THE STRAITS TIMES

Safety issues flagged in 2022 incident where tube

covers still fitted on SIA jet leaving Brisbane

PLINES HSBC

ARESS13
50-900

HE

RANGEN

For SIA flights, the covers must be removed about 20 minutes before departure. PHOTO: AUSTRALIAN TRANSPORT SAFETY BUREAU

Esther Loi

UPDATED MAR 21, 2024, 08:26 AM

SINGAPORE – The Australian authorities have found several safety issues in an incident from
May 2022 involving a Singapore Airlines (SIA) jet, in which the covers of its pitot probes were not
removed as it was about to depart from Brisbane Airport.
The probes or tubes, which measure air pressure to assess airspeed, are especially important for
take-off and the initial climb.

They are routinely covered during turnarounds at Brisbane Airport, in the capital of Australia’s
Queensland, as mud wasps can build nests in them within just 20 minutes.

https://www.straitstimes.com/singapore/transport/safety-iss n-sia-jet-leaving-brisbane?utm_campaign=ST_Newsletter_AM 21/3/24, 8 57 AM

Page 1 of 6
:
u
 The covers must be removed about 20 minutes before departure for SIA flights. Blockage of these
probes could result in inaccurate or absent airspeed readings, which can lead to unsafe flight
conditions.

Just before the Airbus A350 aircraft pushed away from the gate for departure on May 27, 2022, a
refueller in the next bay alerted a licensed aircraft maintenance engineer with Heston MRO, SIA’s
engineering maintenance contractor in Brisbane, to the fitted pitot covers.

The engineer removed the covers at 9.18am, two minutes to the scheduled departure time of
9.20am, and the aircraft later took off for Singapore.

The findings from the final report on the incident, published by the Australian Transport Safety
Bureau (ATSB) on March 15, showed that Heston MRO failed to adhere to procedures.

Get a round-up of the top stories to start your day

Enter your e-mail Sign up

By signing up, I accept SPH Media's Terms & Conditions and Privacy Policy as amended from time to time.

Yes, I would also like to receive SPH Media Group's marketing and promotions.

It also found that SIA’s flight crew had not effectively carried out pre-flight inspections, in which
a pilot walks around the aircraft to ensure visible equipment is safe for flight.

The bureau, based on its review of closed-circuit television (CCTV) camera footage of five SIA
turnarounds at Brisbane Airport from May 23 to 27 in 2022, flagged that none of the inspections
by SIA pilots was fully completed.

SIA’s procedures dictate that flight crew must carry out these inspections about 30 minutes
before departure.

While the flight crew operating the flight in question should still expect to see the probe covers
fitted then, the ATSB noted it is critical for inspections to be “completed in full and with careful
diligence”.

In January 2024, SIA told the bureau it had published a memo, and later a notice, to its pilots on
Dec 12, 2023, emphasising the importance of adhering to procedures regarding these
inspections.

The airline added that it had engaged Heston MRO to use more visible and longer probe covers.
Responding to ST’s queries on March 19, SIA said it has worked with its engineering teams and
pilots to strengthen its procedures. The airline did not specify how it is enforcing pilots’
adherence to pre-flight inspection protocol when asked.

https://www.straitstimes.com/singapore/transport/safety-iss n-sia-jet-leaving-brisbane?utm_campaign=ST_Newsletter_AM 21/3/24, 8 57 AM

Page 2 of 6
:
u
 “The safety of our customers and staff is always our No. 1 priority,” it added.
Besides pre-flight inspections, final walk-arounds – which are done by maintenance crew – are
also required.

MORE ON THIS TOPIC

CAAS flags ‘shortcomings’ in 2022 incident where SIA jet forced to land in Batam with very low fuel

SIA flight from London to S'pore diverted to Frankfurt due to issues with cabin pressure

From the review of CCTV footage of the five SIA turnarounds, final engineering walk-arounds
done by Heston MRO were completed fully from May 23 to 26, but had not been carried out for
the May 27 flight in 2022.

During these final walk-arounds after all aircraft doors are closed, an engineer must ensure,
among other things, that all covers and pins are removed.

On the day of the incident, the licensed aircraft maintenance engineer noted in a technical log
that the probe covers had been removed, and removed a placard stating the covers were fitted
from the plane’s cockpit, without visually or verbally confirming that the covers had been
removed.
He assumed an aircraft maintenance engineer he was supervising had removed them, but the
more junior engineer – who had started work just three weeks before – had been told not to
remove the covers without instruction.

The ATSB also found that Heston MRO did not roll out a previous proposal accepted by the ATSB
to account for equipment before an aircraft is towed away from the gate.

In February 2022, Heston MRO had proposed to audit the contents of all toolboxes – which
include probe covers – being taken to an aircraft, and reaudit them to ensure all contents were
returned before the aircraft leaves the gate.

This was after an incident involving a Malaysia Airlines Airbus A330 jet that departed from
Brisbane with its pitot covers still fitted in July 2018. The crew had to turn the plane back to
Brisbane Airport.

MORE ON THIS TOPIC

Plane makes U-turn after taking off in London with missing windows

Investigators find S’pore-owned plane in Selangor crash had ‘irregular maintenance’

In the SIA incident, the bureau highlighted several factors that increased safety risks, including
the dual roles of the licensed aircraft maintenance engineer, who was also Heston MRO’s regional
manager for south-east Queensland. Heston MRO also did not track the working hours of crew
with dual roles.

https://www.straitstimes.com/singapore/transport/safety-iss n-sia-jet-leaving-brisbane?utm_campaign=ST_Newsletter_AM 21/3/24, 8 57 AM

Page 3 of 6
:
u
 This increased the risk of fatigue-related incidents involving staff.
When asked about his level of fatigue on the day of the incident, the licensed aircraft
maintenance engineer said he was “moderately tired and let down” on most days, which is five on
an alertness scale from one to seven – with one being fully alert and seven being completely
exhausted.
He added that he could not remember the last time he had a full day of rest, noting that he was
“working to catch up with duties” even at home.
In January 2024, Heston MRO told the ATSB it was completing a review of its tool control
procedures. The changes will include a more specific requirement to review and document a
check of the toolbox before an aircraft is released to service.

The company also employed an independent regional manager who will not hold a maintenance
role. It will also require its staff, including engineers, to submit time sheets to better manage
fatigue. ST has contacted Heston MRO for comment.

MORE ON THIS TOPIC

Boeing to tie more worker bonuses to safety after series of lapses

CAAS to poll 10,000 aviation workers in sector-wide survey tracking safety culture over time

Dive deeper into the topics that matter to you.

ST ONE DIGITAL - ANNUAL

$9.90 $4.95/month
Get offer

$59.40 for the first year and $118.80 per year thereafter.

ST ONE DIGITAL - MONTHLY

$9.90/month
Subscribe today

No lock-in contract

https://www.straitstimes.com/singapore/transport/safety-iss n-sia-jet-leaving-brisbane?utm_campaign=ST_Newsletter_AM 21/3/24, 8 57 AM

Page 4 of 6
:
u
 Unlock subscriber-only benefits

Personalise your feed with brain-tickling content on your favourite topics, from your favourite authors.

All subscriber-only content on ST app and straitstimes.com.

Easy access any time via ST app on one mobile device.

Join ST's WhatsApp Channel and get the latest news and must-reads.

https://www.straitstimes.com/singapore/transport/safety-iss n-sia-jet-leaving-brisbane?utm_campaign=ST_Newsletter_AM 21/3/24, 8 57 AM

Page 5 of 6
:
u
  E-paper

 Facebook

 Instagram

 Twitter

 LinkedIn

 Newsletters

 RSS Feed

 Telegram

 Youtube

 TikTok

• SINGAPORE • TECH

• ASIA • SPORT

• WORLD • VIDEOS

• OPINION • PODCASTS

• LIFE • MULTIMEDIA

• BUSINESS

About Us

Terms & Conditions

Privacy Policy

Need help? Reach us here.

Advertise with us

MCI (P) 066/10/2023. Published by SPH Media Limited, Co. Regn. No. 202120748H. Copyright © 2024 SPH Media Limited. All rights reserved.

https://www.straitstimes.com/singapore/transport/safety-iss n-sia-jet-leaving-brisbane?utm_campaign=ST_Newsletter_AM 21/3/24, 8 57 AM

Page 6 of 6
:
u