Aviation Safety: FAA's Safety Oversight System Is Effective but  
Could Benefit from Better Evaluation of Its Programs' Performance
(17-NOV-05, GAO-06-266T).					 
                                                                 
The U.S. commercial aviation industry has an extraordinary safety
record. However, when passenger airlines have accidents or	 
serious incidents, regardless of their rarity, the consequences  
can be tragic. The Federal Aviation Administration (FAA) works to
maintain a high level of safety through an effective safety	 
oversight system. Keys to this system are to: (1) establish	 
programs that focus resources on areas of highest safety risk and
on mitigating risks; (2) provide training and communication to	 
ensure that inspectors can consistently carry out the agency's	 
oversight programs; and (3) have processes and data to		 
continuously monitor, evaluate, and improve the numerous	 
oversight programs that make up the safety oversight system. This
statement focuses on these three key areas and is based on recent
GAO reports on FAA's inspection oversight programs, industry	 
partnership programs, enforcement program, and training program. 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-266T					        
    ACCNO:   A41697						        
  TITLE:     Aviation Safety: FAA's Safety Oversight System Is	      
Effective but Could Benefit from Better Evaluation of Its	 
Programs' Performance						 
     DATE:   11/17/2005 
  SUBJECT:   Airlines						 
	     Data integrity					 
	     Employee training					 
	     Inspection 					 
	     Program evaluation 				 
	     Regulatory agencies				 
	     Risk assessment					 
	     Safety regulation					 
	     Safety standards					 
	     Training utilization				 
	     Transportation safety				 

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GAO-06-266T

United States Government Accountability Office

GAO Testimony

Before the Subcommittee on Aviation, Committee on Commerce, Science, and
Transportation, U.S. Senate

Not to Be Released Before10:00 a.m. EST

Thursday, November 17, 2005 AVIATION SAFETY

    FAA's Safety Oversight System Is Effective but Could Benefit from Better
                    Evaluation of Its Programs' Performance

Statement for the Record by
Gerald L. Dillingham, Ph.D., Director
Physical Infrastructure Issues

GAO-06-266T

[IMG]

Thursday, November 17, 2005

AVIATION SAFETY

FAA's Safety Oversight System Is Effective but Could Benefit from Better
Evaluation of Its Programs' Performance

                                 What GAO Found

FAA's safety oversight system includes programs that focus on risk
identification and mitigation through a risk-based system safety approach,
leveraging of resources through designee and partnership relationships,
and enforcement of safety regulations, but the benefits of these programs
are not being fully realized. For example, FAA's system safety approach
includes the addition of a program that emphasizes risk identification to
its traditional inspection program for overseeing some airlines, which is
not based on risk. However, it is likely that the benefits of this
approach could be enhanced if the inspection workload was not as heavily
oriented to the traditional inspection program's non-risk based
activities. FAA leverages its resources through its designee programs, in
which designated individuals and organizations perform about 90 percent of
certification-related activities, and through its industry partnership
programs, which are designed to assist the agency in receiving safety
information. An outgrowth of FAA's inspection process is its enforcement
program, which is intended to ensure industry compliance with safety
regulations. However, GAO has expressed concerns that this program may not
be as effective as it could be in deterring violations.

FAA has made training an integral part of its safety oversight system, but
several actions could improve the results of its training efforts,
including ensuring that inspectors are well-trained in FAA's system safety
approach and have sufficient knowledge of increasingly complex aircraft
and systems to effectively identify safety risks. FAA has established
mandatory training requirements for its workforce and designees. 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.

GAO has found inadequate evaluative processes and limitations with data
for FAA's inspection programs, designee programs, industry partnership
programs, and enforcement program. For example, FAA lacked requirements or
criteria for evaluating its designee programs. In another example, FAA's
nationwide enforcement database is not as useful as it could be because of
missing or incomplete historical information about enforcement cases.

FAA's Safety Oversight System Includes Inspections, Training, and Other
Activities

                 United States Government Accountability Office

Mr. Chairman and Members of the Subcommittee:

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. This record is a result of the efforts of the Federal Aviation
Administration (FAA), airlines, manufacturers, and others in the aviation
industry to maintain one of the safest aviation systems in the world.
However, when passenger airlines have accidents or serious incidents,
regardless of their rarity, the consequences can be tragic, as a single
accident can result in hundreds of deaths. In order to maintain a high
level of safety, it is critical 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. FAA's workforce of about 3,200 inspectors stationed at
more than 100 field offices throughout the world is responsible for
carrying out the agency's processes to certify, inspect, and enforce
safety regulations for all aspects of the aviation industry, including the
aircraft and its component parts, over 100 commercial airlines, about
5,000 aircraft repair stations, and hundreds of thousands of pilots and
mechanics. FAA augments its inspector workforce with nearly 13,600
designated organizations and individuals (designees) that conduct the more
routine aspects of industry oversight, such as administering tests to
pilots and mechanics as part of their certification requirements, and
augments the safety information that it obtains from inspections with
industry partnership programs. Keys to making this safety oversight system
work are to: (1) establish programs that focus resources on areas of
highest safety risk and on mitigating risks; (2) provide training and
other communication to ensure that inspectors maintain the skills and
knowledge to consistently carry out the agency's oversight programs; and
(3) have processes and data to continuously monitor, evaluate, and improve
the numerous oversight programs that make up the safety oversight system.
This statement focuses on these three key areas of FAA's "early warning
system" and is based on our recent reports on FAA's inspection oversight
programs, industry partnership programs, enforcement program, and training
program. We will also discuss our recommendations that FAA has not fully
addressed in these areas.

In summary:

o 	FAA's aviation safety oversight system includes programs that focus on
risk identification and mitigation through a system safety approach, the
leveraging of resources, and enforcement of safety regulations, but the

benefits of these programs are not being fully realized. FAA's system

safety approach has many strengths, including the addition of a program

that emphasizes risk identification to its traditional inspection program
for

overseeing non-legacy airlines,1 which is not based on risk. However, it
is

likely that the benefits of this approach could be enhanced if the

inspection workload for non-legacy airlines was not still heavily oriented

to the traditional inspection program's non-risk based activities. FAA

leverages resources through its designee programs, in which designees

perform about 90 percent of certification-related activities, thus
allowing

FAA to better concentrate its limited staff resources on the most safety

critical functions. However, concerns about the consistency and adequacy

of designee oversight that FAA field offices provide have been raised by

experts and other individuals we interviewed. FAA also leverages its

resources through industry partnership programs, which are designed to

assist the agency in receiving safety information. For example, FAA

encourages voluntary reports of safety violations by responding to them

by issuing a warning letter rather than a fine or other legal sanction.
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. FAA's policy for

assessing legal sanctions against entities or individuals that do not
comply

with aviation safety regulations is intended 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.

o 	FAA has made training an integral part of its safety oversight system,
but several actions could improve the results of its training efforts.
FAA's use of a risk-based system safety approach to inspections requires
inspectors to apply data analysis and auditing skills to identify and
control potential risks. Therefore, it is important that inspectors are
well-trained in this approach and have sufficient knowledge of
increasingly complex aircraft and systems to effectively identify safety
risks. FAA has established mandatory training requirements for its
workforce as well as designees.

1We refer to all passenger airlines that are not in FAA's Air
Transportation Oversight System (ATOS) as non-legacy airlines. The seven
"legacy" airlines and eight other airlines are overseen through ATOS. The
air carriers in the ATOS program are Alaska; American; Continental; Delta;
Northwest; United; American Eagle; Champion; ExpressJet; SkyWest;
Southwest; Trans States; FedEx; United Parcel Service; and US Airways,
which recently merged with America West.

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
have yet to be fully implemented. 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.

o 	It is important for FAA to have effective evaluative processes and
accurate nationwide data for its numerous safety oversight programs so
that program managers and other officials have assurance that the safety
programs are having their intended effect. Such processes and data are
especially important because FAA's workforce is so dispersed throughout
the world-with thousands of staff working out of more than 100 offices
worldwide-and because FAA's use of a system safety approach represents a
cultural shift from its traditional inspection program. Evaluation is
important for understanding if the cultural shift has effectively
occurred. Our most recent work has shown the lack of evaluative processes
and limitations with data for FAA's inspection program for non-legacy
airlines, designee programs, industry partnership programs, and
enforcement program. For example, we found that FAA lacked requirements or
criteria for evaluating its designee programs. In another example, FAA's
enforcement policy calls for the assessment of sanctions that would
potentially deter future violations. However, FAA lacks an evaluative
process, so it is not known whether the agency's enforcement practices,
such as at times reducing sanctions, may weaken any deterrent effect that
would be expected from such sanctions. Furthermore, FAA's ability to
evaluate its programs is hindered by the lack of useful nationwide data.
For example, FAA's nationwide enforcement database is not as useful as it
could be because of missing or incomplete historical information about
enforcement cases.

o 	In order to help FAA fully realize the benefits of its safety oversight
system, we have made a number of recommendations to address the weaknesses
that we identified in our reviews. These recommendations have not been
fully implemented, although in some cases FAA has taken steps towards
addressing them. Evaluative processes and relevant data are particularly
important as FAA works to change its culture by incorporating

Background

a system safety approach into its oversight, and we have recommended that
FAA develop continuous evaluative processes for its oversight of nonlegacy
airlines, its designee programs, and its enforcement program, and
systematically assess inspectors' technical training needs. In addition,
FAA's nationwide databases are in need of improvements in their
comprehensiveness and ease of use. We have recommended that FAA improve
the consistency and completeness of its designee and enforcement
databases. Continuous improvements in these areas are critical to FAA's
ability to have a robust "early warning system" in order to maintain one
of the safest aviation systems in the world.

FAA's safety oversight system is made up of a number of programs for
airlines and other entities. Safety oversight programs for airlines
provide for their initial certification, periodic surveillance, and
inspection. Since 1985, FAA has used National Work Program Guidelines
(NPG), its traditional inspection program for airlines, as a primary means
of ensuring that airlines comply with safety regulations. In NPG, an FAA
committee of program managers identifies an annual minimum set of required
inspections that are to be undertaken to ensure that airlines are in
compliance with their operating certificates. In 1998, the agency
implemented the Air Transportation Oversight System (ATOS), which
currently oversees the nation's largest 15 commercial airlines and cargo
carriers, with the goal of eventually including all commercial passenger
and cargo airlines in it. ATOS emphasizes a system safety approach that
extends beyond periodically checking airlines for compliance with
regulations to the use of 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 assessment of risks, and adjust the plans periodically based
on inspection results. However, the agency has been delayed in placing a
significant number of other passenger airlines in ATOS, resulting in 99
passenger airlines, which we refer to as non-legacy airlines, continuing
to be overseen through NPG, a process that is not risk-based or system
safety oriented. In 2002, FAA added the Surveillance and Evaluation
Program (SEP) to the NPG inspection program to incorporate principles of
ATOS into its oversight of non-legacy passenger airlines. The two programs
are used together to establish the number of annual inspections for
non-legacy airlines. (Appendix 1 describes each inspection program.)
Figure 1 illustrates some typical activities covered during inspections.

Figure 1: FAA's Safety Inspections Cover a Wide Range of Activities

Source: FAA.

Note: As a workforce, FAA inspectors conduct a wide variety of
inspections, including ensuring that pilots are qualified to operate
aircraft, inspecting aircraft for safety, and overseeing FAA-certified
mechanics.

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 about
180 organizations (called "designees") to act as its representatives to
conduct many safety certification activities, 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 (see fig. 2).

Figure 2: FAA Offices That Manage the Different Designee Programs and
Numbers of Designees (as of May 2004)

Since 1990, FAA has emphasized gaining compliance from the aviation
industry through cooperative means by establishing industry partnership
programs with the aviation community 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

FAA's Safety Oversight System Focuses on Risk Identification and
Mitigation Through System Safety, Leveraging of Resources, and Enforcement
of Safety Regulations, but Benefits Are Not Being Fully Realized

participants that can include air carriers and repair stations. Appendix
II describes the industry partnership programs.

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

In recent reports, we found that FAA's safety oversight system has
programs that focus on risk identification and mitigation through a system
safety approach, the leveraging of resources, and enforcement of safety
regulations, but that the benefits of these programs are not being fully
realized. In our recent report on FAA's oversight of non-legacy airlines,
we found that the focus on risk identification through the addition of SEP
has many strengths and allows for enhancing the efficiency of FAA's
oversight activities.2 Rather than relying on NPG's customary method of
conducting a set number of inspections of an airline's operations, SEP
emphasizes a system safety approach of using risk analysis techniques. SEP
allows for the efficient use of inspection staff and resources by
prioritizing workload based on areas of highest risk, and it includes a
requirement that inspectors verify that corrective actions have occurred.
For example, FAA has developed risk assessment worksheets for SEP that are
aligned with key airline systems that guide inspectors through identifying
and prioritizing risks. The worksheets guide inspectors to organize the
results of their previous inspections and surveillance into a number of
areas such as flight operations and personnel training in order to
identify specific risks in each area and target the office's resources to
mitigating those risks. The development of a system safety approach
addresses a longstanding concern by us that FAA did not have a methodology
for assessing airline safety risks so that it could target limited
inspection resources to high-risk conditions.3 Another strength of SEP,
consistent with findings in

2GAO, Aviation Safety: System Safety Approach Needs Further Integration
into FAA's Oversight of Airlines, GAO-05-726 (Washington, D.C.: Sept. 28,
2005).

3GAO, Aviation Safety: Weaknesses in Inspection and Enforcement Limit FAA
in Identifying and Responding to Risks, GAO/RCED-98-6 (Washington, D.C.:
Feb. 27, 1998); GAO, Aviation Safety: FAA Needs to More Aggressively
Manage Its Inspection Program, GAO/T-RCED-92-25 (Washington, D.C.: Feb. 6,
1992).

our past reports, is that SEP relies on teams of inspectors, which are
generally more effective than individual inspectors in their ability to
collectively identify concerns.4

However, the benefits of FAA's system safety approach for the inspection
of non-legacy airlines could be enhanced by a more complete implementation
of SEP and addressing other challenges. The inspection workload for
non-legacy airlines is still heavily oriented to the NPG's nonrisk based
activities. For example, as shown in table 1, from fiscal years 2002
through 2004, 77 percent of inspection activities required for the top 25
non-legacy airlines in terms of the number of enplanements were identified
through NPG, and the remaining percentage of inspection activities were
identified based on risk through SEP. Although inspectors can replace
NPG-identified activities with SEP-identified activities that they deem
constitute a greater safety risk, we found that FAA inspectors interpret
agency emphasis on NPG as discouraging this practice. In order to ensure
that all inspectors who oversee non-legacy airlines have a complete and
timely understanding of the agency's policies relating to the inspection
process, we recommended in September 2005 that FAA improve communication
with and training of inspectors in this area.

Table 1: SEP-and NPG-Initiated Required Inspections for the Top 25
Non-legacy Airlines, Fiscal Years 2002-2004

              Type of inspection      2002   2003     2004              Total 
                   SEP-initiated     1,261  1,567     927         3,755 (23%) 
                   NPG-initiated     5,470  3,623    3,338       12,431 (77%) 
                           Total     6,731  5,190    4,265      16,186 (100%) 

Source: GAO analysis of FAA information.

Another way that FAA attempts to enhance the efficiency of its oversight
activities is through its designee programs. We reported that FAA
maximizes its resources by allowing designees to perform about 90 percent
of certification-related activities, thus allowing FAA to better
concentrate its limited staff resources on the most safety-critical
functions.5 For example, while designees conduct routine certification
functions, such as approvals of aircraft technologies that the agency and

4GAO/RCED-98-6; GAO/T-RCED-92-25.

5GAO, Aviation Safety: FAA Needs to Strengthen the Management of Its
Designee Programs, GAO-05-40 (Washington, D.C.: Oct. 8, 2004).

designees have had previous experience with, FAA focuses on new and
complex aircraft designs or design changes. In addition, the use of
designees expands FAA's access to technical expertise within the aviation
community. For the aviation industry, the designee programs enable
individuals and organizations to obtain required FAA certifications-such
as approvals of the design, production, and airworthiness of aircraft-in a
timely manner, thus reducing delays and costs to the industry that might
result from scheduling direct reviews by FAA staff. For example, officials
from an aircraft manufacturer told us that the use of designees has added
significantly to the company's ability to enhance and improve daily
operations by decreasing certification delivery time and increasing the
flexibility and utilization of company resources. In addition, designees
are convenient to the aviation industry due to their wide dispersal
throughout the United States.

However, concerns about the consistency and adequacy of designee oversight
that FAA field offices provide 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. Experts also
ranked this issue as a top weakness.6 Table 2 shows the top five
weaknesses identified by our experts. Experts also made a number of
suggestions to strengthen the designee program, including clearly defining
and following agency criteria for selecting designees and increasing
penalties for designees found to violate standards or who do not exercise
proper judgment. 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 and
incorporate, as appropriate, suggestions from our expert panel. In
response to our recommendations, FAA is planning, among other

6We identified 62 aviation experts with knowledge and expertise in FAA's
designee programs, who participated on a Web-based panel that provided the
group's views on the strengths and weaknesses of the designee programs and
ways to improve the programs. The experts included designees, FAA
inspectors and engineers, independent experts and university academics,
and private sector and aviation industry associations. We obtained the
experts' views by employing an iterative and controlled feedback process
for obtaining individual views and then allowing each participant to
respond to the entire panel's comments.

things, to form a team to identify and share best practices for overseeing
designee programs.

Table 2: Experts' Ranking of Top 5 Oversight Weaknesses

                                Ranking Weakness

FAA offices level of oversight and interpretation of rules are
inconsistent.

Inactive, unqualified, or poor performing designees are not identified and
removed expeditiously.

It is difficult to terminate poor performing designees.

Inadequate surveillance and oversight of designees.

        FAA has not made oversight of designees a high enough priority.

Source: GAO analysis of expert panel information.

Note: Rankings based on responses from 62 experts and the frequency of
responses indicating a "great" or "very great" weakness.

FAA also leverages its resources through its industry partnership
programs. These partnership programs are designed to assist the agency in
receiving safety information, including reports of safety violations.
According to FAA officials, the Aviation Safety Action Program, Aviation
Safety Reporting Program, and Voluntary Disclosure Reporting Program
augment FAA's enforcement activities and allow FAA to be aware of many
more safety incidents than are discovered during inspections and
surveillance. In addition, the Flight Operational Quality Assurance
Program provides safety information in the form of recorded flight data
from participating airlines. FAA has established some management controls
over its partnership programs, such as procedures to track actions taken
to correct safety incidents reported under the programs, but the agency
lacks management controls to measure and evaluate the performance of these
programs, an issue that we will discuss later in the testimony.

FAA's enforcement process, which is intended to ensure industry compliance
with safety regulations, is another important element of its safety
oversight system. FAA's policy for assessing legal sanctions against
entities or individuals that do not comply with aviation safety
regulations is intended to deter future violations. FAA has established
some management controls over its enforcement efforts, with procedures
that provide guidance on identifying regulated entities and individuals
that are subject to inspections or surveillance actions, determining
workload priorities on the basis of the timing and type of inspection to
be performed, detecting violations of safety regulations, tracking the
actions

that are taken by the entities and individuals to correct the violations
and achieve compliance with regulations, and imposing punitive sanctions
or remedial conditions on the violators. These procedures provide FAA
inspectors, managers, and attorneys with a process to handle violations of
safety regulations that are found during routine inspections.

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 that are not associated with the merits of the
case. We found that from 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 that the agency sometimes reduces sanctions
in order to prioritize attorneys' caseloads by closing the cases more
quickly through negotiating a lower fine. Economic literature on
deterrence suggests that although negative sanctions (such as fines and
certificate suspensions) can deter violations, if the violator expects
sanctions to be reduced, he or she may have less incentive to comply with
regulations. In effect, the goal of preventing future violations is
weakened when the penalties for present violations are lowered for reasons
not related to the merits of the case. In addition, FAA lacks management
controls to measure and evaluate its enforcement process, which we discuss
later in this testimony.

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. Therefore, it is
important that inspectors are well-trained in this approach and have
sufficient knowledge of increasingly complex aircraft, aircraft parts, and
systems to effectively identify safety risks. 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 and has established mandatory training
requirements for its workforce as well as designees. FAA provides
inspectors with extensive training in federal aviation regulations;
inspection and investigative techniques; and technical skills, such as
flight training for operations inspectors. The agency provides its
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

FAA Has Made Training an Integral Part of Its Safety Oversight System but
Several Actions Could Improve Results

its technical training7 for safety inspectors, although some practices
have yet to be fully implemented.8 In its planning activities for
training, FAA has linked technical training efforts to its goal of safer
air travel and has identified technical proficiencies needed to improve
safety inspectors' performance in meeting this goal. For example, FAA's
Offices of Flight Standards and Aircraft Certification have identified
gaps in several of the competencies required to conduct system safety
inspections, including risk assessment, data analysis, systems thinking,
and designee oversight. According to FAA, it is working to correct these
gaps. We have also identified gaps in the training provided to inspectors
in the Office of Flight Standards who oversee non-legacy airlines, 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 inspection policies. We have
identified similar competency gaps related to designee oversight. For
example, FAA does not require refresher training concerning designee
oversight, which increases the risk that staff 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.9 We did not identify any specific
gaps in the competencies of designees.10 In prioritizing funding for
course development activities, FAA does not explicitly consider which
projects are most critical. Figure 3 describes the extent to which FAA
follows effective management practices in planning training.

7We 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.

8GAO, 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
outlined 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).

9GAO-05-40.

10However, many experts on our panel indicated it was of high or highest
importance to ensure standard training of designees within specific
specialties to improve the consistency of their work, and to increase the
number of subject-matter workshops for designees.

Figure 3: Extent that FAA Follows Effective Management Practices in
Planning Technical Training

In developing its training curriculum for inspectors, FAA also for the
most part follows 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 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. Figure 4 describes the extent to
which FAA follows effective management practices in developing training.

Figure 4: 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.

In delivering training, FAA has also generally followed effective
management practices. (See fig. 5.) For example, FAA has established clear
accountability for ensuring that inspectors have access to technical
training, 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. In addition, FAA acknowledges the need to increase communication
between inspectors and management with respect to the training program,
especially to ensure that inspectors have bought into the system safety
approach to inspections.

Figure 5: Extent that FAA Follows Effective Management Practices in
Delivering Technical Training

FAA offers numerous technical courses from which inspectors can select to
meet job needs. However, from our survey of FAA's inspectors, we estimate
that only about half think that they have the technical knowledge needed
for their jobs.11 FAA officials told us that inspectors' negative views
stem from their wanting to acquire proficiencies that are not as crucial
in a system safety environment. We also found a disparity between
inspectors and FAA concerning the receipt of requested training. We
estimated that 28 percent of inspectors believe that they get the
technical training that they request. However, FAA's records show that FAA
approves about 90 percent of these requests, and inspectors are making
good progress in receiving training. Over half of the inspectors have
completed at least 75 percent of technical training that FAA considers
essential. FAA officials told us that inspectors' negative views on their
technical knowledge and the training they have received stem from their
not accepting FAA's move

11Because of the statistical survey techniques we employed in surveying
FAA's inspectors, we are 95 percent confident that the results we present
are within 4.6 percentage points of the results that we would have
obtained if we had surveyed all 3,000 inspectors. That is, we are 95
percent confident that had we surveyed all inspectors, between 48 and 57
percent of them would have told us that, to a great or very great extent,
they have the technical knowledge to do their jobs. All percentage
estimates from the survey have a margin of error of plus or minus 4.6
percentage points or less, unless otherwise noted.

to a system safety approach. That is, the inspectors are concerned about
acquiring individual technical proficiency that is not as crucial in a
system safety environment. Given that it has not completed assessing
whether training for each inspector specialty meets performance
requirements, FAA is not in a position to make definitive conclusions
concerning the adequacy of inspector technical training.

FAA also generally followed effective management practices in evaluating
training. The agency requires that each training course receive a
systematic evaluation every 3 years to determine if the course is up to
date and relevant to inspectors' jobs, although training officials noted
that many courses have yet to undergo such an evaluation. However, FAA
collects limited information on the effectiveness of training, and its
evaluations have not measured the impact of training on FAA's mission
goals, such as reducing accidents. Training experts acknowledge that
isolating performance improvements resulting from training programs is
difficult for any organization. (See fig. 6.)

Figure 6: Extent that FAA Follows Effective Management Practices in
Evaluating Its Training Program

While FAA follows many effective management practices in its training
program, the agency also recognizes the need for improvements, including
(1) systematically assessing inspectors' needs for technical and other
training, (2) better timing of technical training so that inspectors
receive it when it is needed to perform their jobs, and (3) better linking
the training provided to achieving agency goals of improving aviation
safety. FAA has begun to act in these areas, and we believe that if
effectively implemented, the actions should improve the delivery of
training and ultimately improve aviation safety. Therefore, it is
important for FAA to follow through with its efforts. As a result, we
recommended in September 2005, among other things, that in order to ensure
that inspector technical training needs are identified and met in a timely
manner, FAA systematically assess inspectors' technical training needs,
better align the timeliness of training to when inspectors need the
training to do their jobs, and gain inspectors' acceptance for changes
made or planned to their training.

It is important that both FAA's inspection workforce and FAA-certified
aviation mechanics are knowledgeable about increasingly complex aircraft,
aircraft parts, and systems. 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. 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.12 We recommended that FAA review the curriculum and
certification requirements and update both. FAA plans to make changes in
the curriculum for FAA approved aviation maintenance technicians that
reflect up-to-date aviation technologies and finalize and distribute a
revised Advisory Circular in March 2006 that describes the curriculum
changes. FAA then plans to allow the aviation industry time to implement

12GAO, Aviation Safety: FAA Needs to Update the Curriculum and
Certification Requirements for Aviation Mechanics, GAO-03-317 (Washington,
D.C.: Mar. 6, 2003).

FAA Has Evaluated Some Safety Programs, but the Lack of Evaluative Systems
and Nationwide Data Impedes FAA's Ability to Continuously Monitor Its
Safety Programs

the recommended curriculum changes before changing the requirements for
FAA-issued mechanics certificates.

It is important for FAA to have effective evaluative processes and
accurate nationwide data on its numerous safety oversight programs so that
program managers and other officials have assurance that the safety
programs are having their intended effect. Such processes and data are
especially important because FAA's workforce is so 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.
Evaluation is important to understanding if the cultural shift has
effectively occurred. Our most recent work has shown the lack of such
processes and limitations with data for FAA's inspection programs for
non-legacy airlines, designee programs, industry partnership programs, and
enforcement program. In response to recommendations that we have made
regarding these programs, some improvements are being made. On the
positive side, as we mentioned earlier, our most recent work found that
FAA generally follows effective management practices in evaluating
individual technical training courses.

FAA has not evaluated its inspection oversight programs for non-legacy
airlines-which include SEP and NPG-to determine how the programs
contribute to the agency's mission and overall safety goals, and its
nationwide inspection database lacks important information that could help
it perform such evaluations-such as whether risks identified through SEP
have been mitigated. In addition, the agency does not have a process to
examine the nationwide implications of or trends in the risks that
inspectors have identified through their risk assessments-information it
would need to proactively determine risk trends at the national level on a
continuous basis. FAA's evaluation office instead conducts analyses of the
types of inspections generated under SEP by airline and FAA region,
according to FAA. We recommended that FAA develop a continuous evaluative
process for activities under SEP and link SEP to the performance-related
goals and measures developed by the agency, track performance toward these
goals, and determine appropriate program changes. FAA is considering our
recommendation, but its plan to place the remaining non-legacy airlines in
the ATOS program by the end of fiscal year 2007 might make this
recommendation unnecessary, according to the agency. Since FAA's past
efforts to move airlines to ATOS have experienced delays, we believe that
this recommendation is still valid.

We also found that FAA lacked requirements or criteria for periodically
evaluating its designee programs. In 2004, we reported that the agency had
evaluated 6 of its 18 designee programs over the previous 7 years and had
plans to evaluate 2 more, although it had no plans to evaluate the
remaining 10 programs because of limited resources.13 FAA conducted these
evaluations on an ad hoc basis usually at the request of headquarters
directors or regional office managers. In addition, we found that FAA's
oversight of designees is hampered, in part, by the limited information on
designees' performance contained in the various designee databases.14
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 establish a process to evaluate all
designee programs and strengthen the effectiveness of its designee
databases by improving the consistency and completeness of information in
them. To address our recommendations, FAA expects to develop a plan to
evaluate all designee programs on a recurring basis and intends to
establish a team that will examine ways to improve automated information
related to designees.

In addition, we found that FAA does not evaluate the effects of its
industry partnership and enforcement programs to determine if stated
program goals, such as deterrence of future violations, are being
achieved. For example, little is known about nationwide trends in the
types of violations reported under the partnership programs or whether
systemic, nationwide causes of those violations are identified and
addressed. Furthermore, FAA's enforcement policy calls for inspectors and
legal counsel staff to recommend or assess enforcement sanctions that
would potentially deter future violations. However, without an evaluative
process, it is not known whether the agency's practice of generally
closing cases with

13GAO-05-40.

14These databases are Flight Standards Service's Program Tracking and
Reporting Subsystem and National Vital Information Subsystem, Aircraft
Certification Service's Designee Information Network, and Office of
Aerospace Medicine's Airmen Medical Certification Information Subsystem.

administrative actions rather than legal sanctions15 and at times reducing
the amount of the fines, as mentioned earlier in this testimony, may
weaken any deterrent effect that would be expected from sanctions.

FAA's ability to evaluate the impact of its enforcement efforts is also
hindered by the lack of useful nationwide data. FAA inspection offices
maintain independent, site-specific databases because they do not find the
nationwide enforcement database-the Enforcement Information System
(EIS)-as useful as it could be because of missing or incomplete historical
information about enforcement cases. As a result of incomplete data on
individual cases, FAA inspectors lack the complete compliance history of
violators when assessing sanctions. We recommended that FAA develop
evaluative processes for its enforcement activities and partnership
programs and use them to create performance goals, track performance
towards those goals, and determine appropriate program changes. We also
recommended that FAA take steps to improve the usefulness of the EIS
database by enhancing the completeness of enforcement information. FAA
expects to address some of these issues as it revises its enforcement
policy, which is expected to be issued later in fiscal year 2006. In
addition, FAA has established a database workgroup that is developing
long-and short- term solutions to address the problems with EIS.

Recommendations We Have Made to Improve FAA's Safety Oversight System

In order to help FAA fully realize the benefits from its safety oversight
system, we have made a number of recommendations to address weaknesses
that we identified in our reviews. These recommendations have not been
fully implemented, although in some cases FAA has taken steps towards
addressing them. Evaluative processes and relevant data are particularly
important as FAA works to change its culture by incorporating a system
safety approach into its oversight, and we have recommended that FAA
develop continuous evaluative processes for its oversight programs for
non-legacy airlines, its designee programs, and its industry partnership
and enforcement programs, and systematically assess inspectors' technical
training needs. In addition, FAA's nationwide databases are in need of
improvements in their comprehensiveness and ease of use. Without
comprehensive nationwide data, FAA does not have the information needed to
evaluate its safety programs and have assurance

15We found that during fiscal years 1993 through 2003, FAA closed about 53
percent of the nearly 200,000 enforcement actions with administrative
actions (such as warning notices). About 28 percent of the actions were
closed with legal sanctions (such as fines) and about 18 percent were
closed with no enforcement action.

that they are having the intended results. We have recommended that FAA
improve the completeness of its designee and enforcement databases.
Continuous improvements in these areas are critical to FAA's ability to
have a robust "early warning system" and maintain one of the safest
aviation systems in the world.

Contacts and 	For further information on this testimony, please contact
Dr. Gerald Dillingham at (202) 512-2834 or by email at
[email protected].

Acknowledgments 	Individuals making key contributions to this testimony
include Brad Dubbs, Phillis Riley, Teresa Spisak, and Alwynne Wilbur.

Appendix I: Description of FAA's Inspection Programs

Table 3 describes the Federal Aviation Administration's (FAA) three
inspection processes for overseeing airlines: Air Transportation Oversight
System (ATOS), National Work Program Guidelines (NPG), and Surveillance
and Evaluation Program (SEP). Many of the elements of ATOS, such as the
use of data to identify risks and the development of surveillance plans by
inspectors, are incorporated in the SEP process. The NPG process, in
contrast, is not focused on the use of data and relies on an established
set of inspections that are not risk based.

                Table 3: Various Elements of ATOS, NPG, and SEP

ATOS NPG SEP

Description of  o  Focuses on safety vulnerabilities  o  Focuses on
inspectors  o  Focuses on inspectors program rather than regulatory
compliance completing a prescribed conducting a risk assessment

o  Analysts and inspectors review airline number of inspection activities
of various areas

data to identify areas of safety risk  o  Primarily based on checking  o 
Inspectors review data to

o 	Inspectors develop surveillance plans airline compliance with identify
areas of safety risk and for each airline, based on data regulations use
Flight Standards Safety

analysis and assessment of risks,  o  Relies on inspectors' expertise
Analysis Information Center and adjust the plans periodically to identify
trends and risks and the Safety Performance based on inspection results
Analysis System as analytical

tools

o 	Inspectors develop surveillance plans for each airline, based on data
analysis and assessment of risks, and adjust plans periodically based on
inspection results

o 	Inspectors can also verify that planned NPG activities meet the
surveillance needs for a particular year

Type of commercial Legacy commercial airlines Non-legacy commercial
airlines Non-legacy commercial airlines
passenger airline
inspected

Frequency of Continuous safety        Periodic; regular     Periodic;      
                    oversight              inspections are  inspections are   
inspections                     established annually by established during 
                                                    an FAA      meetings held 
                                   headquarters committee  at least twice a   
                                                           year using risk-   
                                                             based criteria   

Approximate number           585               1,100b               1,100b 
of aviation safety                                         
inspectors                                                 
conducting                                                 
inspections a                                              

Number of                       13c                 99                  99 
commercial                                                   
passenger airlines                                           
under the program b                                          

Source: GAO and FAA

aAs of July 2005.

bThere are a total of about 1,100 inspectors for both the NPG and SEP
inspections.

cFedEx and United Parcel Service, two cargo air carriers, are also in the
ATOS program. This number reflects the recent merger of US Airways and
America West, which were both in ATOS prior to the merger.

Appendix II: Description of FAA's Partnership Programs

Aviation Safety Action Program (ASAP)

Year Established: 1997

Participation: Participants include employees of air carriers and repair
stations that have entered into a memorandum of understanding with the
Federal Aviation Administration (FAA). The memoranda can cover employee
groups, such as pilots, maintenance employees, dispatchers, or flight
attendants. Each employee group is covered by a separate memorandum of
understanding. As of June 2004, FAA had accepted 54 memoranda of
understanding and received over 80,000 ASAP reports, which may or may not
include safety violations, according to FAA officials.

Purpose: ASAP seeks to improve aviation safety through the voluntary
self-reporting of safety incidents under the procedures set forth in the
memorandum of understanding. Under the program, FAA does not take
enforcement action against employees who voluntarily self-reported safety
violations for reports that are sole-source (the report is the only way
FAA would have learned about the incident) and will pursue administrative
action only for reports that are not sole-source. Incidents that involve
alcohol, drugs, criminal activity, or an intentional disregard for safety
are not eligible for self-reporting under ASAP.

Process: Each memorandum of understanding is a voluntary partnership
between FAA, the airline, and an employee group. Although employee groups
are not always included, FAA encourages their participation. The
memorandum of understanding ensures that employees who voluntarily
disclose FAA safety violations in accordance with the procedures and
guidelines of ASAP will receive administrative action or no action in lieu
of legal enforcement action.

Once a memorandum of understanding is approved, employees can begin
reporting violations that fall under the agreement. When a violation
occurs, an employee notifies the Event Review Committee, which includes
representatives from FAA and the airline or the repair station and
generally includes the appropriate employee association. The committee
must be notified in writing within the time limit specified in the
memorandum of understanding. The committee then determines whether to
accept the report under the ASAP program. If the report is accepted (it
meets the acceptance criteria in the memorandum and does not involve
criminal activity, substance abuse, controlled substances, or alcohol),
then the committee determines the action to take. That action may include
remedial training or administrative action, but it will not include a
legal sanction.

Results: FAA does not know the overall program results because it does not
have a national, systematic process in place to evaluate the overall
success of ASAP. However, FAA cites examples that describe ASAP's
contribution to enhanced aviation safety. These examples include
identifying deficiencies in aircraft operations manuals, airport
equipment, and runways. In July 2003, FAA's Compliance and Enforcement
Review recommended that FAA evaluate the use and effectiveness of this
program.

Aviation Safety Reporting Program (ASRP)

Year Established: 1975

Participation: Participants are all users of the national airspace system,
including air traffic controllers and employees of air carriers and repair
stations.

Purpose: The program is designed to improve aviation safety by offering
limited immunity for individuals who voluntarily report safety incidents.
ASRP was founded after TWA Flight 514 crashed on approach to landing in
December 1974 after the crew misinterpreted information on the approach
chart. This accident occurred only 6 weeks after another plane experienced
the same error.

Process: The National Aeronautics and Space Administration (NASA)
administers this program. When a safety incident occurs, a person may
submit a form and incident report to NASA. There are four types of forms
that can be submitted to NASA: (1) Air Traffic Control, (2) General
Reports (includes Pilots), (3) Flight Attendants, and (4) Maintenance
Personnel.

At least two aviation safety analysts read these forms and the incident
reports that accompany them. The analysts at NASA screen the incident
reports for urgent safety issues, which will be marked for immediate
action to the appropriate FAA office or aviation authority. NASA analysts
also edit the report's narrative to eliminate any identifying information.
In addition, each report has a tear-off portion, which is separated and
returned to the individual who reported the incident as a receipt of the
incident report's acceptance into the ASRP. When a safety violation that
has been previously reported under ASRP comes to the attention of FAA, the
agency issues a legal sanction, which is then waived. Reports that would
not be eligible to have a legal sanction waived include deliberate
violations, violations involving a criminal offense, or accident; reports
filed by participants who have committed a violation of federal aviation

regulations or law within the last 5 years and reports filed later than 10
days following an incident.

Results: While FAA and NASA do not know the overall program results
because they do not have a formal national evaluation program to measure
the overall effectiveness of the program, the agencies widely disseminate
information generated from the program to aircraft manufacturers and
others. ASRP reports are compiled into a database known as the Aviation
Safety Reporting System. When a potentially hazardous condition is
reported, such as a defect in a navigational aid or a confusing procedure,
NASA will send a safety alert to aircraft manufacturers, the FAA, airport
representatives, and other aviation groups. The database is used for a
monthly safety bulletin that includes excerpts from incident reports with
supporting commentary by FAA safety experts. NASA officials estimate that
the bulletin is read by over 150,000 people. In addition, individuals and
organizations can request a search of the database for information on
particular aircraft aviation safety subjects, including human performance
errors and safety deficiencies. Further, NASA has used the database to
analyze operational safety issues, such as general aviation incidents,
pilot and controller communications, and runway incursions.

Flight Operational Quality Assurance (FOQA)

Year Established: 1995

Participation: Participants include air carriers that equip their
airplanes to record flight data. As of March 2004, 13 airlines had
FAA-approved FOQA programs, and approximately 1,400 airplanes were
equipped for the program.

Purpose: FOQA is designed to enhance aviation safety through the analysis
of digital flight data generated during routine flights.

Process: Air carriers that participate in the program equip their aircraft
with special acquisition devices or use the airplanes' flight data
recorders to collect data and determine if the aircraft are deviating from
standard procedures. These data include engine temperatures, descent rate,
and deviations from the flight path. When the aircraft lands, data are
transmitted from the aircraft to the airline's FOQA station, where they
are analyzed for flight trends and possible safety problems.

Once the data are transmitted to the FOQA ground station, the data are
extracted and analyzed by software programs. The FOQA data are combined
with data from maintenance databases, weather conditions, and

other safety reporting systems, such as ASAP, in order to identify trends
in flight operations. The analysis typically focuses on events that fall
outside normal boundaries specified by the manufacturer's operational
limitations and the air carrier's operational standards.

FOQA data are collected and analyzed by individual air carriers. The data
on safety trends are made available to FAA in an aggregated form with no
identification of individual carriers. According to FAA officials, air
carriers do not want to release this data to any outside party (including
FAA) because of concerns that the data could then be publicly released.
Air carriers pay for the special flight data recorders that can record
FOQA data, which cost approximately $20,000 each. Although this can be an
expensive investment for some air carriers, most newer aircraft models
come with the data recorder built into the airplane. The International
Civil Aviation Organization (ICAO) has recommended that airlines from
member countries implement a FOQA program. FAA has notified ICAO that the
program will remain voluntary in the United States.

Results: Although FAA has no formal national evaluation program to measure
the overall results or effectiveness of FOQA programs, FAA cites examples
that describe FOQA's contribution to enhanced aviation safety. For
example, one FOQA program highlighted a high rate of descent when
airplanes land at a particular airport. On the basis of the information
provided from FOQA, air traffic controllers at the airport were able to
develop alternative approach procedures to decrease the rate of descent.

Voluntary Disclosure Reporting Program (VDRP)

Year Established: 1990

Participation: Participants include air carriers, repair stations, and
production approval holders.1

Purpose: FAA initiated the program to promote aviation safety by
encouraging the voluntary self-reporting of manufacturing, and quality
control problems and safety incidents involving FAA requirements for
maintenance, flight operations, drug and alcohol prevention programs, and
security functions.

1A production approval holder is an entity that holds a certificate,
approval, or authorization from FAA to manufacture aircraft, aircraft
engines, propellers, and related parts and articles.

Process: Upon discovering a safety violation, participants can voluntarily
disclose the violation to FAA within 24 hours. The initial notification
should include a description of the violation, how and when the violation
was discovered, and the corrective steps necessary to prevent repeat
violations. Within 10 days of filing the initial notification to FAA, the
entity is required to provide a written report that cites the regulations
violated, describes how the violation was detected, provides an
explanation of how the violation was inadvertent, and provides a
description of the proposed comprehensive fix. FAA may pursue legal action
if the participant discloses violations during, or in anticipation of, an
FAA inspection.

The violation must be reported immediately after being detected, must be
inadvertent, must not indicate that a certificate holder is unqualified,
and must include the immediate steps that were taken to terminate the
apparent violation. If these conditions are met, and the FAA inspector has
approved the comprehensive fix, then the FAA inspector will prepare a
letter of correction and the case is considered closed with the
possibility of being reopened if the comprehensive fix is not completed.

Results: FAA does not know the overall program results because it does not
have a process to measure the overall effectiveness of the program
nationwide. A 2003 internal FAA report recommended that the agency
evaluate the use and effectiveness of this program.

                    Selected GAO Reports on Aviation Safety

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.

Aviation Safety: FAA's New Inspection System Offers Promise, but Problems
Need to Be Addressed. GAO/RCED-99-183. Washington, D.C.: June 28, 1999.

Aviation Safety: Weaknesses in Inspection and Enforcement Limit FAA in
Identifying and Responding to Risks. GAO/RCED-98-6. Washington, D.C.:
February 27, 1998.

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