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At least 19 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS1996

Early Warning: Development of Confidential Incident Reporting Systems

Accidents hardly ever happen without warning. The combination, or sequence, of failures and mistakes that cause an accident may indeed be unique but the individual failures and mistakes rarely are. In the USA in 1974 the crews on two different aircraft misunderstood the same aeronautical chart and descended towards their destination dangerously early towards a mountain. The first crew were in good weather conditions and could see the mountain and resolved their misinterpretation of the chart. The second crew six weeks later were not so lucky. In cloud they had no clues to point out their mistake nor the presence of the mountain. The resulting crash and the ensuing inquiry, which brought to light the previous incident, shocked the country but gave it the impetus to instigate a safety reporting system. This system eventually became the NASA's Aviation Safety Reporting System (ASRS). The programme collects incident reports from pilots, controllers, mechanics, cabin attendants and many others involved in aviation operations. By disseminating this safety information the ASRS has helped enormously to give US airlines and airspace the highest safety standards. Accident prevention is a goal sought by everyone in the aviation industry and establishing effective incident reporting programmes can go a long way toward achieving that goal. This article will describe the steps and issues required to establish an incident reporting system. The authors summarize the lessons learned from the ASRS, now in its twentieth year of operation and from the Confidential Human Factors Reporting (HER) Programme run by British Airways, an airline that is a recognized world leader in safety reporting and analysis. The differences between government and airline operation of confidential safety reporting systems will be addressed.

OLeary, Mike J.↗
NASA NTRS2008

Patterns of Error in Confidential Maintenance Incident Reports

Confidential reports of maintenance incidents are a valuable source of information on maintenance errors and the contexts within which they occur. NASA's Aviation Safety Reporting System (ASRS) has been receiving an increasing number of maintenance incident reports since a specialized maintenance reporting form was introduced in 1996. In a series of studies, the database of ASRS maintenance incidents was examined using correspondence analysis, a statistical technique that converts complex data tables into a visual form. The analyses revealed patterns within the ASRS data set that would have otherwise been difficult to detect. The results have implications for a range of purposes including human factors training, the design of procedures, and the identification of improvements in aircraft design.

Hobbs, Alan↗
NASA NTRS2021

Positive Train Control (PTC) Study: An Analysis of PTC-Related Reports Submitted to the Confidential Close Call Reporting System (C3RS)

A supplemental analysis of reports submitted to the voluntary Confidential Close Call Reporting System (C3RS) was conducted to identify the potential operational risks associated with the integration and operation of Positive Train Control (PTC) systems. This study identified four areas that may merit further investigation by FRA and rail carriers: System/Paperwork synchronization, training, PTC acceptance, and alerting mechanisms.

C3RS↗
NASA NTRS2004

The Office of Inspector General (OIG)

The NASA Office of Inspector General is the Federal Law Enforcement Agency at NASA which conducts criminal and regulatory investigations in which NASA is a victim. The OIG prevents and detects crime, fiaud, waste and abuse and assists NASA management in promoting economy, efficiency, and effectiveness in its programs and operations. Investigations (OI) and the Office of Audits (OA). The investigations side deals with criminal Investigations, administrative investigations, and civil investigations. The Audits side deals with inspections and assessments as well as the Auditing of NASA Programs and Activities. Our mission at the OIG is to conduct and supervise independent and objective audits and investigations relating to agency programs and operations; to promote economy, effectiveness and efficiency within the agency; to prevent and detect crime, fraud, waste and abuse in agency programs and operations; to review and make recommendations regarding existing and proposed legislation and regulations relating to agency programs and operations. We are also responsible for keeping the agency head and the Congress fully and currently informed of problems in agency programs and operations. deal with False Claims, False Statements, Conspiracy, Theft, Computer Crime, Mail Fraud, the Procurement Integrity Act, the Anti-Kickback Act, as well as noncompliance with NASA Management Instructions, the Federal Acquisition Regulations (FAR), and the Code of Federal Regulations (CFR). Most of the casework that is dealt with in our office is generated through gum shoe work or cases that we generate on our own. These cases can come from Law Enforcement Referrals, GIDEP Reports, EPlMS (NASA Quality System), Defense Contract Audit Agency, Newspaper Articles, and Confidential Information. In many cases, confidentiality is the biggest factor to informants coming forward. We are able to maintain confidentiality because the 01 is independent of NASA Management and doesn t report to the Center Directors, therefore the informant s mangers and supervisors are unaware of the informants actions. The only time when an informant s confidentiality may be compromised is when it is needed in a Court of Law and is released through a Judicial Court Order. During my tenure here at the NASA OIG/OI at Glenn Research Center, I have been involved in many different tasks. They have ranged from updating Suspected Unapproved Parts case files to independently interviewing NASA employees to turn up general background information. The 01 has the duty of informing NASA aeronautical safety managers of potential Nonconforming products. My mission is to compile a database of Nonconformance reports for distribution. The background information that I turn up from my interviews is then used to determine NASA s susceptibility to acceptance of unapproved parts. The IG organization is divided up into two separate disciplines, the Office of 01 investigations primarily focus on violations of Federal laws. Some of these violations

Macisco, Christopher A.↗
NASA NTRS2011

NASA Aviation Safety Reporting System (ASRS)

The NASA Aviation Safety Reporting System (ASRS) collects, analyzes, and distributes de-identified safety information provided through confidentially submitted reports from frontline aviation personnel. Since its inception in 1976, the ASRS has collected over 900,000 reports and has never breached the identity of the people sharing their information about events or safety issues. From this volume of data, the ASRS has released over 5,500 aviation safety alerts concerning potential hazards and safety concerns. The ASRS processes these reports, evaluates the information, and provides de-identified report information through the online ASRS Database at http://asrs.arc.nasa.gov. The NASA ASRS is also a founding member of the International Confidential Aviation Safety Systems (ICASS) group which is a collection of other national aviation reporting systems throughout the world. The ASRS model has also been replicated for application to improving safety in railroad, medical, fire fighting, and other domains. This presentation \vill discuss confidential, voluntary, and non-punitive reporting systems and their advantages in providing information for safety improvements.

Connell, Linda↗
NASA NTRS2017

NASA Aviation Safety Reporting System (ASRS)

The NASA Aviation Safety Reporting System (ASRS) collects, analyzes, and distributes de-identified safety information provided through confidentially submitted reports from frontline aviation personnel. Since its inception in 1976, the ASRS has collected over 1.4 million reports and has never breached the identity of the people sharing their information about events or safety issues. From this volume of data, the ASRS has released over 6,000 aviation safety alerts concerning potential hazards and safety concerns. The ASRS processes these reports, evaluates the information, and provides selected de-identified report information through the online ASRS Database at http:asrs.arc.nasa.gov. The NASA ASRS is also a founding member of the International Confidential Aviation Safety Systems (ICASS) group which is a collection of other national aviation reporting systems throughout the world. The ASRS model has also been replicated for application to improving safety in railroad, medical, fire fighting, and other domains. This presentation will discuss confidential, voluntary, and non-punitive reporting systems and their advantages in providing information for safety improvements.

Connell, Linda J.↗
NASA NTRS2016

NASA Aviation Safety Reporting System (ASRS)

The NASA Aviation Safety Reporting System (ASRS) collects, analyzes, and distributes de-identified safety information provided through confidentially submitted reports from frontline aviation personnel. Since its inception in 1976, the ASRS has collected over 1.4 M reports and has never breached the identity of the people sharing their information about events or safety issues. From this volume of data, the ASRS has released over 6,000 aviation safety alerts concerning potential hazards and safety concerns. The ASRS processes these reports, evaluates the information, and provides selected de-identified report information through the online ASRS Database at http:asrs.arc.nasa.gov. The NASA ASRS is also a founding member of the International Confidential Aviation Safety Systems (ICASS) group which is a collection of other national aviation reporting systems throughout the world. The ASRS model has also been replicated for application to improving safety in railroad, medical, fire fighting, and other domains. This presentation will discuss confidential, voluntary, and non-punitive reporting systems and their advantages in providing information for safety improvements.

Connell, Linda↗
NASA NTRS1999

Employee Assistance Program Issues

Employee Assistance Program (EAP) officers, as well as personnel in other disciplines from eight NASA Centers, attended this breakout session. Ms. Brenda Blair, MA, CEAP, a guest speaker at the conference, also attended as a consultant. Representatives from the NASA Centers introduced themselves and spoke briefly about their programs. In a discussion related to the conference theme on benchmarking, quality control issues within the EAP community and adequate documentation of cases were addressed. Disposition and provision for quality assurance checks for EAP providers in single person offices were also discussed. Ms. Blair presented methods for consulting with other NASA personnel in single person EAP offices as a quality control measure. EAP intervention in critical incidents was discussed. The question of whether EAP assistance is an asset or a potential liability in those situations was addressed. Suggestions were made of topics for future EAP video-teleconference topics. A program on EAP ethics was planned for a September video teleconference. Each person was asked to provide intake forms they use to Mr. Gettleman or Ms. Blair. Ms. Blair said she would review the forms to ensure that adequate notification is provided to the client for confidentiality. She would also review them to ensure they have adequate limits of confidentiality--a topic for future video teleconferencing. Mr. Gettleman described the NASA initiative to reduce stresses in the workplace, and the activities of an ad-hoc EAP group that will make recommendations to NASA senior management. Alternative training methods were discussed for reaching target audiences such as employees at risk, supervisors, and others. Pfc. David A. Pendleton, Victim Assistance Coordinator, U.S. Capitol Police. U.S. House of Representatives made a special presentation. Pfc. Pendleton was on duty during the tragic shooting of two Federal guards at the U.S. Capitol. He related the events immediately after the incident. He described the nature and structure of the EAP's and the separate nature of the House and Senate programs. This episode was a particularly difficult situation as large numbers of tourists were involved. William S. Barry, MD, the new Manager of the NASA Occupational Health Program Office was introduced to those attending the breakout session.

Gettleman, Alan G.↗
NASA NTRS2012

A DNA-Inspired Encryption Methodology for Secure, Mobile Ad Hoc Networks

Users are pushing for greater physical mobility with their network and Internet access. Mobile ad hoc networks (MANET) can provide an efficient mobile network architecture, but security is a key concern. A figure summarizes differences in the state of network security for MANET and fixed networks. MANETs require the ability to distinguish trusted peers, and tolerate the ingress/egress of nodes on an unscheduled basis. Because the networks by their very nature are mobile and self-organizing, use of a Public Key Infra structure (PKI), X.509 certificates, RSA, and nonce ex changes becomes problematic if the ideal of MANET is to be achieved. Molecular biology models such as DNA evolution can provide a basis for a proprietary security architecture that achieves high degrees of diffusion and confusion, and resistance to cryptanalysis. A proprietary encryption mechanism was developed that uses the principles of DNA replication and steganography (hidden word cryptography) for confidentiality and authentication. The foundation of the approach includes organization of coded words and messages using base pairs organized into genes, an expandable genome consisting of DNA-based chromosome keys, and a DNA-based message encoding, replication, and evolution and fitness. In evolutionary computing, a fitness algorithm determines whether candidate solutions, in this case encrypted messages, are sufficiently encrypted to be transmitted. The technology provides a mechanism for confidential electronic traffic over a MANET without a PKI for authenticating users.

Shaw, Harry↗
NASA NTRS2013

Ground Operations and ASRS

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline

human factors↗
NASA NTRS2013

System Driven Workarounds

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline. Safety reports highlighting system driven workarounds for the aviation community highlight the human workaround for the complex aviation system.

aviation safety↗
NASA NTRS2014

Cabin Safety Issues Related to Pre-Departure and Inflight Issues

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline. Safety reports highlighting the human element in cabin safety issues and concerns.

confidential reporting↗
NASA NTRS2014

Dangers on the Ramp: Aviation Safety Reporting System

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline.

confidential reporting↗
NASA NTRS2014

“Terrain, Terrain Pull-up!” Air Carrier Controlled Flight Toward Terrain Incidents Reported to the NASA ASRS

The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline. Safety reports highlighting controlled flight toward terrain incidents as reported to the NASA ASRS.

confidential reporting↗
NASA NTRSDate not supplied

NASA C3RS: Communication Works For Those Who Work At It!

The objective of the study is to learn about Communication Breakdown related to safety events reported to the Confidential Close Call Reporting System (C3RS). Studying the reported close calls can yield information about communication breakdowns that may be present in the railroad operations.

Confidential Close Call Reporting System↗
NASA NTRS1962

HUMAN CONTROL PERFORMANCE AND TOLERANCE UNDER SEVERE COMPLEX WAVE FORM VIBRATION, WITH A PRELIMINARY HISTORICAL REVIEW OF FLIGHT SIMULATION

What can we do, preparing for these pioneers, to insure that these expected vibrations will not jeopardize their lives nor their missions? This paper will describe one approach, of attempting to simulate the expected and more than the expected complex wave form vibrations to determine tolerance and pilot control capabilities, to attempt to find solutions in simulation before the first flights in reality. The experimental work to be described was done in November, 1959, and June, 1960, on the Johnsville Navy human centrifuge, at the Aviation Medical Acceleration Laboratory, U.S. Naval Air Development Center, Johnsville, Pennsylvania, and in June, 1960, on the North American "G-seat", the vertical accelerator of the North American Aviation Co., Inc., Columbus, Ohio, while the author was Jostle Program Officer at the Aviation Medical Acceleration Laboratory. The experimental work was the subject of the confidential reports NADC-MA-L6005 and NADC-MA-6128, U.S. Naval Air Development Center, and NA60H-444, North American Aviation, Inc., Columbus. Unclassified aspects can now be reported.

Vibration↗
NASA NTRS1965

Aerodynamic Design of Axial Flow Compressors

An overview of 'Aerodynamic systems design of axial flow compressors' is presented. Numerous chapters cover topics such as compressor design, potential and viscous flow in two dimensional cascades, compressor stall and blade vibration, and compressor flow theory. Theoretical aspects of flow are also covered. This work is based substantially on a three-volume Confidential Research Memorandum f h t issued by the National Advisory Committee for Aeronautics in 1956 and declassified in .1958 for release to the general public. The material, which was of a fundamental character, has been updated for the present edition in the light of subsequent developments in the field and has been carefully reexamined for current validity by members of the staff of the NASA Lewis Research Center, Cleveland, Ohio. It is now published for the first time in a single volume to meet continuing demand for the information and to make it readily available in convenient form to the engineering community both within and outside the National Aeronautics and Space Administration.

Axial flow compressor↗