    Aviation Safety: FAA's Safety Efforts Generally Strong but Face
    Challenges (20-SEP-06, GAO-06-1091T).

    The U.S. commercial aviation industry has had an extraordinary
    safety record in recent years. However, expected increases in
    air-traffic--including the introduction of new vehicles into the
    national airspace, such as unmanned vehicles and very light
    jets--and human resource issues, present challenges that have the
    potential to strain the existing safety oversight system. GAO's
    testimony focuses on these questions: (1) How is the Federal
    Aviation Administration (FAA) ensuring that the areas of highest
    safety risk are addressed? (2) How is FAA ensuring that its staff
    maintain the skills and knowledge to consistently carry out the
    agency's oversight programs? and (3) What are the key safety
    challenges facing FAA? This statement is based on our recent
    reports on FAA's inspection oversight programs, industry
    partnership programs, and enforcement and training programs. It
    is also based on interviews with FAA and relevant industry
    officials.
    -------------------------Indexing Terms-------------------------
    REPORTNUM:   GAO-06-1091T
        ACCNO:   A61201
      TITLE:     Aviation Safety: FAA's Safety Efforts Generally Strong
    but Face Challenges
         DATE:   09/20/2006
      SUBJECT:   Aircraft accidents
    	     Aircraft industry
    	     Airlines
    	     Commercial aviation
    	     Employee training
    	     Employees
    	     Inspection
    	     Program evaluation
    	     Program management
    	     Risk assessment
    	     Safety standards
    	     Strategic planning
    	     Transportation safety
    	     FAA Air Transportation Oversight System
    	     FAA Surveillance and Evaluation Program

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    GAO-06-1091T

         * Background
         * FAA's Safety Oversight System Includes Programs That Focus o
              * FAA's Oversight Focuses on Leveraging Inspector Resources, W
              * Enforcement Is an Important Element of FAA's Safety Oversigh
              * Data Limitations and Lack of Evaluations Limit FAA's Ability
         * Training Is an Integral Part of FAA's Safety Oversight Syste
         * FAA Faces a Number of Challenges in Overseeing Aviation Safe
              * FAA Faces Challenges in Human Resources
              * FAA Faces Challenges in Implementing Advanced Technology to
              * FAA Faces Challenges in Having Controllers Prepared for the
              * FAA's Inspector and Controller Workload Will Be Challenged b
              * FAA Needs to Retain Its Leadership Role in International Saf
         * GAO Contact and Staff Acknowledgments
         * Appendix I: Extent to Which FAA Follows Effective Management
         * Appendix II: Deployment of Surface Detection Equipment at Ai
         * Related GAO Products
              * Order by Mail or Phone

    Testimony

    Before the Subcommittee on Aviation, Committee on Transportation and
    Infrastructure, House of Representatives

    United States Government Accountability Office

    GAO

    For Release on Delivery Expected at 2:00 p.m. EDT

    Wednesday, September 20, 2006

    AVIATION SAFETY

    FAA's Safety Efforts Generally Strong but Face Challenges

    Statement of Gerald L. Dillingham, Ph.D. Director, Physical Infrastructure
    Issues

    GAO-06-1091T

    Mr. Chairman and Members of the Subcommittee:

    Thank you for the opportunity to testify today on issues related to
    aviation safety. The U.S. commercial aviation industry has had an
    extraordinary safety record in recent years. In order to maintain a high
    level of safety, it is important for the Federal Aviation Administration
    (FAA) to have a safety oversight system that is comprehensive, efficient,
    and effective and can provide an early warning of hazards that can lead to
    accidents. It is equally important to have a skilled, well-trained
    workforce to implement and monitor this safety oversight system. However,
    expected increases in air traffic-including the introduction of new
    vehicles into the national air space, such as unmanned vehicles and very
    light jets-and human resource issues present challenges that have the
    potential to strain the existing safety oversight system. My testimony
    today focuses on these questions: (1) How is FAA ensuring that the areas
    of highest safety risk are addressed? (2) How is FAA ensuring that its
    staff maintain the skills and knowledge to consistently carry out the
    agency's oversight programs? and (3) What are the key safety challenges
    facing FAA? We will also discuss our related recommendations that FAA has
    not fully addressed. This statement is based on our recent reports on
    FAA's inspection oversight programs, industry partnership programs, and
    enforcement and training programs. Additionally, we met with FAA officials
    and relevant industry groups and reviewed their documentation to obtain
    information on challenges facing FAA. We conducted this work in accordance
    with generally accepted government auditing standards.

    Following is a summary of our findings:

               o  FAA's safety oversight system has programs that focus on
               identifying and mitigating risk through a system safety approach,
               leveraging resources, and enforcing safety regulations, but
               concerns exist with each aspect of the system. FAA's system safety
               approach for overseeing airlines-through the Air Transportation
               Oversight System (ATOS) and Surveillance and Evaluation Program
               (SEP)-has many strengths. Both programs, for example, use
               inspection staff efficiently by prioritizing workload based on
               areas of highest risk and ensuring that corrective actions have
               been taken. However, the full potential of SEP is not being
               realized because the inspection workload for the 81 airlines
               included in SEP is heavily oriented to nonrisk based activities.
               Of additional concern is that recent and planned changes to
               transfer about 100 airlines from SEP to ATOS will affect inspector
               workload that may affect FAA's capability to oversee the aviation
               industry. FAA leverages resources and saves money through its
               "designee" programs, in which individuals and organizations have
               been delegated to act on FAA's behalf to perform about 90 percent
               of certification-related activities. The designee program allows
               FAA to better concentrate its limited staff resources on the most
               safety-critical functions. However, planned changes to some
               designee programs that would create a new "organizational
               designation authorization" will result in FAA focusing on the
               performance of organizations rather than the individuals within
               the organization who carry out the delegated functions. As FAA
               moves from direct oversight of the individuals performing
               delegated activities, it will be important for the agency to have
               valid and reliable data and strong evaluative processes to monitor
               any program changes that have implications for safety. FAA's
               enforcement program, which is an outgrowth of its inspection
               process, is intended to ensure industry compliance with safety
               regulations and is another important element of its safety
               oversight system. A key objective of FAA's policy of assessing
               legal sanctions against entities or individuals that do not comply
               with aviation safety regulations is to deter future violations.
               However, we found that recommendations for sanctions are sometimes
               reduced on the basis of factors that are not associated with the
               merits of the case, and the economic literature on deterrence
               suggests that the goal of preventing future violations is weakened
               when the penalties for violations are lowered for reasons not
               related to the merits of the case. For fiscal years 1993 through
               2003, we found that civil monetary penalties were reduced by 52
               percent from a total of $334 million to $162 million. It is
               important for FAA to have effective evaluative processes and
               relevant data on its numerous safety programs so that the agency
               has assurance the programs are having their intended effect,
               especially as FAA's oversight becomes more indirect and as
               significant program changes are made. Our most recent work has
               shown the lack of evaluative processes and limitations with data
               for FAA's SEP program, designee programs, industry partnership
               programs, and enforcement program.

               o  FAA has made training an integral part of its safety oversight
               system and has established mandatory training requirements for its
               workforce as well as designees, but several actions could improve
               the results of its training efforts. We have reported that FAA has
               generally followed effective management practices for planning,
               developing, delivering, and assessing the impact of its technical
               training for safety inspectors, although some practices are still
               early in the implementation phase. For example, in developing its
               training curriculum for inspectors, FAA followed effective
               management practices, such as developing courses that support
               changes in inspection procedures resulting from regulatory changes
               or agency initiatives. On the other hand, FAA develops technical
               courses on an ad hoc basis rather than as part of an overall
               curriculum for each type of inspector, such as inspectors of
               operations or cabin safety, because the agency has not
               systematically identified the technical skills and competencies
               each type of inspector needs to effectively perform inspections.
               FAA has recognized the need for improvements to its training
               program in this and other areas and has begun taking some action
               to address these and other training issues.

               o  FAA faces a number of key safety challenges, including meeting
               its performance target for commercial air carrier safety, which it
               will not meet in fiscal year 2006 because of recent fatal
               accidents. The challenge of meeting its performance target will be
               exacerbated by other challenges in human capital management, the
               acquisition and operation of new safety enhancing technologies,
               and new types of vehicles, such as very light jets (VLJ), that may
               place additional workload strains on FAA inspectors and air
               traffic controllers. FAA's ability to oversee aviation safety will
               be affected by recent and anticipated trends in inspector and air
               traffic controller attrition. For example, FAA estimates it will
               lose 10,291, or about 70 percent of the controller workforce, over
               the next 10 years, primarily due to retirements. FAA intends to
               enhance runway safety by relying on new advanced technologies that
               are expected to reduce runway accidents. However, schedule delays
               and cost increases have affected FAA's ability to deploy this
               technology. Finally, if predictions about new types of aviation
               vehicles are borne out, it will change the aviation landscape and
               will require new areas of expertise for FAA's inspectors and
               controllers. For example, the industry predicts there may be as
               many as 5,000 to 10,000 VLJs operating in the national airspace by
               2020, which would further congest the national airspace system
               especially at and near smaller airports, where VLJs are expected
               to be prevalent because of their smaller size.

               Background

    			  The U.S. commercial aviation industry, with less than one fatal
               accident per 5 million flights from 2002 through 2005 has an
               extraordinary safety record. However, when passenger airlines have
               accidents or serious incidents, regardless of their rarity, the
               consequences can be tragic. In addition, according to Bureau of
               Transportation Statistics data, flight arrival delays have
               increased from 15 percent in 2003 to 22 percent in 2006. Increases
               in flight delays can be viewed as evidence of strain in the
               aviation system, as a loss of efficiency in the air system is a
               symptom of increased strain. Losses of efficiency and the
               corresponding strain on the system could potentially result in
               hazards that decrease safety. In order to maintain a high level of
               aviation safety, it is critical to have well-established,
               efficient, and effective systems in place to provide an early
               warning of hazards that can lead to accidents.

               FAA has established a number of systems and processes to inspect
               and oversee various aspects of passenger airline safety, such as
               aircraft maintenance and flight operations. In 1998, the agency
               implemented the Air Transportation Oversight System (ATOS), which
               currently oversees 35 commercial airlines and cargo carriers; the
               goal is for ATOS to oversee all commercial passenger and cargo
               airlines. ATOS emphasizes a system safety approach that extends
               beyond periodically checking airlines for compliance with
               regulations to using technical and managerial skills to identify,
               analyze, and control hazards and risks. For example, under ATOS,
               inspectors develop surveillance plans for each airline, based on
               data analysis and risk assessment, and adjust the plans
               periodically based on inspection results. Our review of ATOS's
               early implementation found weaknesses, which FAA addressed by
               improving guidance to inspectors and increasing data usefulness.

               FAA's inspection process for the 81 commercial airlines not
               covered by ATOS has two components. The National Work Program
               Guidelines (NPG) is the original oversight program for these
               airlines. Under NPG, an FAA-wide committee of managers identifies
               an annual minimum set of required inspections to ensure that
               airlines comply with their operating certificates; this process is
               not risk-based. In 2002, FAA added another component, the
               Surveillance and Evaluation Program (SEP), to the inspection
               process to incorporate principles of ATOS into its oversight of
               commercial airlines. The two components are used together to
               establish the number and types of annual inspections for airlines.
               Inspections can encompass many different activities, such as
               visually spot-checking an airplane at a gate, monitoring
               procedures on a scheduled flight, or observing maintenance
               performed on an aircraft. Each year, FAA headquarters establishes
               a baseline number and type of inspections for each airline through
               NPG. Through SEP, teams of FAA inspectors analyze the results of
               an airline's prior inspections at periodic meetings and, based on
               their assessment of specific risks, establish other inspections
               that may be needed.

               Since 1990, FAA has emphasized industry partnership programs that
               allow participants, such as airlines and pilots, to self-report
               violations of safety regulations and help identify safety
               deficiencies and potentially mitigate or avoid fines or other
               legal action. For example, the Voluntary Disclosure Program
               encourages the self-reporting of manufacturing problems and safety
               incidents by participants that can include air carriers and repair
               stations.1

               When violations of statutory and regulatory requirements are
               identified through inspections, partnership programs, or other
               methods, FAA has a variety of enforcement tools that it may use to
               respond to the violations, including administrative actions (such
               as issuing a warning notice or a letter of correction that
               includes the corrective actions the violator is to take) and legal
               sanctions (such as levying a fine or suspending or revoking a
               pilot's certificate or other FAA-issued certificate).

               The achievement of FAA's mission is dependent in large part on the
               skills and expertise of its workforce, whose aviation safety
               activities include air traffic control, maintenance of air traffic
               control equipment, and certification and inspection of various
               industry participants. As of 2006, 714 of FAA's approximately
               3,400 inspectors were dedicated to overseeing the 35 airlines in
               ATOS. Approximately 1,100 inspectors2 oversee other entities and
               individuals, including the remaining 81 commercial airlines that
               are included in the SEP inspection program, about 5,200 aircraft
               repair stations, and approximately 625,000 pilots. FAA's safety
               oversight programs for other aspects of the aviation
               industry-including manufacturers of aircraft and aircraft parts,
               repair stations, flight schools, aviation maintenance technician
               schools, pilots, and mechanics-involve certification,
               surveillance, and inspection by FAA's safety inspectors,
               engineers, flight surgeons, and designated representatives. FAA
               authorizes about 13,400 private individuals and 218 organizations
               (called "designees") to act as its representatives to conduct many
               safety certification activities that FAA considers to be nonsafety
               critical, such as administering flight tests to pilots, inspecting
               repair work by maintenance facilities, conducting medical
               examinations of pilots, and approving designs for aircraft parts.
               These designees are grouped into 18 different programs and are
               overseen by three FAA offices-Flight Standards Service, Aerospace
               Medicine, and Aircraft Certification Service-all of which are
               under the Office of Aviation Safety. In addition, FAA's Air
               Traffic Organization (ATO) includes the approximately 16,700 air
               traffic controller workforce3 and nearly 7,200 field maintenance
               technicians responsible for maintaining ATO's equipment and
               facilities, which include 21 air traffic control centers, 518
               airport control towers, and 76 flight service facilities.

               While overall commercial aviation safety trends have been
               generally positive over the last several years, recent safety
               trends may warrant scrutiny. On the positive side, the number of
               serious runway incursions4 has decreased since fiscal year 2002.
               Specifically, in fiscal year 2002, there were 37 serious runway
               incursions, compared with 29 in fiscal year 2005. Recent fiscal
               year 2006 data also continue the downward trend, with 25 serious
               runway incursions as of August 1, 2006-fewer than at the same time
               in the previous fiscal year. However, with four fatal accidents in
               fiscal year 2006,5 FAA will not meet its performance target for
               fiscal year 2006 for commercial air carrier safety.6 Although
               general aviation accidents have decreased from 1,715 in 2002 to
               1,669 in 2005, general aviation safety continues to be a concern
               because it represents a significant number of fatal accidents
               every year. (See fig. 1.) For example, 321 of the 1,669 general
               aviation accidents in 2005 were fatal. Additionally, the poorer
               safety records of cargo and air ambulances services, compared with
               the commercial passenger airline accident rate, point out the
               safety vulnerabilities in this area. According to FAA, from 1998
               through 2005, the accident rate for scheduled air cargo operators
               declined significantly, but was still about 2.5 times higher than
               the accident rate for scheduled passenger operators. Further, in
               instances where there was not an isolated injury to a single
               individual, the accident rate for cargo was about 6.3 times higher
               than for commercial passenger aviation.7 In addition, from January
               2002 to January 2005, there were 55 emergency medical services or
               air ambulance accidents, with 54 fatalities, the highest number of
               accidents since the 1980s.8 In addition, FAA did not meet its
               performance target with regard to operational errors9 for fiscal
               years 2003 through 2005. While operational errors continued an
               upward trend in 2006, FAA was below the fiscal year 2006 target of
               4.27 operational errors per million activities as of June 2006.

               Figure 1: Number of General Aviation Accidents and Fatalities,
               2000 through 2005

               FAA's Safety Oversight System Includes Programs That Focus on Risk
    			  Management and Leveraging Resources, but System Is Hindered by Data
    		     Limitations and Lack of Evaluations

               FAA's safety oversight system has programs that focus on
               identifying and mitigating risk through a system safety approach,
               leveraging resources, and enforcing safety regulations, but the
               programs lack fully developed evaluative processes. As mentioned
               previously, FAA oversees commercial airlines by one of two
               programs-ATOS, which includes 35 airlines, and SEP, which includes
               the remaining 81 airlines. Both programs emphasize a system safety
               approach of using risk analysis techniques, which allow for the
               efficient use of inspection staff and resources by prioritizing
               workload based on areas of highest risk and require that
               inspectors verify that corrective actions are taken. For example,
               FAA has developed risk assessment worksheets for both programs
               that guide inspectors through identifying and prioritizing risks
               associated with key airline areas, such as flight operations and
               personnel training. Information from the worksheets is then used
               to target resources to mitigating those risks.

               In recent work we found that the benefits of FAA's system safety
               approach for the inspection of airlines covered under SEP could be
               enhanced if FAA more completely implemented the program and
               addressed other challenges.10 Most of FAA's inspections of those
               airlines were not risk-based. For example, as shown in figure 2
               from fiscal years 2002 through 2004, SEP-a risk-based
               approach-guided only 23 percent of the inspection activities for
               the top 25 SEP airlines in terms of the number of enplanements.
               The remaining 77 percent of inspection activities were identified
               through NPG, a process that is not risk-based or system safety
               oriented. Although inspectors can replace NPG-identified
               activities with SEP-identified activities that they deem address a
               greater safety risk, we found that FAA inspectors interpret agency
               emphasis on NPG as discouraging this practice. To address this
               issue, we recommended that FAA improve communication with and
               training of inspectors in areas of system safety and risk
               management. In response to our recommendations, FAA revised its
               guidelines to require inspectors and managers to ensure that risk
               information is used and updated its SEP training course to reflect
               that change. Since FAA's focus on system safety represents a
               cultural shift in the way the agency oversees the aviation
               industry, it will be important for FAA to monitor the
               implementation of system safety and risk management principles. We
               recommended that FAA establish a continuous evaluative process for
               its activities under SEP, but the agency does not intend to set up
               a process since it expects to eliminate the SEP program after
               December 2007, which is its deadline for moving all commercial
               airlines to the ATOS program. If the deadline slips, we believe
               our recommendation remains valid.

               Figure 2: SEP- and NPG-Initiated Required Inspections for the Top
               Airlines Covered by the Programs, Fiscal Years 2002-2004

               Note: Top airlines ranked in terms of number of enplanements.

               Furthermore, FAA's plans to dissolve the SEP program after moving
               all commercial airlines to ATOS will shift the inspectors
               workloads and present a challenge to FAA's inspection oversight
               process. As FAA shifts airlines to ATOS, it will also move
               inspectors to the program. Unlike SEP inspectors, ATOS inspectors
               are dedicated to an airline and generally cannot be used to
               inspect other entities. SEP inspectors, on the other hand, have
               other duties in addition to overseeing airlines-such as certifying
               and approving aircraft types; overseeing repair stations,
               designees, and aviation schools; and investigating accidents. For
               example, our analysis of FAA data indicated that, for fiscal years
               2002 through 2004, about 75 percent of SEP inspectors had
               responsibility for more than 3 entities, and about half had
               responsibility for more than 15. As inspectors are transitioned to
               ATOS, the remaining SEP inspector workforce will have to add those
               other entities to their workload. Furthermore, ATOS requires more
               inspectors per airline than SEP. For example, when FAA recently
               transitioned four airlines to ATOS,11 the total size of the four
               inspection teams increased 30 percent, from 73 to 95 inspectors.
               With the expansion of the ATOS program, it will be important to
               monitor the magnitude of the shift in resources and the effect it
               may have on FAA's overall capability to oversee the industry as
               well as any changes to the current ATOS program that may be
               required by the expansion.12

               FAA's Oversight Focuses on Leveraging Inspector Resources, Which
    			  Results in Less Direct Oversight of the Industry

               An important part of FAA's safety oversight system are designee
               programs, through which FAA authorizes about 13,400 private
               individuals and 218 organizations to act on its behalf to conduct
               safety certification activities that FAA considers to be
               non-safety critical. We reported that designees perform about 90
               percent of certification-related activities, thus greatly
               leveraging the agency's resources and enabling inspectors to
               concentrate on what FAA considers the most safety-critical
               activities.13 However, concerns about the consistency and adequacy
               of designee oversight by FAA have been raised by experts and other
               individuals we interviewed. For example, designees and industry
               officials that we spoke with indicated that FAA's level of
               oversight and interpretation of rules differ among regions and
               among offices within a region, which limits FAA's assurance that
               designees' work is performed uniformly in accordance with FAA's
               standards and policy, the primary goal of which is the safety of
               U.S. aviation. To improve management control of the designee
               programs, and thus increase assurance that designees meet FAA's
               performance standards, we recommended that FAA develop mechanisms
               to improve the compliance of FAA program and field offices with
               existing policies. In response to our recommendations, FAA has,
               among other things, established a designee quality assurance
               office to address inconsistent and nonstandard oversight issues
               among offices. FAA has also developed a survey that will collect
               information from individuals who recently worked with designees,
               such as pilots who recently received their license through a
               designee, to gather information that can be used to continually
               improve designee programs.

               To increase FAA's assurance that its designees are meeting FAA's
               safety standards, it will be important for FAA to continue these
               activities, which are in the early stages of development or
               implementation, especially as the agency moves to replace certain
               designee programs with an organizational designation authorization
               (ODA). ODA would expand the number and types of organizational
               designees and further transform FAA's role to that of monitoring
               the performance of others. In October 2005, FAA issued a final
               rule that established the ODA program and provides for the phasing
               out of organizational designees by November 2009. By that time,
               the current 218 organizational designees will have to apply for
               and be granted status as an ODA.14 In August 2006, FAA issued an
               order that establishes procedures for the ODA program, including
               the capability to expand the activities that may be delegated out.
               Under the program, FAA will focus on the performance of
               organizations rather than the individuals within the organization
               who carry out the delegated functions. As FAA makes these changes
               to its designee programs that remove FAA from direct oversight of
               the individuals performing the delegated activities, it will be
               important for the agency to adhere to its policy of using
               designees only for less safety-critical work. It will also be
               important for FAA to have the data and evaluative processes, which
               we discuss later in this testimony, to effectively monitor the new
               program.

               FAA is also becoming increasingly removed from overseeing airline
               maintenance. In recent years, in an attempt to reduce costs,
               airlines have increasingly contracted out maintenance. For example
               in 2000, 44 percent of major air carriers' maintenance expenses
               were attributable to outsourcing; in 2004, it had increased to 54
               percent. However, FAA's inspection activities have remained
               focused on air carriers' in-house maintenance, according to DOT's
               Inspector General.15

               Enforcement Is an Important Element of FAA's Safety Oversight
    			  System, but Deterrent Effect of Sanctions Is Unclear

               FAA's enforcement process, which is intended to ensure industry
               compliance with safety regulations, is another important element
               of its safety oversight system. FAA assesses legal sanctions
               against entities or individuals that do not comply with aviation
               safety regulations. Such sanctions are intended to deter future
               violations. However, we found that the effect of FAA's legal
               sanctions on deterrence is unclear, and that recommendations for
               sanctions are sometimes changed on the basis of factors not
               associated with the merits of the case.16 For fiscal years 1993
               through 2003, attorneys in FAA's Office of the Chief Counsel
               authorized a 52 percent reduction in the civil monetary penalties
               assessed (from a total of $334 million to $162 million). FAA
               officials told us the agency sometimes negotiate lower fines,
               thereby reducing sanctions to close cases more quickly and reduce
               FAA attorneys' caseloads. Economic literature on deterrence
               suggests that although negative sanctions (such as fines and
               certificate suspensions) can deter violations, if violators expect
               sanctions to be reduced, they may have less incentive to comply
               with regulations. In effect, it becomes more difficult to achieve
               the goal of preventing future violations when the penalties for
               present violations are lowered for reasons not related to the
               merits of the case.

               Recent changes that FAA has made to its enforcement program may
               lead to more uniformly set fines and, thus, potentially less need
               to revise fines. Prior to September 2005, the initial
               recommendation to use administrative actions (such as warning
               notices and letter of correction) or legal sanctions (such as
               fines or suspension of operating certificates) was based on the
               judgment of the inspectors. If inspectors recommended a legal
               sanction, they then consulted FAA's sanction guidance policy to
               determine the amount of the proposed penalty. In September 2005,
               FAA adopted changes to its enforcement program that incorporated
               system safety risk management principles and established explicit
               criteria for inspectors to use in making an initial enforcement
               recommendation. As soon as FAA investigators have gathered
               sufficient information to categorize the safety risk and the
               conduct (i.e., whether it was intentional, reckless, or systemic),
               they prepare a risk statement that describes the hazard created by
               the act and the potential consequence of that hazard. An example
               of a risk statement is "an aircraft that operates in Class B
               airspace without a clearance providing separation from other
               aircraft could cause a mid-air collision." The investigators then
               review the risk statement to determine the severity of the hazard
               (using a scale of catastrophic, critical, marginal, or negligible)
               and the likelihood of the worst credible outcome (using a scale of
               frequent, occasional, or remote). Based on these assessments,
               investigators apply a decision tool that determines the type of
               action (legal or administrative) to take against an individual or
               business. Inspectors no longer have the responsibility of
               recommending a specific fine level. It is too early to determine
               if these changes to the enforcement program have resulted in a
               more uniform application of penalties and fewer penalty
               reductions.

               Data Limitations and Lack of Evaluations Limit FAA's Ability to
    			  Manage Risk and Are Particularly Critical as FAA's Oversight
    			  Becomes More Indirect

               Effective processes for evaluating FAA's safety oversight
               programs, along with accurate nationwide data on those programs
               would provide FAA's program managers and other officials with
               assurance that the programs are having their intended effect,
               especially as FAA's oversight becomes more indirect. Such
               processes and data are also important because FAA's workforce is
               dispersed worldwide-with thousands of staff working out of more
               than 100 local offices-and because FAA's use of a risk-based
               system safety approach represents a cultural shift from its
               traditional inspection program. The experiences of successful
               transformations and change management initiatives in large public
               and private organizations suggest that it can take 5 to 7 years or
               more until such initiatives are fully implemented and cultures are
               transformed in a sustainable manner. As a result, evaluation is
               important to understanding if the cultural shift has effectively
               occurred. Our most recent work has shown that FAA had not
               evaluated its safety programs, and we recommended that the agency
               establish continuous evaluative processes for the SEP program,
               designee programs, industry partnership programs, and enforcement
               program. FAA has made recent progress in implementing some of
               these recommendations. For example, FAA has scheduled audits of
               all its designee programs, to be completed by the end of fiscal
               year 2009, and established a delegation steering group that first
               met in August 2006 and will be responsible for agencywide
               monitoring of the designee programs for compliance with program
               policies and evaluating the effectiveness of the designee
               programs. Additionally, as FAA implements its new enforcement
               policy, it has established procedures to monitor the new policy on
               a quarterly basis and to recommend process improvements based on
               the information collected. However, FAA does not plan to evaluate
               the SEP program because it intends to discontinue the program
               after December 2007.

               Yet, FAA's ability to evaluate its programs is hindered by its
               lack of useful nationwide data. For example, we found that FAA's
               oversight of designees was hampered, in part, by the limited
               information of designee's performance contained in the various
               designee databases.17 These databases contain descriptive
               information on designees, such as their types of designations and
               status (i.e., active or terminated). More complete information
               would allow the agency to gain a comprehensive picture of whether
               staff are carrying out their responsibilities to oversee
               designees. To improve management control of the designee programs,
               and thus increase assurance that designees meet the agency's
               performance standards, we recommended that FAA improve the
               consistency and completeness of information in the designee
               databases. To address this recommendation, FAA has established the
               Designee Integration User Group, which expects to begin work in
               September 2006 on an automated information tool that will track
               data on all designees. We also found problems with the accuracy or
               completeness of data in the SEP and enforcement programs, which
               FAA has recently taken steps to begin addressing.

               Training Is an Integral Part of FAA's Safety Oversight System, but Several
                             Actions Could Improve Results

    			  FAA's use of a risk-based system safety approach to inspections
               requires inspectors to apply data analysis and auditing skills to
               identify, analyze, assess, and control potential hazards and
               risks. To effectively identify safety risks, inspectors must be
               well-trained in the system-safety approach and have sufficient
               knowledge of increasingly complex aircraft, aircraft parts, and
               systems. It is also important that FAA's large cadre of designees
               is well-trained in federal aviation regulations and FAA policies.
               FAA has made training an integral part of its safety inspection
               system by establishing mandatory training requirements for its
               workforce as well as designees. Although FAA provides inspectors
               with extensive training in federal aviation regulations;
               inspection and investigative techniques; and technical skills,
               such as flight training for operations inspectors, we have
               identified weaknesses with the training program. The agency
               provides designees with an initial indoctrination that covers
               federal regulations and agency policies, and refresher training
               every 2 to 3 years.

               We have reported that FAA has generally followed effective
               management practices for planning, developing, delivering, and
               assessing the impact of its technical training18 for safety
               inspectors, although some practices have yet to be fully
               implemented.19 Appendix I describes the extent to which FAA
               follows effective management practices in each of these four
               areas. Some examples follow:

               o  In developing its training curriculum for inspectors, FAA has
               developed courses that support changes in inspection procedures
               resulting from regulatory change or agency initiatives. On the
               other hand, FAA develops technical courses on an ad hoc basis
               rather than as part of an overall curriculum for each inspector
               specialty-such as air carrier operations, maintenance, and cabin
               safety-because the agency has not systematically identified the
               technical skills and competencies each type of inspector needs to
               effectively perform inspections.

               o  In delivering training, FAA has established clear
               accountability for ensuring that inspectors have access to
               technical training, has developed a way for inspectors to choose
               courses that meet job needs and further professional development,
               and offers a wide array of technical and other courses. However,
               both FAA and its inspectors recognize the need for more timely
               selection of inspectors for technical training.

               To address some of these issues, we recommended, among other
               things, that FAA ensure that inspector technical training needs
               are identified and met in a timely manner by systematically
               assessing inspectors' technical training needs and better aligning
               the timeliness of training to when inspectors need the training to
               do their jobs. In addition, we have identified gaps in the
               training provided to SEP inspectors, and have recommended that FAA
               improve inspectors' training in areas such as system safety and
               risk management to ensure that these inspectors have a complete
               and timely understanding of FAA's policies in these areas. We
               identified similar competency gaps related to designee oversight.
               For example, FAA does not require refresher training on how to
               oversee designees, which increases the risk that inspectors do not
               retain the information, skills, and competencies required to
               perform their oversight responsibilities. We recommended that FAA
               provide additional training for staff who directly oversee
               designees.

               FAA has begun to address these recommendations. For example, FAA
               plans to release five Web-based courses by the end of 2006, which
               will allow the agency to provide training closer to the time that
               employees need it. Also, FAA has instituted an electronic learning
               management system that provides for employee input to their own
               learning plans. FAA has also updated the SEP training course to
               reflect recent policy changes that emphasize the importance of
               risk management. Finally, FAA has begun developing a new designee
               oversight training course that is planned to be ready by the
               summer of 2007.

               It is important that FAA's inspection workforce, designees, and
               FAA-certified aviation mechanics are knowledgeable about the
               latest technology changes. While we did not attempt to assess the
               technical proficiency that FAA's workforce requires and will
               require in the near future, FAA officials said that inspectors do
               not need a substantial amount of technical training courses
               because inspectors are hired with a high degree of technical
               knowledge of aircraft and aircraft systems. They further indicated
               that inspectors can sufficiently keep abreast of many of the
               changes in aviation technology through FAA and industry training
               courses and on-the-job training. Similarly, we did not identify
               any specific gaps in the competencies of designees. However, in
               its certification program for aviation mechanics, we found that
               FAA standards for minimum requirements for aviation courses at
               FAA-approved aviation maintenance technician schools and its
               requirements for FAA-issued mechanics certificates do not keep
               abreast with the latest technologies. In 2003, we reported that
               those standards had not been updated in more than 50 years.20 We
               recommended that FAA review the curriculum and certification
               requirements and update both. In response to this recommendation,
               Vision 100-Century of Aviation Reauthorization Act, which was
               passed December 12, 2003, required FAA to update the standards 1
               year after enactment of the law and to conduct reviews and updates
               every 3 years after the initial update. FAA issued an Advisory
               Circular in January 2005 that described suggested curriculum
               changes; however, the agency has not updated the certification
               requirements for mechanics.

               FAA Faces a Number of Challenges in Overseeing Aviation Safety

    			  FAA faces a number of key safety challenges, including meeting its
               performance target for commercial air carrier safety, which it
               will not meet in fiscal year 2006 because of recent fatal
               accidents. With four fatal commercial air carrier accidents in
               fiscal year 2006, the agency will not meet its target of 0.018
               fatal accidents per 100,000 departures.21 Moreover, for the past 3
               years, FAA did not meet its performance target for severe
               operational errors, which occur when aircraft do not maintain safe
               distances in the air; as of June 2006, the agency was slightly
               below its target level of 4.27 severe operational errors per
               million activities. In addition, although general aviation
               accidents have, on the whole, decreased in recent years, general
               aviation safety is also a concern because of the large number of
               fatal accidents every year-an average of 334 fatal accidents have
               occurred annually since 2000. Furthermore, other industry sectors,
               such as cargo operations22 and on-demand air ambulances,23 have
               poor safety records, as mentioned earlier. It will be important
               for FAA to develop the appropriate strategies to deal with the
               challenges posed by these safety records and to continuously
               monitor safety information to identify trends and early warnings
               of other safety problems.

               Also as described earlier, FAA also faces a number of challenges
               to several of its oversight programs. Specifically, FAA's rapid
               expansion of ATOS, by transferring about 100 airlines and
               additional inspectors to the program over about 2 years, will
               cause shifts in inspector workload that may affect the agency's
               ability to oversee other parts of the industry. Furthermore, some
               activities, such as FAA's creation of ODAs and the trend for
               airlines to outsource maintenance, will remove FAA from direct
               oversight. It will be important for FAA to have robust data and
               continuous evaluative processes to monitor such activities and
               program changes in order to ensure they are not having a negative
               effect on safety.

               Meeting the challenges posed by recent safety trends and program
               changes will be exacerbated by other challenges in human capital
               management; the acquisition and operation of new safety enhancing
               technologies; and new types of vehicles, such as very light jets
               (VLJ), that may place additional workload strains on FAA
               inspectors and air traffic controllers.

               FAA Faces Challenges in Human Resources

    			  FAA's ability to oversee aviation safety will be affected by
               recent and anticipated trends in attrition of its inspectors
               compounded, in some cases, by delays in hiring and increased
               workload. For example, for fiscal years 2005 through 2010, FAA
               estimated that over 1,100 safety inspectors who oversee commercial
               airlines and general aviation will leave the agency, with an
               average loss due to attrition of about 195 inspectors per year.
               However, FAA's efforts to hire more inspectors have been hindered
               by a budget situation in 2005 that resulted in a hiring freeze
               during part of that year. During the hiring freeze, FAA filled
               safety-critical positions, such as principal inspectors, through
               internal appointments. As other safety inspectors left, they were
               not replaced and their workload was divided among the remaining
               inspectors.

               Concerned about the need for additional safety inspectors, for
               fiscal year 2006, Congress provided additional funding over the
               budget request to FAA with the expectation that the funding would
               increase the safety staff by 248. This increase in funding would
               allow for hiring an additional 182 safety inspectors in Aviation
               Flight Standards (AFS) and an additional 66 inspectors and
               engineers in Aircraft Certification Service (AIR). However, as a
               result of a rescission and unfunded pay raises for fiscal year
               2006, FAA lacks the funds to hire 67 staff of the expected 248 new
               staff. As a result, FAA's revised hiring target is 139 AFS staff
               and 42 AIR staff. As of August 2006, FAA has hired an additional
               25 AFS and 28 AIR staff. (See fig. 3.) According to FAA, it has a
               pipeline of applicants and expects to reach its goal of filling
               the 181 slots by the end of the fiscal year. However, the actual
               number of aviation safety inspector slots needed is unknown,
               because FAA lacks staffing standards for safety inspectors. The
               National Academy of Sciences, under a congressional mandate, has
               just completed a study for FAA to estimate staffing standards for
               inspectors to ensure proper oversight over the aviation industry.

               Figure 3: Number of Additional Staff for AFS and AIR, Fiscal Year
               2006

               During the coming decade, FAA will need to hire and train
               thousands of air traffic controllers to replace those who will
               retire and leave for other reasons. FAA estimates it will lose
               10,291 controllers, or about 70 percent of the controller
               workforce, for fiscal years 2006 through 2015, primarily due to
               retirements.24 To replace these controllers and to accommodate
               forecasted increases in air traffic and expected productivity
               increases, FAA plans to hire a total of 11,800 new controllers
               over the next 10 years, or 1,180 per year, on average.25 By the
               end of fiscal year 2006, FAA expects to hire 930 controllers. As
               of August 2006, FAA had hired 920. Figure 4 shows the estimated
               losses each year as well as the number of planned hires.

               Figure 4: Estimated Controller Losses and Planned Hires, Fiscal
               Years 2006-2015

               Recent events may exacerbate the staffing situation. New data
               indicate that controllers are retiring at a faster rate than FAA
               anticipated. In its 2004 workforce report, FAA projected 341
               retirements for fiscal year 2005; 465 controllers actually
               retired-36 percent more than FAA's estimate. In addition, a new
               contract with the air traffic controllers union was recently
               implemented by FAA after lengthy negotiations. Under this new
               contract, most current air traffic controllers would continue to
               receive their existing base salaries and benefits, which may
               remove a financial incentive to continue working past their
               retirement eligibility date, while newly hired controllers would
               be hired at lower wage rates, which may affect FAA's ability to
               hire new controllers. FAA has maintained that this contract will
               result in significant cost savings, freeing up resources for other
               critical agency needs. It is too soon to know what effect, if any,
               the new contract may have on retirement decisions.

               In addition to the challenge of hiring large numbers of
               controllers, FAA will face a challenge in training its new hires
               expeditiously so that it can plan to have the right number of
               controllers in the right facilities when they are needed.
               According to FAA, its ability to train the new controllers depends
               upon several factors, including hiring a relatively even number of
               controllers each year, reducing the time it takes to hire a
               controller, and reducing the duration of training. FAA estimates
               that because of the long training time, it must hire enroute
               controllers26 an average of 3 to 5 years in advance of when they
               are needed. FAA is taking actions to address these issues. For
               example, in line with our recommendation, a recent change to the
               training program allows individuals who complete collegiate
               requirements under the Air Traffic Collegiate Training
               Initiative27 to bypass the first 5 weeks of initial FAA Academy
               training required for controllers.

               FAA also faces the challenge of ensuring that control facilities
               have adequate staffing based on their unique traffic demands and
               the accuracy of FAA's retirement forecast. Historically, FAA has
               computed staffing standards, which are the number of controllers
               needed on a systemwide basis, but distribution of these totals to
               the facility level was a negotiated process. The staffing
               standards did not take into account the significant differences in
               complexity and workload among FAA's 300 terminal and enroute
               control facilities, which can lead to staffing imbalances. FAA has
               begun developing and implementing new staffing standards that use
               an algorithm that incorporates traffic levels and complexity of
               traffic at the facility level to determine the number of
               controllers needed, according to an FAA official. As FAA further
               refines its process for determining controller staffing needs, the
               ultimate objective is to assess the traffic level and complexity
               on a sector-by-sector basis to develop more accurate controller
               staffing requirements.

               FAA Faces Challenges in Implementing Advanced Technology to
    			  Increase Air Traffic Safety

    			  To enhance runway safety, FAA intends to rely on new
               technologies-beginning with the Airport Movement Area Safety
               System (AMASS) and Airport Surface Detection Equipment Model X
               (ASDE-X)-that are expected to reduce runway accidents.28 AMASS and
               ASDE-X are instrumental in mitigating runway incursions and
               operational errors. However, FAA faces challenges-such as a
               reduced number of airports scheduled to receive the equipment,
               schedule delays, and cost increases-that affect its reliance on
               the technologies.

               FAA's original plans called for 34 airports to receive AMASS29 and
               35 airports to receive ASDE-X (see app. II).30 In total, 59
               airports were to receive one or both technologies, but this number
               was reduced to 44 in August 2006 after FAA canceled plans to
               deploy ASDE-X at 15 of the originally scheduled airports. FAA
               plans to take these 15 systems and upgrade certain airports that
               already have AMASS based on the rationale that maximum benefit is
               achieved by deploying ASDE-X to airports with larger traffic
               counts or more complex operations. This decision leaves 15
               airports (see fig. 5) that were supposed to receive ASDE-X without
               either advanced technology system. Since the anticipated future
               increase in air traffic from commuter airlines and very light jets
               are likely to be at smaller airports that lack the advanced
               technologies, it will be important for FAA to periodically
               re-evaluate its deployment strategy.

               Figure 5: Airports Scheduled to Receive ASDE-X before Deployment
               Was Canceled by FAA

               In addition to reducing the number of facilities selected to
               receive the newer technology, FAA has amended the cost and
               extended the implementation dates for the ASDE-X program (see fig.
               6). The 35 ASDE-X systems were originally scheduled to be
               implemented by 2007. As of August 2006, FAA had moved that date to
               2011. FAA estimates the total facilities and equipment cost of the
               ASDE-X program at about $550 million, which is approximately $40
               million more than we reported in 2005.31 The costs of these new
               technologies mean that they may never be deployed at all airports;
               therefore, it will be important for FAA to continue prioritizing
               and maximizing its resources.

               Figure 6: Changes in Cost and Schedule Targets for ASDE-X

               FAA Faces Challenges in Having Controllers Prepared for the Next
    			  Generation Air Transportation System

    			  To ensure a national airspace system that is safe, efficient, and
               capable of meeting a growing demand of air transportation that is
               expected to triple by 2025, the Joint Planning and Development
               Office (JPDO) was created within FAA to plan for and coordinate
               the longer-term transformation to the "next generation air
               transportation system" (NGATS). JPDO was created in 2003 to
               develop an integrated plan for NGATS and to include in the plan,
               among other things, a description of the demand and required
               performance characteristics of the future system, as well as a
               high-level, multiagency road map and concept of operations for the
               future system.

               FAA and JPDO face the challenge of adequately involving
               stakeholders in the development of NGATS to ensure that the system
               meets users' needs, especially air traffic controllers who will be
               end users of the new technology and responsible for using it to
               maximize safety and efficiency. In the past, air traffic
               controllers were permanently assigned to FAA's major system
               acquisition program offices and provided input into air traffic
               control modernization projects. In June 2005, FAA terminated this
               arrangement because of budget constraints. According to FAA, it
               now plans to obtain the subject-matter expertise of air traffic
               controllers or other stakeholders as needed in major system
               acquisitions. It remains to be seen whether this approach will be
               sufficient to avoid problems such as FAA experienced when
               inadequate stakeholder involvement in the development of new air
               traffic controller workstations (known as the Standard Terminal
               Automation Replacement System (STARS)) contributed to unplanned
               work, significant cost growth, and schedule delays.32

               FAA�s Inspector and Controller Workload Will Be Challenged by
    			  Emerging Industries and Established Sectors That May Need More
    			  Safety Oversight

    			  The changing aviation landscape poses further challenges for FAA.
               It is expected that within the next few years several hundred
               VLJs33 will be in operation. FAA estimates that if 2 percent of
               airline passengers switch to VLJs, air traffic controllers will
               have to handle three times more take-offs and landings than
               currently. Additionally, the industry predicts there may be as
               many as 5,000 to 10,000 VLJs operating in the national airspace
               system by 2020. VLJ manufacturers are reporting advance sales of
               thousands of these new jets, their customers include air taxis,
               charter operators, and private owners. In July 2006, FAA granted
               the first provisional certificate for a VLJ to Eclipse Aviation
               Corporation. The provisional certificate allows existing planes to
               be flown, but new ones cannot be delivered to customers until the
               FAA grants a type certificate. According to Eclipse Aviation, it
               has orders for over 2,350 aircrafts. DayJet, which provides
               on-demand jet service, expects to be operating 50 Eclipse VLJs by
               the end of 2007. In September 2006, FAA granted the first type
               certificate to Cessna Aircraft Company. (See fig. 7.) Five other
               companies are in the process of being issued certificates by FAA.
               If this sector expands as quickly as expected, FAA inspectors
               could face workload challenges to expeditiously issue and monitor
               certificates. In addition, air traffic controllers could face the
               challenge of further congested air space, especially at and near
               smaller airports, where VLJs are expected to be prevalent because
               of their smaller size and shorter runway requirements.

               Figure 7: Cessna's Citation Mustang VLJ

               Unmanned aerial vehicles34 (UAV) are another emerging sector that
               will add to FAA's workload and may require additional FAA
               expertise. While historically UAVs have been used primarily by the
               Department of Defense in military settings outside the United
               States, there is growing demand to operate UAVs domestically in
               the national airspace system. (See fig. 8.) Federal agencies such
               as the Customs and Border Protection Service and the Federal
               Emergency Management Agency and state and local law enforcement
               agencies are interested in UAVs for purposes such as border
               security, search and rescue, firefighting, and other law
               enforcement and homeland security initiatives. Some of these
               activities are taking place today. For example, Customs conducts
               surveillance along the border with Mexico. UAVs are also an
               emerging sector of the commercial aviation industry, and possible
               commercial uses include fire detection and firefighting
               management, digital mapping, communications and broadcast
               services, and environmental research and air quality management
               control. Currently, few regulations or guidelines exist for UAVs
               or UAV-related technology. FAA issues a certificate of
               authorization for the operation of a UAV and the airspace is
               restricted during the period of operation.35 In 2006, FAA has
               issue 62 certificates of authorization for UAVs and another 35
               applications are pending review. FAA is receiving numerous
               inquiries from federal agencies, and from local, county, and state
               governments about how to operate UAVs in the national airspace
               system. FAA has established an Unmanned Aircraft Program Office,
               responsible for developing the regulatory framework and plan for
               the safe integration of UAVs into the national airspace system.
               FAA faces the challenge of working with industry to develop
               consensus standards for command and control redundancies in case
               there is a disruption in communication with the UAV, and detect
               and avoid capabilities so that UAVs can sense and avoid other
               aircraft. Such standards will be necessary before UAVs can be
               routinely integrated into the national airspace system. Until UAVs
               are completely integrated into the national airspace system, FAA
               will continue to evaluate each flight on a case-by-case basis,
               adding to the agency's workload.

               Figure 8: U.S. Air Force's Global Hawk UAV

               Space tourism is an additional emerging sector that FAA is
               beginning to respond to. Tourist launches are expected to take
               place at inland locations and may have more impact on the national
               airspace system than previous unmanned commercial space launches,
               which occurred at federal launch sites near or over oceans. While
               UAVs pose a learning curve for safety inspectors, engineers, and
               air traffic controllers, space tourism launches pose a learning
               curve for FAA's commercial space engineers who are responsible for
               licensing and monitoring commercial space launches and nonfederal
               launch sites (called spaceports). The prospect for commercial
               space tourism materialized in 2004 when SpaceShipOne, developed by
               Scaled Composites, flew to space twice, achieving a peak altitude
               of about 70 miles to win the Ansari X Prize.36 Several
               entrepreneurial launch companies are planning to start taking
               paying passengers on suborbital flights within the next few years.
               Virgin Galactic intends to enter commercial suborbital space
               flight service around 2008, launching from a spaceport in New
               Mexico, and according to the company, plans to carry 3,000
               passengers over 5 years, with 100 individuals having already paid
               the full fare of $200,000. Several other companies, including
               former Ansari X Prize competitors, continue to develop their
               vehicles for space tourism. Several spaceports are being developed
               to accommodate anticipated commercial space tourism flights and
               are expanding the nation's launch capacity. As of August 2006, the
               United States had seven federal launch sites, and seven
               spaceports, and an additional eight spaceports have been proposed
               (see fig. 9). We will be issuing a report later this year on FAA's
               oversight of commercial space launches.

    1Other industry partnership programs include the Aviation Safety Action
    Program, which allows for the self-reporting of safety incidents by
    employees of air carriers and repair stations; the Aviation Safety
    Reporting Program, which allows any participant in the national airspace
    system, such as air traffic controllers, pilots, and flight attendants, to
    self-report safety incidents; and the Flight Operation Quality Assurance
    Program, whose participant airlines equip their aircraft to record flight
    data, which the airlines analyze for safety trends that are provided to
    FAA.

    2The remaining approximately 1,500 inspectors oversee general aviation.

    3As of June 2006. This number includes about 2,380 traffic management
    coordinators and operations supervisors.

    4A runway incursion is any occurrence at an airport involving an aircraft,
    vehicle, person or object on the ground that creates a collision hazard or
    results in a loss of separation with an aircraft taking off, intending to
    take off, landing, or intending to land.

    5In December 2005, a Southwest Airlines airplane slid off a runway at
    Chicago's Midway Airport, went through a barrier fence and onto a roadway,
    killing a passenger in a passing automobile. Also in December 2005, a
    Chalk's Ocean Airways aircraft experienced an in-flight breakup shortly
    after takeoff in Miami, resulting in 20 fatalities. On January 16, 2006, a
    Continental Airlines ground worker was fatally injured in El Paso, Texas.
    In August 2006, a Comair flight crashed while attempting take-off from the
    Lexington, Kentucky, airport, resulting in 49 fatalities.

    6FAA's performance target for fiscal year 2006 is 0.018 fatal accidents
    per 100,000 departures over the last 3 years.

    7According to FAA, accidents impacting a single person, although they may
    be serious, are isolated to ground workers or a single passenger who may
    walk into a propeller or who may fall while boarding or deplaning.
    Removing these isolated risk accidents from the data helps achieve a more
    informative comparison of accident data, according to the agency.

    8Comprehensive activity data regarding emergency medical services
    operations (for example, exposure rates and missions flown) are limited
    because the sources for these data are generally poor. Therefore, accident
    rates cannot be calculated.

    9An operational error is a violation of FAA separation standards that
    define minimum safe distances between aircraft, between aircraft and other
    physical structures, and between aircraft and otherwise restricted
    airspace.

    10GAO, Aviation Safety: System Safety Approach Needs Further Integration
    into FAA's Oversight of Airlines, GAO-05-726 (Washington, D.C.: Sept. 28,
    2005).

    11The airlines are Champion, American Eagle, ExpressJet, and SkyWest.

    12For example, we found that when Champion Airlines became part of ATOS in
    January 2005, FAA has, in this one case, revised its procedures to allow
    the Northwest Airlines inspection team to share its data analyst and
    manager with the Champion inspection team.

    13GAO, Aviation Safety: FAA Needs to Strengthen the Management of Its
    Designee Programs, GAO-05-40 (Washington, D.C.: Oct. 8, 2004).

    14Examples of companies that are organizational designees include Boeing,
    Gulfstream, United Airlines, and Continental Airlines, as well as smaller
    companies.

    15DOT Inspector General, Air Carriers' Use of Aircraft Repair Stations
    (Washington, D.C.; July 8, 2003).

    16GAO, Aviation Safety: Better Management Controls Are Needed to Improve
    FAA's Safety Enforcement and Compliance Efforts, GAO-04-646 (Washington,
    D.C.: July 6, 2004).

    17These databases are the Program Tracking and Reporting Subsystem,
    National Vital Information Subsystem, Designee Information Network, and
    Airmen Medical Certification Information Subsystem.

    18We define technical training as training in aviation technologies. FAA
    includes in its definition of technical training topics such as system
    safety and risk analysis, inspector job skills, data analysis, and
    training in software packages.

    19GAO, Aviation Safety: FAA Management Practices for Technical Training
    Mostly Effective; Further Actions Could Enhance Results, GAO-05-728
    (Washington, D.C.: Sept. 7, 2005). We compared FAA's management of its
    inspector technical training efforts with effective management practices
    in GAO, Human Capital: A Guide for Assessing Strategic Training and
    Development Efforts in the Federal Government, GAO-04-546G (Washington,
    D.C.: Mar. 1, 2004).

    20GAO, Aviation Safety: FAA Needs to Update the Curriculum and
    Certification Requirements for Aviation Mechanics, GAO-03-317 (Washington,
    D.C.: Mar. 6, 2003).

    21After a fourth fatal accident occurred in August 2006, FAA estimated
    that 0.023 fatal accidents per 100,000 departures had occurred over the
    last 3 years. Since the fatal accident rate is small and could
    significantly fluctuate from year to year due to a single accident, FAA's
    performance measure is a 3-year average, which helps to smooth the
    fluctuation that may occur in any given year.

    22The risk factors that may affect the safety record of cargo carriers
    include operating a large number of flights at night and the age of cargo
    aircraft. FAA estimates the median age of in-service passenger jets was
    6.25 years, compared with the median age of cargo jets of over 25 years.

    23We have ongoing work for this subcommittee that is examining in detail
    FAA's oversight of air ambulances.

    24The high percentage of retirements is attributable to the 1981
    controller strike, when President Ronald Reagan fired over 10,000 air
    traffic controllers, and the consequent need to quickly rebuild the
    controller workforce. From 1982 through 1991, FAA hired an average of
    2,655 controllers per year. These controllers will become eligible for
    retirement during the next decade.

    25FAA, A Plan for the Future, 2006-2015 (Washington, D.C.: June 2006).

    26Enroute air traffic controllers issue clearances and instructions for
    airborne aircraft.

    27To bypass initial Academy training, individuals must have successfully
    completed an aviation-related program of study from a school under FAA's
    collegiate training initiative program. FAA has agreements with 13 schools
    for this program.

    FAA Faces Challenges in Implementing Advanced Technology to Increase Air Traffic
    Safety

    28AMASS processes data from Airport Surface Detection Equipment Model 3
    (ASDE-3) systems and uses visual and sound signals to warn controllers of
    potential conflicts between arriving aircraft, and aircraft and vehicles
    on the ground. ASDE-X is the upgraded digitally based technology that
    enables air traffic controllers to detect potential runway conflicts by
    providing detailed coverage of movement on runways and taxiways. Both
    systems warn the controllers of potential incursions. Among the systems,
    only ASDE-X works in poor weather conditions.

    29By December 2003, FAA had installed AMASS at the 34 airports.

    30Ten airports that were scheduled to receive ASDE-X already had AMASS.

    31GAO, National Airspace System: FAA Has Made Progress but Continues to
    Face Challenges in Acquiring Major Air Traffic Control Systems, GAO-05-331
    (Washington, D.C.: June 10, 2005).

    FAA Faces Challenges in Having Controllers Prepared for the Next Generation Air
    Transportation System

    32 GAO-05-331 .

    FAA's Inspector and Controller Workload Will Be Challenged by Emerging
    Industries and Established Sectors That May Need More Safety Oversight

    33Very light jets are jet aircraft weighing 10,000 pounds or less maximum
    certificated take-off weight and certificated for single pilot operations.
    Aircraft possess at least some of the following features: (1) advanced
    cockpit automation, such as moving map GPS and multifunction displays; (2)
    automated engine and systems management; and (3) integrated auto-flight,
    autopilot and flight-guidance systems.

    34Unmanned aerial vehicles do not carry a human operator; they are either
    programmed for autonomous flight (called a "drone") or are flown remotely
    by a ground operator.

    35A certificate of authorization allows an operator to use defined
    airspace for a specified time (up to one year, in some cases) and includes
    special provisions unique to each operation. For instance, a certificate
    may include a requirement to operate only under visual flight rules.

    36The X Prize Foundation was established in 1995 to award $10 million to
    the first team to launch a suborbital reusable launch vehicle capable of
    carrying three people to an altitude of 70 miles, return safely to Earth,
    and repeat the exercise within 2 weeks using the same vehicle.
    Twenty-seven teams from seven countries competed.

    Figure 9: Existing and Proposed Federal and Nonfederal Spaceports in the
    United States, April 2006

    FAA Needs to Retain Its Leadership Role in International Safety Standard Setting

    Maintaining U.S. position as a global leader in aviation safety calls for
    robust participation in the setting of international safety standards. The
    International Civil Aviation Organization (ICAO), a United Nations
    organization, develops standards and recommended practices for aviation
    safety and security for 188 member states.37 In 2002, the Commission on
    the Future of the United States Aerospace Industry38 reported that the
    United States had not devoted enough resources to ICAO and was, therefore,
    losing its position as the de facto standard setter. Furthermore, the
    position of U.S. ambassador to ICAO, which was filled earlier this year,
    had been vacant for more than a year, which may have affected the U.S.
    impact on international aviation issues. To ensure that qualified U.S.
    applicants apply for U.S. positions at ICAO, FAA has supported a number of
    activities, including outreach efforts, incentive pay programs, and a
    fellowship program that sends FAA employees to work at ICAO for up to 12
    months. However, as of December 2005, FAA had filled only 13 of the 31
    positions allocated to the United States at ICAO. FAA faces difficulty in
    filling the allocated positions for reasons beyond its control. For
    example, while FAA can recruit applicants, it does not make the final
    hiring decisions. With unfilled positions at ICAO, it will remain
    important for FAA to continue these efforts to enhance the presence of the
    United States in the international aviation community.

                         GAO Contact and Staff Acknowledgments

    For further information on this testimony, please contact Dr. Gerald L.
    Dillingham at (202) 512-2834 or dillinghamg@gao.gov . Individuals making
    key contributions to this testimony include Teresa Spisak, Jessica Evans,
    Colin Fallon, David Hooper, and Rosa Leung.

    Appendix I: Extent to Which FAA Follows Effective Management Practices for
    Inspector Training

    Figure 10: Extent That FAA Follows Effective Management Practices in
    Planning Technical Training

    Figure 11: Extent That FAA Follows Effective Management Practices in
    Developing Technical Training

    aThis management practice is not specifically identified in our assessment
    guide. However, a management approach that assesses training needs
    holistically rather than on a course-by-course basis can provide for a
    more systematic assessment of whether and how training will help meet
    organizational needs.

    Figure 12: Extent That FAA Follows Effective Management Practices in
    Delivering Technical Training

    Figure 13: Extent That FAA Followed Effective Management Practices in
    Evaluating Its Training Program

    Appendix II: Deployment of Surface Detection Equipment at Airports

    Figure 14: Airports with Airport Movement Area Safety System (AMASS)

    Figure 15: Airport Surface Detection Equipment Model X (ASDE-X) Deployment
    Sites

    Related GAO Products

    Aviation Safety: FAA's Safety Oversight System Is Effective but Could
    Benefit from Better Evaluation of Its Programs' Performance. GAO-06-266T .
    Washington, D.C.: November 17, 2005.

    Aviation Safety: System Safety Approach Needs Further Integration into
    FAA's Oversight of Airlines. GAO-05-726 . Washington, D.C.: September 28,
    2005.

    Aviation Safety: FAA Management Practices for Technical Training Mostly
    Effective; Further Actions Could Enhance Results. GAO-05-728 . Washington,
    D.C.: September 7, 2005.

    Aviation Safety: Oversight of Foreign Code-Share Safety Program Should Be
    Strengthened. GAO-05-930 . Washington, D.C.: August 5, 2005.

    Aviation Safety: FAA Needs to Strengthen the Management of Its Designee
    Programs. GAO-05-40 . Washington, D.C.: October 8, 2004.

    Aviation Safety: Better Management Controls Are Needed to Improve FAA's
    Safety Enforcement and Compliance Efforts. GAO-04-646 . Washington, D.C.:
    July 6, 2004.

    Aviation Safety: Information on FAA's Data on Operational Errors at Air
    Traffic Control Towers. GAO-03-1175R . Washington, D.C.: September 23,
    2003.

    Aviation Safety: FAA Needs to Update the Curriculum and Certification
    Requirements for Aviation Mechanics. GAO-03-317 . Washington, D.C.: March
    6, 2003.

    Aviation Safety: FAA and DOD Response to Similar Safety Concerns.
    GAO-02-77 . Washington. D.C.: January 22, 2002.

    Aviation Safety: Safer Skies Initiative Has Taken Initial Steps to Reduce
    Accident Rates by 2007. GAO/RCED-00-111 . Washington, D.C.: June 30, 2000.

    37ICAO also addresses issues such as air navigation, airspace capacity,
    and environmental concerns such as engine noise and emissions.

    38Final Report of the Commission on the Future of the United States
    Aerospace Industry (Arlington, Va.; November 2002).

    (540136)

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    www.gao.gov/cgi-bin/getrpt? GAO-06-1091T .

    To view the full product, including the scope
    and methodology, click on the link above.

    For more information, contact Gerald L. Dillingham, Ph.D., at (202)
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    Highlights of GAO-06-1091T , a testimony before the Subcommittee on
    Aviation, Committee on Transportation and Infrastructure, House of
    Representatives

    September 20, 2006

    AVIATION SAFETY

    FAA's Safety Efforts Generally Strong but Face Challenges

    The U.S. commercial aviation industry has had an extraordinary safety
    record in recent years. However, expected increases in air-
    traffic-including the introduction of new vehicles into the national
    airspace, such as unmanned vehicles and very light jets-and human resource
    issues, present challenges that have the potential to strain the existing
    safety oversight system. GAO's testimony focuses on these questions: (1)
    How is the Federal Aviation Administration (FAA) ensuring that the areas
    of highest safety risk are addressed? (2) How is FAA ensuring that its
    staff maintain the skills and knowledge to consistently carry out the
    agency's oversight programs? and (3) What are the key safety challenges
    facing FAA? This statement is based on our recent reports on FAA's
    inspection oversight programs, industry partnership programs, and
    enforcement and training programs. It is also based on interviews with FAA
    and relevant industry officials.

    What GAO Recommends

    To help FAA fully realize the benefits of its safety oversight system, GAO
    has made several recommendations to address the weaknesses identified in
    GAO's reviews. Although FAA has begun addressing the recommendations, many
    have not been fully implemented.

    FAA's aviation safety oversight system includes programs that focus on
    identifying and mitigating risks through a system safety approach and by
    leveraging resources, but as FAA is still developing evaluations for some
    of these programs, it remains unclear the extent to which they are
    achieving their intended effects. FAA's system safety approach for
    overseeing airlines-through the Air Transportation Oversight System (ATOS)
    and Surveillance and Evaluation Program (SEP)-uses inspection staff
    efficiently by prioritizing workload based on areas of highest risk and
    ensuring that corrective actions have been taken. However, recent and
    planned changes that would move inspections of about 100 airlines from SEP
    to ATOS will shift inspector workload and might affect FAA's capability to
    oversee the industry. FAA also concentrates its limited staff resources on
    the most safety-critical functions and through its designee programs
    delegates other, less critical activities to designees. Designees perform
    about 90 percent of certification-related activities, and thus allow FAA
    to better leverage resources. GAO's recent work found some weaknesses in
    FAA's system safety approach and recommended that FAA develop effective
    evaluative processes and accurate nationwide data on its safety oversight
    programs to address these weaknesses so that program managers and other
    officials have assurance that the programs attain their intended effect.
    FAA has begun implementing those recommendations but does not plan to
    evaluate SEP, which it intends to discontinue after December 2007.

    Training-including mandatory training requirements for FAA's workforce as
    well as designees-is an integral part of FAA's safety oversight system.
    GAO has reported that FAA has generally followed effective management
    practices for planning, developing, delivering, and assessing the impact
    of its technical training for safety inspectors, although some practices
    have yet to be fully implemented. However, several actions could improve
    the results of its training efforts. For example, FAA develops technical
    courses on an ad hoc basis rather than as part of an overall curriculum
    for each type of inspector, such as inspectors of operations or cabin
    safety, because the agency has not systematically identified the technical
    skills and competencies each type of inspector needs to effectively
    perform inspections. FAA has recognized the need to improve its training
    program in this and other areas.

    FAA faces several key safety challenges, including not meeting its
    performance target for commercial air carrier safety this year because of
    recent fatal accidents. Further, FAA's ability to oversee aviation safety
    will be affected by recent and anticipated trends in inspector and air
    traffic controller attrition. Also, FAA intends to enhance runway safety
    by relying on new technologies that are expected to reduce runway
    accidents. However, schedule delays and cost increases challenge FAA's
    ability to deploy this technology. Finally, new types of aviation vehicles
    are changing the aviation industry and will require new areas of expertise
    for FAA's inspectors and controllers.
    *** End of document. ***