A study on the characteristics on the error of the flight crew

운항승무원 실수 특성에 관한 연구 : LOSA를 중심으로

  • Published : 2009.06.30


LOSA is a flight safety program that analyses human errors in normal operations. Trained pilot observers monitor the normal flights at the observer seat. LOSA is a proactive non jeopardy data collection tool using threat and error management(TEM) as a framework. With the analysis of crew behaviors through LOSA with The LOSA collaborative(TLC), the airlines can identify the behaviors of the crew during normal operations. The major objective of LOSA is to measure how the crew manage threats, errors and undesired aircraft deviations in the cockpit on day to day operations. The airlines are able to set up effective TEM training with practical six generation Crew recourse management(CRM) with data of error from LOSA instead of theoretical CRM courses. The Airlines can use TEM as an integral part of a Safety Management System(SMS) and uses monitoring and cross-checking skills in the flight operations to manage threats and errors effectively when we know the errors we make in the cockpit on daily operation. The result of LOSA indicates that the error detection rate should be enhanced since around the half of the errors went undetected. The areas which should be focused for enhancing the error detection are monitor, cross-check, the management of workload, automation and taxiway/ runway to manage errors effectively.


  1. Klinect, J.R., Murray, P., Merritt, A., & Helmreich, R. “Line Operations Safety Audit : Definition and operating characteristics.” In Proceedings of the Twelfth International Symposium on Aviation Psychology, The Ohio State University 2003, pp. 663-668.
  2. The ICAO Journal - Special Edition LOSA, Vol 57, No. 4, May. 2002.
  3. Walker, R. E., Stone, A. R., and Shandor, M., " Secondary Gas Injection in a Conicial Rocket Nozzle," AIAA Journal, Vol. 1, Feb. 1963, pp.334-338. https://doi.org/10.2514/3.1533
  4. FAA AC 120-90, Line Operations Safety Audits, 2006, Appendix p1
  5. Ashleigh Merritt, Ph.D. & James Klinect, Ph.D, “Defensive Flying for Pilots: An Introduction to Threat and Error Management“ The University of Texas Human Factors Research Project1, TLC, Dec. 2006, p. 1
  6. ICAO DOC 9803, Line Operations Safety Audits, 2002, P.2-3