TSB Quarterly Review — Third quarter 2017-18

ISSN 2369-7954

January 2018

Chair's message

As we embark on 2018, it is natural to look back and reflect on the work we accomplished in the previous year. During the last quarter of 2017, we deployed investigators to 18 accident sites across the country, started 14 new investigations and released 12 investigation reports.

One of those reports (A15P0081) includes a recommendation for Transport Canada and the industry to develop and implement requirements for a comprehensive substance abuse program to reduce the risk of impairment of persons while engaged in safety-sensitive functions. Also, as a marine accident report (M16A0327) demonstrates, concerns remain about unsafe operating practices and the use and availability of lifesaving appliances on board, such as emergency position-indicating radio beacons.

As part of our efforts to modernize our investigation processes and products, we have undertaken a pilot project and published a new short-form type of report for a few investigations. This pilot project will wrap-up in the next quarter and we expect to issue a new Occurrence Classification Policy along with some changes to our processes and products.

In the months ahead, we will continue through our investigations to dedicate time and effort to finding out what happened and why, to reduce the risk of it happening again. We will also take stock of the bigger picture and identify the key safety issues to be included in the next edition of our Watchlist, which will be published in late Fall.

Happy New Year!

Kathy Fox

Completed investigations

Developments

Blog posts: The TSB Recorder

Investigations started

  • Baldur, MB (Air)
  • Tweed, ON (Air)
  • Fond-du-Lac, SK (Air)
  • Fraser River, BC (Marine)
  • Billy Bishop Toronto City Airport (Air)
  • Saint-Luc Yard, Montreal, QC (Rail)
  • Thompson Airport, MB (Air)
  • Springbank Airport, AB (Air)
  • Lac-aux-Sables, QC (Rail)
  • Jean Lesage International Airport, QC (Air)
  • Mountain Subdivision, BC (Rail)
  • Belledune, NB (Marine)
  • Antelope, SK (Rail)
  • Campbell River, BC (Air)

This is not a comprehensive list.

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