibility” and “creativity”. Herzberg defined
the other group as hygiene factors. Company policy, management, compensation,
job security, status and personal life are the most prominent ones. These factors
that are mostly related to tangible negativities at work create direct
dissatisfaction. Failure to satisfy expectations is also a cause of disappointments.
They easily demotivate the person. In order to prevent this phenomenon, the
positive thinking may be sufficient. A positive message is more motivating than a
negative one. On the contrary, our negative thoughts influence us negatively. We
need to continue to believe in ourselves despite consecutive setbacks.
o apathy and indifference to the job, including reduced regard for safety
whilst working;
o a poor record of time keeping and high absenteeism;
o an exaggeration of the effects/difficulties encountered in problems,
disputes and grievances;
o a lack of co-operation in dealing with problems or difficulties;
o unjustified resistance to change.
Safety Culture
Basically all organizations are founded with the purpose of profits and increasing
production. For aviation, a significant dimension in this respect is flight safety. For
airliners, “safety” should be the priority. Being successful in controlling risks and
preventing accidents is only possible by embedding the concept of safety in
corporate culture.
It is a necessity to develop an understanding of the classical human factor, and
an understanding and act of safety in order to reduce and prevent behaviors that
place safety at jeopardy. In this direction, any effort towards “human” reduces the
risks of the institution.
Since aviation is a technological system is complex and is dependent on many
sub-systems, many organizational errors are found to be the underlying reason
when accidents and the factors causing accidents were analyzed.
In other words, an understanding in the corporate culture that even partially
underestimates the safety principle may be nourished in the long-run, and may
trigger certain conditions and lead to an accident.
Even in companies that adhere to rules and make no compromises in terms of
safety, unofficial behaviors (culture) that tolerate and even encourage deviations
from the procedures may develop. This tendency of corporate culture is extremely
dangerous and harmful. There should definitely be a combat against these
kinds of understandings and behavior. In order for the safety culture to develop in
an organization, all employees regardless of their positions should be actively
involved in the prevention of error.
o Security policy
o Workforce resources
o Man-hour planning control for the planned maintenance
o Procedures for identifying and correcting maintenance errors
o Shift / task turnover procedures
o Procedures for notifying the company regarding the errors
and uncertainties in maintenance data.
Module 9
Human Factors
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common words
and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate, typical
examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws
describing the subject.
The applicant should be able to read and understand sketches, drawings and schematics describing
the subject.
The applicant should be able to apply his knowledge in a practical manner using detailed procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and comprehensive
manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other subjects.
The applicant should be able to give a detailed description of the subject using theoretical
fundamentals and specific examples.
The applicant should understand and be able to use mathematical formulae related to the subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using manufacturer's
instructions.
The applicant should be able to interpret results from various sources and measurements and apply
corrective action where appropriate. Intentionally Blank
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
A sick and weak physique may have adverse effects on (work) performance.
The quality of work done may be poor. The likelihood of making mistakes is high.
The technician should be made aware of how he should behave if he feels sick
or is exhausted to the level that he is unable to work.
He should undertake an easier task. He should ask a colleague to control the
work he does. He should not neglect his treatment.
Stress is how our body responds to our lifestyle. If our lifestyle contains many
factors that increase stress, our tensions will also increase. However, stress is one
of the essentials of life. If it disappears completely, it may yield to biological and
psychological consequences that might be equivalent of death. Therefore, we
should first stop having a negative perception of stress in life, and learn to live with
it and learn how to control it before it controls us.
o Alarm reaction
o Resistance and protection reaction
o Fatigue and disease symptoms.
The first symptom of stress is physical and the response of the body is in the
form of alarm. Alarm initially begins in the pupils; then mental alertness increases,
heartbeats become variant; we start sweating or feeling cold; gastric secretion
increases, blood sugar rate alternates, blood pressure may increase
(hypertension); and observable symptoms such as appetite and sleep disorders,
muscle pains, back and chest pains begin.
o Heart Attack
o Stomach Ulcer
o Cancer
o Constipation
o Irritability
o Obliviousness
The sources of stress are divided into two, namely physical and psychological
stress.
Physical sources
- Diseases
o Acute Illnesses (Colds, flu)
o Chronic Disease (Diabetes, heart disease, alcoholism)
- Environment
o Climate - Temperature (Heat, cold, wind, humidity, health effects,
performance effects)
o Noise (hearing, cognitive performance and health effects)
o Motion - Vibration (operating the power engine, moving platforms, devices,
laying rivets, performance and health effects)
o Gas - Smoke (disturbing environment, threats to health)
- Fatigue
o Shift work (circadian rhythm, activities outside of work, lack of sleep)
o Workload (overtime hours, inadequate rest periods)
Psychological sources
The sources of stress that particularly come to mind when it comes to aircraft
maintenance are time pressure and emergencies.
We can say that speed is the symbol of our industry. Undoubtedly, time pressure
and speed becomes a source of stress for us when safety (especially human life)
is included in the formula.
Urgent and important tasks become “firefighting” for us every day. Such a working
environment is a natural source of stress, and when we add shifts in the picture,
it becomes apparent that we need definitely to control it.
Another effect is temperature. When working in a (-) 15 oC environment, especially
in winter and night conditions, naturally, subconsciously we think about “warming
up”. On the contrary, when working at 30oC, focusing on the thoughts of
“drinking something cold” and “cooling down” increase the possibility of error
making.
When we are not vigorous and energetic, or when it is at low levels, our attention
mechanism is not fully ready. At the same time, our production capacity is low.
Boredom and inattention dominate. At the other end of the curve above, that is,
when the person is over energetic, productivity also drops. The reason for that is,
to some degree, people divide their job to pieces when they work and try to finish
the job by focusing on the information they deem necessary. We can call this,
focusing on a narrow area.
Being energetic at a workplace varies with the level of job satisfaction. At the same
time, however, environmental factors such as sound level (noise) also affect the
status of being energetic and vigorous.
Workload Management
Another factor affecting the performance is situations of work overload or work
having little work to do. Very long working hours, and particularly, having a lot of
work requiring concentration of attention creates stress among employees and
increases the risk of making mistakes. The level of mental and physical exhaustion
increases.
Managing your workload is important. (Do not wait until the deadline to speed up
the job.)
If the speed of the job is prioritized over the accuracy of the job, the likelihood of
it being of low quality and erroneous increases.
Accidents / incidents often emerge from poor management of the workload.
To do it fast, to do it right?
Can a task that is completed fast be correctly completed? Can a task that is
completed correctly be speedily completed?
Notwithstanding, having a small workload also creates tension. Purposeless free
time emerges and creates certain habits among employees. This situation
prevents commitment, achievement and the desire to be challenged, and hence
brings about consequences such as indifference and disruptions to the peace of
mind.
If you say “Hurry up and finish your work” to someone, you are calling in errors.
Working in Shifts
Since aircrafts mainly fly during the day, aircraft maintenance is required to be
done at night. Human organism, however, is in a more active condition during the
day. It is programmed to rest and sleep at night. It is inevitable that the efficiency
of the business is affected negatively due to this adjustment disorder due to the
working conditions. Health and physical conditions of the aircraft maintenance
technicians is very important for the efficiency of the system. Most of the
maintenance errors that led to airplane accidents are made at night shifts. Based
on this fact, we can conclude that working in shifts is an important factor affecting
human performance.
Sleep disorders caused by shifts, discomfort in stomach due to bad eating habits,
and stress caused by inharmoniousness in social life is reflected seriously on
work if no precautions are taken.
Some people welcome the variety of working different times associated with
regular shift work patterns. Advantages may include more days off and avoiding
peak traffic times when travelling to work. The disadvantages of shift working are
mainly associated with:
o working ‘unsociable hours’, meaning that time available with friends, family, etc.
will be disrupted;
o working when human performance is known to be poorer (i.e. between 3 a.m.
and 5 a.m.);
o problems associated with general desynchronisation and disturbance of the
body’s various rhythms (principally sleeping patterns).
PHYSIOLOGICAL PSYCHOMOTOR
Body temperature - Memory -
Muscular strength - Communication skills -
Sight - Visual monitoring of objects -
Blood circulation - Attention -
Muscle glycogen - Personal care -
Blood sugar + Mobility -
Light reflex + Job sharing -
Visual adaptation time + Being open to criticisms -
Pulse + Fear, depression +
Errors +
Response time +
Not only the repetitive tasks that are completed with the minimum number of
moves or simple moves per unit of time, but also the littleness of the information
obtained per unit of time increase monotony. Monotone jobs result in tiredness
and decreased attention, and hence increase the likelihood of errors.
In order to reduce the negative effects of exhaustion, Planning critical tasks for the
day shift. Validating jobs done at the night shift with appropriate control tools next
day. Breaking long and repetitive tasks into smaller pieces by putting small breaks
in- between.
HEALTH EFFECTS
Irregularities in the stomach and intestines Decreased attention
Irritability Lack of concentration
Weight loss Memory loss
Exhaustion Intense sensuality
Weakness against diseases Unwillingness
Some of the precautions against insomnia include staying away from beverages
that contain caffeine and theine before going to sleep, not allowing small naps
(snoozing/catnaps) during the day, staying away from stress (actions that would
create emotional or physical impacts), drinking a warm drink (milk etc.), and
doing light exercises.
There is still no definitive answer to “Why do we need to sleep?”, however, there
are two available theories:
1 - Sleeping in order to conserve energy – to save energy
2 - Regeneration
Dreaming is important for learning, reasoning, controlling emotions and other
mental activities. The importance of the dreamless period is that in this period
proteins are structured, and the brain and the nervous system regain their control
over the other systems of the body. The factors affecting the need for sleep are
age, health, circadian rhythm, the body metabolism, physical working level, sleep
quality, the most recent amount of sleep, body temperature, and personal
differences.
Alcohol
It is common knowledge that nutrition is an influential factor in human behavior
and performance. For instance, protein, fats, and refined sugar may cause
negative situations such as restlessness, short temper and sleepiness.
Coffee, tea, rich seasonings, spicy meat and well-cooked food affect the nervous
system and accelerate the metabolism.
Alcohol has negative effects on vision and hearing, and long-term and short-term
memory. It hinders decision-making and conception systems, and impairs reflexes.
It deteriorates motion coordination. And worse of all, it alters the individual’s
perception about himself, and puts forward emotions of overconfidence or lack of
confidence.
Alcohol, drug and substance usage influences performance. Three main effects
are:
o Impairment of the central nervous system (examples: alcohol, pain killer and
sleeping pills): reflexes and thinking ability slows down.
o Stimulation of the central nervous system (examples: amphetamine and
caffeine): reflexes and thinking speeds up, however, too much of it creates
negative effects
o Hallucinations (examples: marijuana and LSD): the ability to perceive the
reality is influenced. Alcohol threshold allowed in the blood is 0.4%.
It is established that 10% of the causes of fatal accidents between 1975 and
1981 is alcohol. Moreover, as for accidents whose causes are still not determined
fully, the effect of alcohol is unknown.
The individual needs to know what kinds of effects the drugs etc. that he uses
have on their performance. If the drug is a prescribed one, the individual needs to
know its side effects. (Examples: sleepiness or decrease in mental capacity).
That way, the person can act consciously, being aware of the effects of the pill on
his performance (Not working with technical equipment; Not undertaking
complicated tasks; Staying home.)
Module 9
Human Factors
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common
words and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate,
typical examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws
describing the subject.
The applicant should be able to read and understand sketches, drawings and schematics
describing the subject.
The applicant should be able to apply his knowledge in a practical manner using detailed
procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and
comprehensive manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other subjects.
The applicant should be able to give a detailed description of the subject using theoretical
fundamentals and specific examples.
The applicant should understand and be able to use mathematical formulae related to the subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using manufacturer's
instructions.
The applicant should be able to interpret results from various sources and measurements and apply
corrective action where appropriate. Intentionally Blank
Low Temperature................................................................................................13
Hypothermia……………......................................................................................14
9.5.4 – Motion&Vibration...................................................................................15
9.5.5 – Working Environment...........................................................................16
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
Illumination 9.5
As explained under the hearing topic, noise has adverse effects on employees
both in the short term and in the long-term. It reduces the ability of the employees to
hear, lowers performance, disrupts communication, results in unheard warning
notifications, adversely affects employee health, and also results in errors due to lack
of concentration caused by distractions. Due to the inherent nature of the workplace,
noises produced by the aircraft engines, APU, the vehicles on the apron, equipment
used during maintenance comprise the undesirable and disturbing factors in this
context. In order to be protected from this effect, rules and protection measures
should be paid utmost attention.
Noise-induced hearing loss occurs because excessive noise damages the delicate
hearing mechanism of the inner ear. Initially, the excessive noise causes a temporary
hearing loss, or temporary hearing loss, and hearing recovers to normal over a period
of time.
A temporary hearing loss may occur when a person’s exposure to noise exceeds the
equivalent of 85 dB for 8 hours, or a peak sound pressure level of 140 dB. However,
repeated exposure to such excessive noise normally transforms this into a permanent
loss, or permanent hearing loss.
Temporary and permanent threshold shifts may also be accompanied by ringing in the
ears, called tinnitus. This can also become permanent, and may be extremely
distressing to the individual.
Employees working on the aircraft use a variety of liquid and chemical substance as a
work requirement. For example, technicians are in contact with oil, grease, hydraulic
fluid, fuel, paint, cleaning fluids and solvents.
Besides, they also are exposed to exhaust gas and other dirty and harmful gases.
Other than the negative effects of being in contact with these fluids, the gas
(evaporation) or the unpleasant odors released by these fluids enters into our
body during respiration. Normally it is possible to realize these gases from their
smells, however, some gases are odorless and are not possible to realize. The
amount of gas increases with the increase of temperature, increased surface or
spraying.
These gases cause not only breathing problems, but also vision problems and
irritations in the eye; the situation may be even more serious if the individual is
exposed to those gases in confined areas (such as the fuel tank). For this reason, the
use of masks or protective equipment is required. These harmful gases both disrupt
the employee health and diversely affect the performance as it creates the desire
to move away from the environment as soon as possible because of the negative
circumstances.
For the aircraft technicians to perform their jobs in a safe and efficient way, having
a proper lighting is a must. Detailed information regarding eye and vision was
provided in the 9.2.2 section; besides, we have already mentioned that spotting
colors and details would be easier with adequate lighting. Inappropriate or inadequate
lighting results in errors during job execution, zoning out or extensions in time in task
completion. Many factors need to be considered for proper lighting (The color of
the light, its dissemination, direction and amount etc.). The structure of the
illuminated surface is also important. A dark gray colored dirty surface reflects only 10-
12 percent of the light falling on the surface, whereas a light colored clean surface
can reflect more than 90 percent of it.
Lighting should be bright enough to enable easy vision; and its direction of
propagation should not be in a way to dazzle the eye(s). At the same time, the
level of lighting should be high enough to allow vision. Not only general illumination of
the workplace, but also the lighting of the lodge is important.
Reflection of light from the surface or the direct contact of light with the eye
impairs vision. Dazzling causes hampered vision and decreased operating capacity as
well as increased accidents.
More specifically, working continuously under light that dazzles the eye, may result in
eye disorders. For this reason, the eye needs to be protected from the undesirable
dazzling. In order to prevent dazzling, the light is placed well above the line of
vision or is coated with a glassy (opaque) or a semi-transparent material. Any dirtiness
on the source of light significantly decreases the amount of light emitted by the
source. In the industry, the dusting of the sources of light results in a 50% decrease
in lighting in six months; and in cases of dusty environments, it results in a much
higher decrease. Therefore, if the intensity of lighting that was measured when light
sources were clean is barely sufficient, lighting intensity when these sources get dirty
will be very low and insufficient. It is hence an inevitable requirement to clean the
sources of light on a regular basis, and to prepare a program for the maintenance.
Workplaces are determined by the climatic conditions in the setting, the thermal
state of the environment and the atmospheric pressure.
Human organism has the ability to maintain a level of almost invariant body
temperature for a very short time (in a restricted manner). Good functioning of the
human body is ensured by maintaining the body temperature at a normal level,
which is an essential condition for the health and life of the human. The person should
have thermal comfort, and should live in equilibrium with the environment.
Air temperature, air moisture, airflow rate, and the thermal state of the environment
determined by the thermal radiation (radiant heat that is a function of the
temperature surrounding the object and its environment) may affect the temperature
fluctuations in human organisms positively or negatively (the body gives or receives
heat). The ambient temperature does not consist of one variable only. Together with
the temperature increasing or decreasing in degrees, the condition of the humidity
and the airflow velocity increases or alleviates the effects of the temperature.
Low Temperature
Just like high-temperature, low temperature also may have adverse effects on
work success. At low temperatures, perception and reaction time is reduced. Manual
dexterity decreases. However, the effects of low temperature are not as significant
as the effects of high temperature on success. The adverse effects of low temperature
can be significantly reduced with proper and overclothing.
Hypothermia occurs when a person's body temperature drops below 35C (95F). Normal
body temperature is around 37C (98.6F).
Hypothermia can quickly become life threatening and should be treated as a medical
emergency.
Hypothermia is caused by getting too cold, as the body loses more heat than it can
generate and body temperature drops below 35C (95F).
There are different types of hypothermia, depending on how quickly the body loses heat:
When your body temperature drops, your heart, nervous system and other organs can't
work normally. Left untreated, hypothermia can eventually lead to complete failure of
your heart and respiratory system and to death.
Vibration is low frequency and high amplitude, vibrating energy emission that is
usually emitted in the solid medium and is perceived by the sense of touch. Its
qualities and effect depends on the level of vibration, its frequency, duration of
impact, direction, personal sensibility, region affected and the risk factors.
Stationary engine causing vibrations on the workplace floor, equipment, supplies, all
sorts of hand-held air-compressed, vibrating tools and equipment produce vibrations.
Exposure to vibration can also cause fatigue. If it is for a long-term and severe, it
leads to headache and muscle disorders. Unlike noise, vibration does not cause
permanent damages. Sometimes, however, when rivet gun and similar devices are
used for a long time, they can cause permanent damages to the body. It may result in
pain in the waist, the back and to a lesser the extent the neck spine, and may also
cause disc deformation.
Tissue damages arise as a result of the energy created by the vibration flowing into
the organism. There is a vibration that affects the organism generally or locally.
The degree of harmful impact varies according to the level of vibrations, frequency,
duration, impact site, impact direction, characteristic of the tissue affected, personal
sensibility, and risk factors.
Mobility system (bones), blood vessels, and nervous system get damaged by the
vibration. Towards the end of the shift, pain, numbness, movement difficulties, and
sometimes cramps in the hand, wrist, elbow and shoulder making it difficult to work;
wrist swelling and local pain in the wrist; pain and movement difficulties in the back,
the neck, and sometimes the spine; and bone and joint problems in the elbow may
occur.
Moving platforms or lifts also cause adverse effects on some of the employees.
These tools swing in the air due to height, and hence, are causes of a negative feeling
of uneasiness.
A positive work environment makes employees feel good about coming to work, and
this provides the motivation to sustain them throughout the day.
The working environment must be appropriate for the task carried out and in particular
special requirements observed. Unless otherwise dictated by the particular task
environment, the working environment must be such that the effectiveness of
personnel is not impaired.
The working environment comprises the physical environment, the social environment
and the tasks that need to be carried out. Each of these three components of the
working environment interacts, for example:
Module 9
Human Factors
9.6 Tasks
Intentionally Blank
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common
words and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate,
typical examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws
describing the subject.
The applicant should be able to read and understand sketches, drawings and schematics
describing the subject.
The applicant should be able to apply his knowledge in a practical manner using detailed
procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and
comprehensive manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other
subjects.
The applicant should be able to give a detailed description of the subject using theoretical
fundamentals and specific examples.
The applicant should understand and be able to use mathematical formulae related to the
subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using manufacturer's
instructions.
The applicant should be able to interpret results from various sources and measurements and
apply corrective action where appropriate. Intentionally Blank
9.6 - TASKS
9.6.1 – Physical Work........................................................................................9
9.6.2 – Repetitive Tasks and Overconfidence.................................................9
9.6.3 – Visual Inspection ………………….......................................................10
9.6.4 – Complex Systems................................................................................11
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
Tasks 9.6 1 1 1 1
Since aircraft maintenance has a lot of repetitive tasks, danger of all sorts is
present at all times. As self-confidence increases, the person starts taking less
cognizance of the work and stress decreases, and at this stage, the probability of
error increases. The higher the self-confidence is, the more the necessary warning
to ensure reaction.
If a task is performed often enough, it may eventually become automatic and the
required skills and actions are stored in long term memory. These are known as
motor programmes and are ingrained routines that have been established through
practice. The use of a motor programme reduces the load on the central decision
maker.
Visual inspection is one of the most important controls done by the maintenance
staff in order to provide the status of airworthiness. Visual inspection is done with
the eye alone or with many different assistive instruments in order to evaluate
and examine the condition of the aircraft, and the components or the systems in
the aircraft. In order to enhance their visual capabilities, technical personnel
makes inspections using instruments such as magnifying lens and boroscope.
Furthermore, status information can also be obtained through methods such as
moving or touching the surface.
Visual inspections constitute many of the controls done in the aircraft. However,
these are still a lot of factors that affect the soundness of these controls.
Work-Specific Factors
Topics such as control time, types of damage, repetitiveness / monotony of the
job, probability of damages, feed forwards and feedbacks constitute this
group. The job taking a long time may create weariness, exhaustion and attention
deficit in the employee. Routine and repeated tasks also may result in the
decrease in concentration to the task. Let us think about a task where no
negativities are experienced during the many controls done. In these kinds of
controls, the likelihood of not noticing a damage is very high.
All modern large aircrafts can be described as complex systems. Some of these
many different systems that are different from each other and are complex in
themselves are: flight/cruise controls, power engines, air-conditioning
systems, and the like.
Any complex system has a wide range of different data; it functions using
these data or these data are used to trigger other systems. One or many
different outputs may materialize from the system. It is easy for the technician to
understand the purpose formation, the function and the duty in simple
systems. In other words, the system is clear and concise for him; it is relatively
easy to find and identify troubles.
It can be difficult to maintain attention for long periods on complex tasks. Think
about scheduling appropriate breaks during the task, and ensuring workload is
maintained at an appropriate level.
The technician knows that the system serves, however, in complex systems, the
difference between the systems and how they are envisaged in the mind may
cause complications. Technicians need to be trained to be in possession of
detailed information about the complex system in order to be able to understand
how the system functions, the components comprising the system or why it may
have malfunctioned. It should be ensured that the training provided for the above-
mentioned reasons does not overload the technician with excessive information
and complicates the task even more. For this special training to be successful, the
technician should maintain the balance between knowing the details of the system
and his ability to find and solve the problem.
Written procedures and reference resources about complex systems of an aircraft
are very significant resources. These resources include wide-ranging explanations
regarding the fulfillment of the maintenance drafts, inspection, testing, and
adjustment operations. These explanations provide information regarding the
relationship between one system and the other systems; and more importantly,
they include warnings and alerts about the system, specific regions and
components.
Keeping regular records of the works done, and withholding these records for a
certain periods of time is very important in aviation. Records have been highly
emphasized in most of the audits conducted.
All operations carried out on an aircraft must be documented. This ensures
traceability. When implementing a maintenance board, if the job has more than
one step, the block related to the document must be signed / stamped after the
completion of each step. Before signing all the blocks, the task should be fully
completed. If an operation not mentioned in the aircraft maintenance manual is
completed, it must be absolutely put into records. (Such as the requirement to
remove a clamp on a tube in order to remove the pump, etc.).
It is known that lack of information resulting from insufficient recording has a role
in many of the events and accident that occurred.
Procedures and Practices
A clear and complete procedure written in plain language decreases the risk that
the person performing tasks in accordance with this procedure makes mistakes,
and also decreases the likelihood that he performs additional tasks that are not
included in this procedure.
The most important issue required by all systems and regulations is that the
records of the transactions are kept once the transaction is complete in a time
manner. That is to say, in simple words, our rule should be as follows:
DO WHAT IS WRITTEN, AND WRITE WHAT YOU HAVE DONE
Module 9
Human Factors
9.7 Communication
Intentionally Blank
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common
words and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate,
typical examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws
describing the subject.
The applicant should be able to read and understand sketches, drawings and schematics
describing the subject.
The applicant should be able to apply his knowledge in a practical manner using detailed
procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and
comprehensive manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other
subjects.
The applicant should be able to give a detailed description of the subject using theoretical
fundamentals and specific examples.
The applicant should understand and be able to use mathematical formulae related to the subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using manufacturer's
instructions.
The applicant should be able to interpret results from various sources and measurements and
apply corrective action where appropriate. Intentionally Blank
9.7 - COMMUNICATION
9.7.1 – Communication Process.......................................................................9
Factors affecting communication........................................................................11
Poor communication ……………………………………….....................................12
9.7.2 – Communication within and between Teams.......................................13
Shift change........................................................................................................14
9.7.3 – Work Logging and Recording..............................................................15
9.7.4 – Keeping up to date and currency.........................................................16
9.7.5 – Dissemination of Information...............................................................17
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
Communication 9.7 2 2 2 2
1. Idea formation
2. Message encoding
3. Message transmission (through communication channel)
4. Message decoding
5. Feedback (not necessarily present in a communication process)
Encoding here means converting the sender’s idea into words and/or gestures with
the purpose to convey its meaning to the receiver. In case of verbal communication,
the main problem is the tendency of some words to have different meaning for
different people.
It is important to remember that the idea creation and encoding process are
influenced by professional and cultural background, his/her knowledge, experience,
and skills, as well as the context of the situation and mood.
For choosing the right communication channel the sender should ask him/herself
different questions, like:
The answer to the question of where perform the communication is our physical and
social environment. The most important factor in the physical environment in a work
setting is noise, and the most important factor in the social environment is
relationships.
A very important factor in communication is the idea of stress. It's a natural feeling
that people have, especially when they are operating in a high-pressure
environment or situation and, in some cases, stress can actually enable them to
communicate more effectively. However, stress can often be a factor that
influences bad communication. When people are suffering from too much stress,
they are more likely to misread other people, act inappropriately or fall into bad
behaviors that end up diminishing the quality of communication with other people.
People's perceptions are also very important to the communication process. How
people interpret the messages given to them by other parties can greatly influence
what is actually communicated and where a relationship leads. It's very important
that people listen closely to one another when communicating because if people
don't do this, the communication can be totally ineffective.
It is said that our brain has the capacity to understand 600 words in 1 minute.
However, a person speaks with an average pace of 120 words in 1 minute. Thus,
we evaluate the remaining 480 words either as a good listener or, as explained
below, as a bad listener:
o by criticizing the subject or the speaker
o by occupying our minds with other things
o by planning what we will say
o by wandering off the subject
o by interrupting the other person
Shift Change
When maintenance operation needs to be completed or the rest of the operation
needs to be transferred due to the changes in shifts or duties, it is important for
the safety that the details of all the completed, unfinished and incomplete or
postponed maintenance activities - that are done so as to realize the shift change
process in a communicative manner and within sufficient time between the
incoming and the outgoing employees- are written down in a clear way.
Keeping regular records of the works done, and with holding these records for
a certain periods of time is very important in aviation. Records have been highly
emphasized in most of the audits conducted.
All operations carried out on an aircraft must be documented. This ensures
traceability. When implementing a maintenance board, if the job has more than
one step, the block related to the document must be signed / stamped after the
completion of each step. Before signing all the blocks, the task should be fully
completed. If an operation not mentioned in the aircraft maintenance manual is
completed, it must be absolutely put into records. (Such as the requirement to
remove a clamp on a tube in order to remove the pump, etc.).
It is known that lack of information resulting from insufficient recording has a role
in many of the events and accident that occurred.
To maintain his currency, he must keep abreast of pertinent information relating to:
o new aircraft types or variants;
o new technologies and new aircraft systems;
o new tools and maintenance practices;
o modifications to current aircraft and systems he works on;
o revised maintenance procedures and practices.
Responsibility for maintaining currency lies with both the individual technician and
the maintenance organisation for which he works. The technician should make it
his business to keep up-to-date with changes in his profession. The organisation
should provide the appropriate training and allow their staff time to undertake the
training before working on a new aircraft type or variant.
Employees and the organization share the responsibility to learn about new
information and events. Safety culture is a good information sharing and
enlightenment inside organizational forms. Typically, the organization will be the
transmitter of information, and the maintenance personnel will be the recipients.
Planning helps the technician regarding how the maintenance should be done or
regarding how he should guide the team members in terms of how to do things.
A part of this method is to understand the information regarding the task to be
completed and to check the information in order to draw conclusions. It is required
to investigate and control whether there is a certain way of doing the job or
whether there is an important warning that explains the equipment to be used, and
the relationship of that equipment with the components or parts. It is also an
obligation that the employees working outside of the main centre (external stations)
are aware of these warnings and new alterations.
There should normally be someone within the maintenance organisation with the
responsibility for disseminating information. Supervisors can play an important role
by ensuring that the engineers within their team have seen and understood any
communicated information.
Below are some of the written communication tools that are subject to rapid
changes and that may lead to errors and malfunctioning when they are not
updated
- Maintenance boards (work card) / non-routine boards
- Bulletin (SB / TYE)
- Circular (A/C, A/D)
- Note, letter, fax, e-mail
Let us remember the bad habits and jargon regarding written communication,
and let as try to avoid those as much as possible:
- The less I write, the less I get into trouble in future!
- If I do not write this, they cannot prove what I am doing!
- All these papers and records cannot ever ensure that the aircrafts fly better!
- I do not have the time to fill out this form!
Module 9
Human Factors
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common
words and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate,
typical examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws
describing the subject.
The applicant should be able to read and understand sketches, drawings and schematics
describing the subject.
The applicant should be able to apply his knowledge in a practical manner using detailed
procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and
comprehensive manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other
subjects.
The applicant should be able to give a detailed description of the subject using theoretical
fundamentals and specific examples.
The applicant should understand and be able to use mathematical formulae related to the subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using manufacturer's
instructions.
The applicant should be able to interpret results from various sources and measurements and
apply corrective action where appropriate. Intentionally Blank
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
Error is a normal and natural part of everyday life, it is generally accepted that we will
make errors daily. In fact, research suggests that we make between three to six errors
every waking hour, regardless of the task being performed.
While this may appear to be a large number of errors, the good news is that the vast
majority have no serious consequences, because they are automatically self-
corrected: somebody or something reminds us what we should be doing, or the errors
we make do not involve a potential safety hazard.
Imagine that you drive the wrong way to the local shops. As you leave home, you turn
down the wrong street and realising this, you alter your course (self-correction), or the
passenger in your car says something (passenger reminds us where we were going),
or you continue on the wrong route (wasting time). Similarly, a pilot forgetting to
perform a checklist can be picked up by another crew member, or a warning system
on the aircraft. The term ‘near-misses’ describes errors that occur, but are corrected
before any damage is caused.
Some people refer to the terms human factors and human error as if they are the
same. Human factors is a field of scientific knowledge drawing from established
disciplines such as ergonomics, physiology, psychology and engineering.
Therefore human error involves all those situations where what you planned to do did
not happen. For example, forgetting to set the parking brake in your car, or hitting the
brakes in wet and slippery road conditions.
Intentional actions
Those actions that involve conscious choices. These actions are largely due to
judgement or motivational processes.
Unintentional actions
Those in which the right intention or plan is incorrectly carried out, or where there is a
failure to carry out an action. These actions typically occur due to attention or memory
failures.
The figure below illustrates the difference between unintentional and intentional
actions:
Slips are errors made when you don’t pay attention, or your plan is incorrectly carried
out (e.g. you intend to drive to the shops, but turn the way you usually do to go work).
Lapses occur as a result of you failing to carry out an intended action, usually due to
a memory failure (you forget to buy something at the shop). For example, you forget to
check that the undercarriage locking pins are in place.
Module 9. 8 Human Error Turkish Technic Inc.
8.10
Rev.02 – 01 Dec 2016 Training Purpose Only © Copyright 2016
Mistakes occur when you plan to do something, and carry out your plan accordingly,
but it does not produce the outcome you wanted (the shop does not sell the item you
are looking for). This is often because your knowledge was inadequate, or the rules
you applied in deciding what to do were inappropriate.
Routine violations result when a violation becomes what is normally done (the norm)
within your workplace, or for you as an individual. Routine violations are often short
cuts taken to help you get the job done more quickly, more easily, or perhaps more
efficiently. Unless you monitor and control this behaviour, it can lead to a culture that
tolerates violations.
Situational violations occur when there is a gap between what the rules or procedures
require and what you think is available or possible. When there is a lack of local
resources, or a failure to understand real working conditions, this may increase
pressure on you to ignore procedures or break the rules to get the job done and
achieve targets.
Optimising violations (personal or organisational) involve you doing something for
personal goals, or simply for the associated thrills (for ‘kicks’). However, where there
are incentives, such as a bonus for meeting production targets, this may encourage
organizational optimising violations. Identifying organisational optimising violations can
assist in improving both productivity and safety goals within your organisation, if
brought out into the open, communicated and discussed.
Exceptional violations these are one-off actions you might take to deal with an unusual
situation, such as speeding to hospital rather than waiting for an ambulance, or
jumping into a runaway vehicle to stop it hitting someone.
Turkish Technic Inc. Module 9.8 Human Error
© Copyright 2016 8.11
Training Purpose Only
Rev.02 – 01 Dec 2016
Person Approach and System Approach
It would be beneficial to correctly separate the human error from the system
failure at the beginning. There are two approaches to error; “individualistic approach”
and “the whole system approach”.
In the individualistic approach, i.e. the traditional approach, the interpretation made
after the incident or the accident suggests that, “Everything was in order, and so
the error is made by the last person that touched the aircraft (which happens to be
the technician in most cases)”. The important thing here is to investigate the issue
throughout the whole system, and to uncover the organizational factors that
contributed to the error.
It is important to understand the underlying causes of errors and violations. We
need to investigate whether the error is individualistic or more systematic, that is to
say, whether it is a repeatable problem or whether it is related to a single
person or the system as a whole.
Human Factor trainings help to recognize these factors one by one, and to prevent
conditions and behaviors that stimulate errors. However, unless the entire system (in
this case, the aircraft maintenance system) is designed to resist errors, the effect will
be limited. (Such as well-written procedures, good planning, mechanisms to detect
errors when they occur etc.)
We call the serious consequences of human errors "failures." Some human errors have
serious consequences, but most do not. In a typical conversation with another person,
we might misspeak several times. The only real consequence of these errors is to
cause us to repeat or clarify our speech. A small percentage of human errors can
cause or contribute to safety lapses or, in severe cases, accidents that destroy
property or injure people.
We typically distinguish between "active" and "latent" failures. The difference here
concerns the length of time that passes before human errors have an adverse impact
upon the safety of the aviation system. An active failure is the specific individual activity
that is an obvious event. In the case of active failures, the negative outcome is almost
immediate. But, for latent failures, the consequences of human actions or decisions
can take a long time to reveal themselves, sometimes many years. A latent failure is
the company issues that lead up to the event.
For example, an AMT climbs up a ladder to do a repair knowing that the ladder is
broken. In this example, the active error was falling from the ladder. The latent error
was the broken ladder that someone should have replaced.
The distinction between active and latent failures can be summarized as follows:
o Active failures are the result of unsafe acts (errors and violations) committed by
those at the "sharp end" of the system (pilots, air traffic controllers, AMTs, etc.).
They are the people at the human-system interface whose actions can, and
sometime do, have immediate adverse consequences.
o Latent failures are created as the result of decisions, taken at the higher echelons
of the organization. Their damaging consequences may lie dormant for a long time,
only becoming evident when they combine with local triggering factors (e.g., errors,
violations and local conditions) to breach the system's defenses.
1. Lack of Communication
Failure to transmit, receive or provide enough information to complete a task. Never
assume anything.
Only 30% of verbal communication is received and understood by either side in a
conversation. Others usually remember the first and last part of what you say.
Improve your communication
o Say the most important things in the beginning and repeat them at the end.
o Use checklists.
3. Lack of Knowledge
Shortage of the training, information, and/or ability to successfully perform.
Don’t guess, know
o Use current manuals.
o Ask when you don’t know.
o Participate in training.
4. Distraction
Anything that draws your attention away from the task at hand.
Distractions are the #1 cause of forgetting things, including what has or has not
been done in a maintenance task.
Get back in the groove after a distraction
o Use checklists.
o Go back 3 steps when restarting the work.
6. Fatigue
Physical or mental exhaustion threatening work performance.
Eliminate fatigue-related performance issues
o Watch for symptoms of fatigue in yourself and others.
o Have others check your work.
7. Lack of Resources
Not having enough people, equipment, documentation, time, parts, etc., to complete
a task.
Improve supply and support
o Order parts before they are required.
o Have a plan for pooling or loaning parts.
9. Lack of Assertiveness
Failure to speak up or document concerns about instructions, orders, or the actions
of others.
Express your feelings, opinions, beliefs, and needs in a positive, productive manner
o Express concerns but offer positive solutions.
o Resolve one issue before addressing another
10. Stress
A physical, chemical, or emotional factor that causes physical or mental tension.
Manage stress before it affects your work
o Take a rational approach to problem solving.
o Take a short break when needed.
o Discuss the problem with someone who can help.
12. Norms
Expected, yet unwritten, rules of behavior.
Help maintain a positive environment with your good attitude and work habits
o Existing norms don’t make procedures right.
o Follow good safety procedures.
o Identify and eliminate negative norms.
The following errors are possible in aircrafts that are taken to maintenance:
1. The error is made during maintenance. (For example: changing a component
during aircraft maintenance and installing the new one wrongfully.)
2. An error exists when the aircraft is accepted for maintenance, and that error is
overlooked during maintenance. (For example: Not noticing the crack on an oil
pipe on the engine.)
Factors that adversely affect aircraft maintenance and cause employee mistakes:
There are varying estimates of the proportion of aircraft accidents related to maintenance
errors. Three studies found between 12 and 20 per cent of accidents involve maintenance.
According to some authorities, maintenance errors may be playing an increasing role in
causing accidents.
Even when accidents are averted, maintenance errors can be costly. Airline data show that
between 20 and 30 % of in-flight engine shutdowns occur after maintenance problems, and
around 50 % of engine-related flight delays and cancellations are due to maintenance
errors.
We could debate the accuracy of these figures. For example, some may argue that the
increase is due to a better awareness today of human factors and what causes accidents.
In other words, engineers may now be reporting a human error today they might not have
reported twenty years ago, because of our more mature safety systems approach.
Whatever the statistics, one thing is clear; we still need to continue to look at why these
errors occur to further improve aviation safety and efficiency.
Ironically, there are no statistics for the positive contribution of human factors. We should
remember that in countless cases, human action has prevented or corrected dangerous
situations. For example, Boeing research indicates that most fatigue cracks in aircraft are
discovered by maintenance engineers who were actually performing an unrelated task
when they noticed the crack.
Three studies give an idea of the kind of maintenance problems that feature in accidents
and incidents.
In 1992 the UK CAA listed the most common maintenance errors found in occurrence
reports:
1. Incorrect installation of the component
2. Use of wrong fittings
3. Use of wrong parts in the electrical equipment (wiring discrepancies)
4. Loose objects (e.g. tools) left around the aircraft
5. Inadequate lubrication
6. Cowling, access panels and fairings not secured
7. Oil/fuel caps, and refuel panels not secured
8. Landing gear ground lock pins not removed before departure
In 2003, a Boeing study found that the three most common errors were:
1. Equipment or part not installed
2. Incomplete installation
3. Cross connections
In 2008, a NASA study analysed 1062 maintenance incidents reported to NASA. The most
common errors were:
1. Required service not performed (e.g. worn tyres not replaced)
2. Documentation problems (e.g. incorrect sign-off)
3. Wrong part fitted (e.g. -250 tyre fitted to -100 aircraft)
4. Unapproved or improper repair (e.g. noncompliance with maintenance manual)
5. Part not installed (e.g. spacers and washers left off)
6. Incomplete installation (e.g. nuts left ‘finger tight’)
Herbert W. Heinrich put forward the following concept that became known as Heinrich's Law:
In a workplace, for every accident that causes a major injury, there are 29 accidents that cause
minor injuries and 300 near misses that cause no injuries. This is commonly depicted as a
pyramid or an iceberg.
Heinrich's law is based on probability and assumes that the number of accidents is inversely
proportional to the severity of those accidents. It leads to the conclusion that minimising the
number of minor incidents will lead to a reduction in major accidents, which is not necessarily
the case.
In this model, we can consider the base of the triangle as the part of the iceberg that is under
the water and hence is invisible. The ones presented here (3000 unsafe acts in our example)
are the events that are overlooked, though sometimes resolved, and yet is never reported;
and their causes are mostly not investigated. The causing factors behind the incidents that
are at the very top of the triangle (e.g. a plane crash) as well as the incidents that are at
the base of the triangle (e.g. filling out a form impartially) are, most of the time, the same. If
we could identify and eliminate these negativities during seemingly unimportant events, it
would be possible to prevent major incidents/accidents.
The main task of an air carrier is to carry its passengers and cargo from point “A”
to point “B” in the most comfortable and economically viable way. This can
only be possible by eliminating the causes of human-related errors in this
process. It would not be possible to completely eliminate all the risks inherent
in a system. Crises can only be controlled and prevented through risk
management. In the operations directed towards preventing risks, crises or
accidents, managers make decisions around the following three potential topics:
Analyzing the “Plane that fell during take-off due to the glaciation” incident as a
solid example to this topic, we can conclude that one of the following
practices should have been preferred to prevent this accident:
o Duplicate inspection
The first control is done by the person is charge. However, a second qualified
employee controls the same job once more. There is no definitive list of tasks
requiring duplicate inspection. The following aspects should be taken into account
in preparing such a list:
Criticality of the task (the result of the malfunction)
The task being vulnerable to human error (previous events, risk
assessment)
Presence/absence of other controls
Control done by the pilot before the flight (Pre-flight check)
Disciplined Management
No matter how large the organization is, it is the management that is responsible
for the functioning of the organization. It must ensure that the rules and procedures
are function properly. The management should never compromise on any topic
related to the maintenance and the flight safety. It is of great importance that the
changes and the regulations are implemented in the specified way and specified
times. In a sector where errors are irreparable or too costly, regulation of the
personnel and the working conditions, proper functioning of the procedures within
the system, and materialization of the required precautions are only possible with a
disciplined management.
The requirements of Part-145 cover issues such as the reporting and comparing,
evaluating and evaluating of the incidents in order to identify the shortcomings of the
organization that are related to safety and to diagnose those unfavourable conditions. Key
behaviours are specific maintenance behaviours that aim to minimize the frequency and
effects of maintenance errors that would affect the safety and the security of the flight.
Examination-Investigation of Errors
The purpose of analysing and investigating errors is to reduce errors arising during
maintenance processes or maintenance support processes, and improve flight
security. Errors have root causes and factors affecting those. Top priority is to
identify human error types and to determine the methods for minimizing these errors.
The personnel that investigates, analyses, and prepares reports needs to have
sufficient experience and must be trained on this issue.
When investigating the incidents, all related personnel should be interviewed and
detailed information should be gathered; and while doing that, it should be recalled
that the main purpose is not to punish the personnel, but to prevent future errors.
Feedback
The personnel should be notified and aware of the results of the investigations and
the research. In this way, repetition of the incident is prevented. Publishing reports
and informing the personnel are some of the duties of the organization. In human
factor trainings, these reports or the causes of the incidents are discussed, and the
employee awareness is raised. The reports are analyzed annually, and the inhibitive
effect of the changes and regulations are checked.
Turkish Technic Inc. Module 9.8 Human Error
© Copyright 2016 8.29
Training Purpose Only
Rev.02 – 01 Dec 2016
MEDA (Maintenance Error Decision Aid)
MEDA is a method developed by Boeing and put to use by many airliners, and it is
a method used for investigating the causes of maintenance errors.
The goal of MEDA is to uncover the factors that adversely affect human performance
and give rise to error. We can easily observe in which areas and issues these
factors that give rise to a maintenance error intensify:
For example, maybe a maintenance technician did not install a spacer on a nose
landing gear wheel (incomplete installation error) while re-installing the wheel,
which leads to an event. During the investigation, we find that he did not use the
maintenance manual to do the task because it was “not available;” he was working
in a poorly lighted room and did not see the spacer on the wheel that was being
replaced; and he was doing the task on overtime on the night shift and was
fatigued.
Module 9
Human Factors
LEVEL 1
A familiarisation with the principal elements of the subject.
Objectives: The applicant should be familiar with the basic elements of the subject.
The applicant should be able to give a simple description of the whole subject, using common
words and examples.
The applicant should be able to use typical terms.
LEVEL 2
A general knowledge of the theoretical and practical aspects of the subject.
An ability to apply that knowledge.
Objectives: The applicant should be able to understand the theoretical fundamentals of the subject.
The applicant should be able to give a general description of the subject using, as appropriate,
typical examples.
The applicant should be able to use mathematical formulae in conjunction with physical laws
describing the subject.
The applicant should be able to read and understand sketches, drawings and schematics
describing the subject.
The applicant should be able to apply his knowledge in a practical manner using detailed
procedures.
LEVEL 3
A detailed knowledge of the theoretical and practical aspects of the subject.
A capacity to combine and apply the separate elements of knowledge in a logical and
comprehensive manner.
Objectives: The applicant should know the theory of the subject and interrelationships with other
subjects.
The applicant should be able to give a detailed description of the subject using theoretical
fundamentals and specific examples.
The applicant should understand and be able to use mathematical formulae related to the
subject.
The applicant should be able to read, understand and prepare sketches, simple drawings and
schematics describing the subject.
The applicant should be able to apply his knowledge in a practical manner using
manufacturer's instructions.
The applicant should be able to interpret results from various sources and measurements and
apply corrective action where appropriate. Intentionally Blank
Licence Category
Part 66
Objective Module 9
Reference
A B1 B2 B3
Hazards at workplace generate health and safety issues, and the employees
must be protected from these dangers. There are many potential factors in aircraft
maintenance. Work accident is a negative situation leading to both financial and
emotional damages. Due to the natural characteristics of the work performed at
the workplace and the working conditions, many physical and chemical risks will
arise at the workplace environment. In fighting against the work accidents, as
the first stage, a comprehensive and thorough Risk Analysis needs to be done.
There are many potential hazards in the aircraft maintenance industry and it is
impossible to list them all here. However, a thorough health and safety appraisal
will reveal the hazards. Physical hazards may include:
The sign must attract a technician’s attention, it must be visible and it must be
understandable to the people it is aimed at. Additionally, in the maintenance
industry, it must be durable enough to remain effective, often for years, in areas
where dust and the elements can be present.
CAUTION SIGNS
The legislation notes that every individual in a workplace also has health and
safety responsibilities.
Thus, in an aircraft maintenance organisation, the health and safety policy might
include statements applicable to technicians such as the need to:
o Take reasonable care of the health and safety of themselves and others who
may be affected by their acts or omissions at work;
o Co-operate with the maintenance organisation to ensure that statutory
requirements concerning health and safety at work are met;
o Work in accordance with any safety instruction and/or training received;
o Inform their supervisor or management of work situations that represent an
immediate or potential danger to health and safety at work and any
shortcomings in protection arrangements;
o Not interfere intentionally or recklessly with, nor misuse, anything provided in
the interests of health and safety.
Technicians should ensure that they keep the working environment safe. Clutter,
rubbish, etc. is not only a nuisance to others, but can constitute a danger (e.g. a
trip hazard, fire hazard, etc.). In addition, technicians should be careful when
working on the line not to leave objects when a job has been completed. Foreign
Object Damage (FOD) is a risk to aircraft operating at an airfield.