December 2018


    AESA Safety Assessment Report 2017

    Until the publication of this report, AESA had been disclosing information from the activity of the Event Reporting System, CEANITA, PESO newsletters, recommendations, directives and safety information on its website and will continue to do so. But there was a lack of an integrative document reflecting the overall picture of the aviation safety situation in the civil aviation system in Spain. There was also a lack of a document of an informative nature that could reach the entire aeronautical community and that could be interpreted by the general public.

    This is the gap that is now intended to be covered with this new 2017 security memory format. Knowing where we are in security matters, knowing our greatest risks and reporting on what we are doing to control them. Sharing, disseminating and joining wills, with the idea of progressing and, ultimately, improving security. This is the primary objective and raison d’être of AESA.

    The 2017 security memory can be found at the following link:


    CEANITA Memory 2017

    The State Aviation Safety Agency (AESA) has published the Annual Report of the Commission for the Study and Analysis of Notifications of Air Transit Incidents (CEANITA) for the year 2017.

    CEANITA, an interministerial collegiate body whose operating rules are laid down in Order PRE/697/2012 of 2 April 2012, aims to provide advice and collaboration to the State Aviation Safety Agency and the Air Force General Staff of the Ministry of Defence for the prevention of air traffic incidents and accidents. To this end, CEANITA studies and analyses such incidents and, where appropriate, proposes safety recommendations, thereby contributing to the improvement of air navigation safety.

    This report contains a summary of the activity of the CEANITA corresponding to the study of those Air Transit Incidents (ITA) that occurred in 2017 that have been analysed by this body, due to the assessment of the associated risk carried out by desati. In addition to the Commission’s activity, the statistical analyses carried out on the basis of the available data and the resulting actions are included. The CEANITA plenary made 333 recommendations related to the 103 incidents analysed for the year 2017.

    The document is accessible via the following link:


    AESA publishes an informative triptych on hazards associated with ballistic parachutes during recovery of crashed aircraft debris

    The State Aviation Safety Agency (AESA) has developed this informative triptych, within the framework of the preventive approach, due to the identified risk of serious injury during the recovery operations of crashed aircraft equipped with a ballistic parachute system.

    This information is aimed at pilots, general aviation users, security forces personnel, local police, health emergencies, rescue and firefighters. It aims to warn of the danger to personnel who come to the scene of an accident to help victims.

    The triptych is available at the following link:


    AESA publishes a new version of the safety recommendation “Recommendations and Good Practices to mitigate the possible inappropriate separation between instrumental or visual outputs and frustrated approaches”

    The State Aviation Safety Agency (AESA) has updated recommendations and best practices to mitigate the possible inappropriate separation between instrumental or visual departures and frustrated approaches.

    You can find the following link on the AESA website:


    This new version includes a recommendation for air operators recalling the importance of maintaining radio silence on Local’s frequency while operating with single runway and high traffic demand.

    This follows recommendation Rec038/18_02 issued by the Commission for the Study and Analysis of Notifications of Air Transit Incidents (CEANITA) following the study of file number 038/18.

    Update of information relating to the SNS (System for Reporting of Events) in the AIP Spain

    Through document ENR1-15 of AIP (Aeronautical Information Publication) Spain, the updating of the set of motivations, procedures and rules for the reporting of civil aviation occurrences in Spain was activated with effect from 6 December 2018.

    This document is the result of the adaptation for airports, air control, and, as a whole, of the entire airspace of national sovereignty, of the most current international standards in the field of occurrence reporting, including European and state regulations.

    The publication, the result of the collaboration between Enaire and AESA, has an approach aimed at achieving greater dissemination and harmonisation among the different reporting cultures of the different groups that make up the aeronautics community.

    The document includes several guides to facilitate the criteria for reporting civil aviation occurrences, and the fact that it is a bilingual Spanish-English document, undoubtedly facilitates its dissemination worldwide, in the hope that, through an analysis of reported events leading to the implementation of better prevention measures, all this will lead to safer skies.

    Day to promote safety culture among AESA-approved Training Organisations (ATOs)

    The State Aviation Safety Agency (AESA) held on 22 November a day dedicated to the promotion of safety culture among training organisations approved by AESA (ATOs), in a commitment to the preventive approach.

    The event, in which representatives from more than 30 organisations participated, provided an opportunity for participants to exchange experiences and concerns that could serve as a basis for close and continuous collaboration and for improved security.

    The aim was to raise awareness of the importance of the preventive approach and to show the methodology of risk prioritisation. AESA has long developed the preventive approach within the field of safety in order to complement the traditional prescriptive approach based on regulation, inspections and audits. The preventive approach aims to identify the areas with the highest risk of civil aviation security, with a view to concentrating resources on those requiring more attention; thus anticipating undesirable situations, thus avoiding serious incidents and accidents. To achieve this, the collaboration of all is necessary and ATOs play an important role in raising awareness of this safety culture.

    The second axis on which the day turned was the Success Reporting System (SNS), and in particular, the culture of notification. The SNS is one of the main sources for the collection of safety data in the context of the State Security Programme and the preventive approach. This system receives, stores, operates and analyses civil aviation occurrence reports.

    AESA explained to the ATOs that train future professionals that the SNS is geared towards the prevention of future accidents and incidents, without seeking at any time faults or responsibilities in the reported occurrences, with the only exceptions of wilful or gross negligence. The collection of data on occurrences in civil aviation is based on reports made by individuals and organisations who, in the exercise of their functions or activities, are aware of them, i.e. the system does not operate without the active participation of all the persons involved in the various civil aviation organisations, hence the importance of everyone engaging and acquiring a safety culture.

    In addition, the attending organisations contributed their vision and experience in relation to the risk management they make through the presentation by FTE Jerez. The main message was that while regulatory requirements are common to all schools, each must adapt the different processes and tools that best suit their particular situation.

    The Agency and the ATOs reviewed the various safety factors considered relevant to operational safety in training organisations, such as the importance of clear procedures in line with the regulations, the documentary culture, the importance of training of trainers, the heterogeneity of fleets or the rotation of staff. Consideration of all these aspects is essential to ensure effective training of pilots who will serve in the aviation sector. The conclusion was that, although much has been achieved, much remains to be done, given the leading role that aeronautical lessons must play in aviation.

    AESA and IATA to share safety information

    On 14 November, the State Aviation Safety Agency (AESA) and the International Air Transport Association (IATA) signed a Memorandum of Understanding to share safety information.

    The aim is to provide a framework for cooperation between the two bodies and to establish efficient communication procedures to identify the most relevant safety information in their possession for the improvement of risk reduction activities.

    Proactive mitigation of security events requires the analysis of multiple and interrelated sources of information and, as both agencies collect critical safety information, the information they can exchange has the potential to provide a clearer perspective on existing and emerging risk areas and to conduct appropriate security enhancement interventions.

    For the effective implementation of this Memorandum a coordination group is created and will meet when necessary. Ownership of the security information exchanged shall remain vested with the contributing party. Under no circumstances shall the mere possession of Security information be construed as the transfer of intellectual property rights.

    The parties shall take steps, if necessary, to ensure the appropriate confidentiality of the information received pursuant to this Memorandum, in fact, undertake to treat in the strictest confidentiality and not use confidential information in any other way than for the purpose for which they were delivered.

    First meeting of the Working Group for Large Planners

    The State Aviation Safety Agency (AESA) held last October the first meeting of the Working Group for Large Planner Birds, which focused on vultures and in particular the problems of Adolfo Suárez Madrid-Barajas Airport and Bilbao Airport, and at which the Fauna Map was presented in detail.

    This was the first time that in addition to the sector, Aena airport manager, air navigation service providers, Ministry of the Environment, academic experts in the field participated, as well as the municipalities and autonomous communities concerned, in particular the City of Bilbao, the Diputación de Vizcaya, and the Autonomous Communities of Madrid and Castilla y León.

    AESA presented in detail to the sector the Interactive Fauna Map which provides accurate information on the wildlife likely to affect air operations at each certified airport, as well as attraction spots and mitigation measures.

    AESA has drawn up this Fauna Map with the aim of providing information on wildlife to airlines, airport managers, air navigation service providers, private pilots and all users of aviation in general, as with the increasing air traffic, as well as the increased presence of birds associated with human activities, they make the risk of impact of birds with aircraft, although controlled, a constant concern in the world of aviation.

    At this meeting agreement was reached to work on the standardisation of the information handled by each Autonomous Community that is relevant to this issue, as well as on the realisation of a common project on the marking of birds.

    Publication of hard landing recommendations

    The State Aviation Safety Agency (AESA) issued in October a series of recommendations aimed at improving operational safety with the intention of reducing landings where Bounced-Landings, Tail-Strikes and Hard-Landings occur.

    The recommendations aim to reduce this type of landings through the reduction of destabilised approaches as a precursor to these events.  In addition, recommendations are also made to avoid, as far as possible, that an aircraft is incorrectly dispatched after having undergone a Hard-Landing without proper maintenance inspection, thereby avoiding the consequent risk to operational safety.

    The recommendation can be found here:


    AESA recommends that air carriers take into account OACI guidance to improve the identification and reporting of air quality events in cabins

    Last September, AESA issued a recommendation for airlines to keep in mind ICAO guidance on “Guidelines on educational, instructional and reporting practices related to emanation incidents”, in which the European Aviation Safety Agency (EASA) has been intimately involved, including detailed guidance material for the identification and reporting of such occurrences.

    The Spanish Agency, in parallel to the large-scale project being developed by the European Commission “Research of the air quality level in the cabin of large transport aircraft and its health implications”, has carried out an analysis of air quality events in the cabin of pressurised aircraft of commercial air transport aircraft with MTOW > 5.800 kg to conclude whether or not additional measures or alternatives to existing ones are necessary.

    Pending the outcome of the European project, all interested people can download the report prepared by AESA that supports this recommendation and is available on our website:


    AEMET advances in the study and monitoring of shear

    Last September was held a day on wind shear and the E-AMDAR program organised by AENA and the State Meteorology Agency (AEMET). The conference was attended by experts from the aeronautical sector, both national and international, and discussed the prediction of this meteorological phenomenon and its affect to the world of aviation.

    Among the various presentations made, the program E-AMDAR (Aircraft Meteorological Data Relay), which allows the obtaining of wind and temperature data from aircraft in flight, which has proved to be of great use to improve predictions of meteorological phenomena from high resolution models. Additional information on the objectives of the E-AMDAR programme can be found on the AEMET website.

    One of the main conclusions of the day was the importance of monitoring with the support of technology in the prediction of phenomenon. The information obtained is processed and transmitted to the pilots, providing them with more information for their operation in the aerodrome environment, and thus greater safety in take-off and approach manoeuvres.

    RAT agreement between ENAIRE and AESA

    The State Aviation Safety Agency (AESA) and ENAIRE signed on 3 August a Protocol on the exchange of information on risk classification of occurrences between ENAIRE and AESA.

    The main purpose of this Protocol is to define the content and procedure for the exchange of information regarding the risk classification of occurrences analysed by AESA and ENAIRE so that ENAIRE includes in the occurrence information transmitted to AESA, among others, the results of Ground and Overall severity obtained from the RAT analysis of the events recorded by its Safety Management Systems between 2017 and 2019.

    In addition to this objective, the protocol establishes both the mechanisms to resolve possible discrepancies that may exist between the analyses of HTM incidents carried out by ENAIRE and those carried out by AESA or CEANITA and the appropriate channels for exchanging information.

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