Training Course: Advanced Aviation Safety, Investigation and RCA Course

Advanced aviation safety covering SMS, accident investigation, root cause analysis and safety leadership is the joined practice of managing hazards before they cause harm, finding out why occurrences happen and leading people to act on the findings. This 15-day advanced course is for experienced safety, quality and operations professionals in aviation, and delegates finish with a mock investigation report and an aviation safety improvement roadmap.

Introduction

Three references anchor the course. ICAO Annex 19 sets the safety management provisions that require service providers to run a Safety Management System. ICAO Annex 13 governs the conduct of accident and incident investigation, with prevention rather than blame as its aim. The Swiss Cheese Model explains how latent conditions and active failures line up to produce an occurrence. The level is advanced, with each discipline given its own depth across fifteen days. Teaching combines investigation simulations, case studies and analysis exercises from airline, maintenance and airport operations.

Course Objectives

• Apply ICAO Annex 19 requirements to the four components of an aviation Safety Management System
• Distinguish immediate, contributing and root causes and select the RCA technique that fits an occurrence
• Compare fault tree, event tree, bow-tie and fishbone analysis and interpret what each reveals
• Apply ICAO Annex 13 investigation steps to collect, preserve and analyse evidence from an occurrence
• Interpret human and organisational factors using the SHELL and Swiss Cheese models
• Justify corrective and preventive actions and leadership measures that strengthen a just safety culture

Target Audience

• Safety managers and SMS coordinators who must decide which hazards and occurrences need full investigation
• Accident and incident investigators who must judge which evidence and RCA method an occurrence requires
• Quality and compliance managers in maintenance organisations who must decide whether corrective actions address root causes
• Flight operations and airport operations managers who must judge how human factors findings change procedures
• HSE team leaders who must choose how safety messages and lessons learned reach front-line staff

Course Outline

Day 1: Aviation Safety Foundations and ICAO Standards

• ICAO Annex 19: Safety Management Provisions for States and Aviation Service Providers
• ICAO Annex 13 vs Annex 19: Accident Investigation Compared With Safety Management Requirements
• SMS Four Components: Safety Policy, Risk Management, Assurance and Promotion
• Accident Facts, Figures and Costs: What Occurrence Data Shows About Aviation Risk
• Major Accident Case Study: Lessons Drawn From a Well-Documented Aviation Occurrence

Day 2: Accident Causation and Safety Behaviour

• Accident Causation Factors: Why Accidents Still Occur Despite Mature Safety Systems
• Conscious vs Unconscious Influences: Deliberate Choices Compared With Habitual Safety Behaviour
• Bradley Curve: Four Stages From Reactive to Interdependent Safety Mindsets
• ABC Model of Attitudes: Affective, Behavioural and Cognitive Components Applied to SMS
• Behavioural Psychology in SMS: Practical Interventions That Change Unsafe Habits

Day 3: Human and Organisational Factors

• Errors vs Violations: Unintended Actions Compared With Deliberate Deviations and Their Triggers
• SHELL Model: Software, Hardware, Environment and Liveware Interfaces Explained
• Swiss Cheese Model: Latent Conditions and Active Failures Aligning Into Accidents
• Teamwork, Communication and Fatigue Management: Human Factors in Flight and Maintenance Operations
• Human Factors Evaluation Exercise: Contributing Factors in Flight and Maintenance Scenarios

Day 4: Hazard Management in Major Hazard Operations

• Major Hazards and Their Prevention: Identifying High-Consequence Aviation and Industrial Scenarios
• ISO 31000: Risk Management Principles and Process Applied to Safety Excellence
• Occupational vs Process Safety: Personal Injury Risk Compared With Major Release Risk
• Asset Risk Management: Linking Equipment Condition to Operational Safety Decisions
• Inspection and Auditing Procedures: Planning and Conducting Safety Assurance Checks

Day 5: Bow-Tie, Fault Tree and Event Tree Risk Tools

• Bow-Tie Methodology: Threats, Barriers, Top Event and Consequence Controls
• Fault Tree vs Event Tree Analysis: Backward Cause Logic Compared With Forward Consequence Paths
• Barrier Analysis: Testing Which Defences Failed or Were Missing
• Emergency Response Plans and Mutual Aid: On-Site and Off-Site Consequence Management
• Event Sequencing: Building Timelines That Order Actions, Conditions and Failures

Day 6: Safety Leadership and Communication

• Self-Awareness in Safety Leadership: How Personal Style Shapes Team Behaviour
• Communication Strategy and Social Performance: Analysing How Safety Leaders Are Received
• Safety Communication Campaigns: Stakeholder Engagement Around Priority Safety Messages
• Have To vs Want To: Compliance-Driven Compared With Commitment-Driven Safety Behaviour
• Situational Leadership: Adapting Style to Changing Challenges and Team Readiness

Day 7: Organisational Risk, Resilience and Crisis Management

• BS 65000: Guidance on Organisational Resilience and Adaptive Capacity in Operations
• ISO 22301 vs ISO 22361: Business Continuity Compared With Crisis Management Guidance
• ISO/IEC 27031: ICT Readiness for Keeping Critical Systems Operational During Disruption
• Strategic Risk and Risk Behaviour Analysis: Current and Future Threats to Operations
• Change and Major Incident Impact: Proactive Measures That Minimise Organisational Disruption

Day 8: Introduction to Root Cause Analysis

• Root Cause Analysis Purpose: Value for Aviation Safety and Performance Improvement
• Incidents vs Accidents vs System Failures: Relationships to Underlying Causes
• RCA Process Stages: Problem Definition, Data Collection, Causal Analysis and Action
• Aviation Safety Analysis Concepts: Hazards, Risk, Causes and Contributing Factors
• RCA and Compliance: How Causal Findings Support Prevention and Safety Oversight

Day 9: RCA Concepts, Data and Method Selection

• RCA Terminology: Immediate, Contributing and Root Causes Distinguished in Practice
• Investigation Data Collection: Evidence Needed for Defensible Causal Conclusions
• Method Selection Criteria: Matching RCA Tools to Event Type and Complexity
• Objectivity vs Confirmation Bias: Evidence-Led Analysis Compared With Premature Conclusions
• Maintenance Event Analysis: RCA Techniques for Technical and Maintenance Failures

Day 10: Five Whys, Fault Trees and Fishbone Diagrams

• Five Whys Technique: Structured Questioning for Aviation Problem Solving
• Fault Tree Construction: Logic Gates and Breakdown Pathways for System Failures
• Fishbone Diagram: Organising Possible Causes of Incidents Into Cause Categories
• Five Whys vs Fishbone vs Fault Tree: Strengths and Limits of Each Technique
• Cause Validation: Data Analysis Techniques That Confirm or Reject Suspected Causes

Day 11: Accident Investigation Process and Evidence

• Investigation Legal Basis and Scope: Objectives and Independence Under ICAO Annex 13
• Investigation Steps: Notification, Site Response, Evidence, Analysis and Reporting
• Evidence Sources: Interviews, Photographs, FDR and CVR Data, and Maintenance Documentation
• Evidence Preservation vs Evidence Analysis: Protecting Perishable Data Compared With Interpreting It
• Investigation Team Roles: HSE Team Leader, Management and Specialist Responsibilities

Day 12: Investigation Methodology and Interviewing

• Investigating All Occurrences: Why Near Misses Deserve the Same Investigative Rigour
• Investigation Checklists and Processes: Structuring Each Phase of the Inquiry
• Listening, Looking and Observing: Field Skills for Gathering Reliable Information
• Cognitive vs Standard Interviews: Memory-Based Recall Compared With Question-and-Answer Formats
• On-Site Investigation Simulation: Collecting and Reviewing Evidence at a Mock Occurrence

Day 13: Analysis, Reporting and Corrective Action

• Factual vs Analytical Report Sections: What Happened Compared With Why It Happened
• Persuasive Report Writing: Recommendations That Prompt Timely Management Action
• Corrective vs Preventive Actions: Fixing the Event Compared With Preventing Recurrence
• Action Feasibility and Effectiveness: Evaluating Sustainability of Proposed Corrective Measures
• Risk-Based Action Planning: Prioritising Measures by Residual Risk and Available Resources

Day 14: Safety Culture, Just Culture and Organisational Learning

• Just Culture: Distinguishing Honest Error From Reckless Behaviour in Safety Decisions
• Safety Reporting Systems: Encouraging Voluntary and Mandatory Occurrence Reports
• Leadership in Safety Culture: Building and Sustaining Commitment Across Operations
• Lessons Learned Dissemination: Sharing Findings Through Training and Safety Bulletins
• Reactive vs Proactive vs Predictive Safety: Three Approaches to Using Safety Data

Day 15: Capstone Practice: Investigation Report and Safety Improvement Roadmap

• Integrated Case Investigation: Applying Evidence, RCA and Human Factors Tools Together
• Mock Investigation Report: Applying Report Structure to Draft and Present Findings
• Findings Integration: Applying Investigation Results to Operational Training and Risk Management
• Peer Review vs Self Review: Testing Report Quality Through External Challenge
• Aviation Safety Improvement Roadmap: Completing the Post-Course Action Plan With Owners

Skills You Will Gain

• Safety Risk Management
• Bow-Tie Analysis
• Fault Tree Analysis
• Evidence Collection
• Investigation Interviewing
• Human Factors Analysis
• Corrective Action Planning
• Just Culture Leadership

Why Attend This Course

• From treating each discipline separately to linking SMS, investigation, RCA and leadership in one safety process
• From stopping at the first plausible cause to testing causes with fault trees, fishbones and barrier analysis
• From reports that describe events to reports that separate facts from analysis and drive corrective action
• From unstructured follow-up to a mock investigation report and an aviation safety improvement roadmap

Conclusion

Aviation safety at this level is a cycle: hazards are managed through the SMS, occurrences are investigated without blame, causes are analysed until they can be acted on, and leaders turn findings into changed behaviour. The course makes three distinctions clear: Annex 13 investigation versus Annex 19 safety management, immediate versus root causes, and honest error versus reckless behaviour. It suits experienced professionals who want each discipline in depth over fifteen days; a five-day integrated course suits those who need an overview.

Course FAQs

What is advanced aviation safety covering SMS, accident investigation and root cause analysis?

It is the combined practice of managing aviation hazards through a Safety Management System, investigating accidents and incidents to establish what happened and why, analysing root causes and leading the safety culture that acts on the findings.

What is the difference between ICAO Annex 13 and Annex 19 in aviation safety?

Annex 13 governs how accidents and serious incidents are investigated, with prevention as the sole objective. Annex 19 sets safety management responsibilities, requiring service providers to identify hazards, manage risk and assure safety performance before occurrences happen.

Which standards does the advanced aviation safety and accident investigation course follow?

The course follows ICAO Annex 19 for safety management, ICAO Annex 13 for investigation, ISO 31000 for risk management and the SHELL and Swiss Cheese models for human and organisational factors, with ISO 22301 and ISO 22361 for continuity and crisis response.

Is the advanced aviation safety and accident investigation course right for a maintenance quality manager?

Yes. Maintenance quality managers apply fault trees, fishbone diagrams and barrier analysis to technical failures, judge whether corrective actions reach root causes and link findings to the SMS used across the organisation.

What do delegates produce on the advanced aviation safety and accident investigation course?

Delegates produce a mock investigation report with factual and analytical sections, causal analysis and recommendations, and an aviation safety improvement roadmap that assigns corrective, preventive and cultural actions to owners.