In closing, I would like to recognize the hard work of the NTSB staff in producing this report, and producing it in such a timely manner in less than a year, and to thank my fellow Board Members for their very thoughtful participation in the process.
I would especially like to commend our research and engineering staff. The accident airplane did not have, and was not required to have, a flight data recorder. By good fortune, however, there was abundant radar data available. Working with our aviation safety staff, the RE staff was able to combine this radar information with information from the cockpit voice recorder and a performance study to determine the accident sequence.
Today, we did not address crash-hardened recorders for accident investigation. Rather, we recommended installing devices for flight data monitoring, to give company management the information necessary to evaluate and, if necessary, correct pilot behavior in order to prevent accidents such the one that we considered today.
Flight data monitoring can provide the fuel to drive continuous safety improvement by ensuring that a company’s safety management system is an effective set of practices, not a binder full of disregarded procedures that sits unused on a shelf.
Today’s recommendations, if acted upon, will help all Part 135 operators to make sure that their flight operations are safe and in compliance with applicable regulations and standard operating procedures.
They will also help the FAA to identify operators with a systemic, company-wide disregard for the regulations and for safety. These companies must either improve their practices or close their doors. All companies have a responsibility to follow the regulations and to actively manage safety in all facets of their operations.
Passengers expect, and should expect, to be flown by competent, well-rested, well-trained professional pilots who are employed by companies that comply with applicable regulations and operate safely.
Today’s recommendations, if acted upon, will help to make this expectation a reality in all Part 135 operations.
We stand adjourned.