ICAO 9859-2009 Safety Management Manual (SMM) Second Edition《安全管理手册(SMM) 第2版》.pdf

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1、 Doc 9859 AN/474 Approved by the Secretary Generaland published under his authority Second Edition 2009 International Civil Aviation Organization Safety Management Manual (SMM) _ Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction

2、or networking permitted without license from IHS-,-,-(ii) Published in separate English, Arabic, French, Russian and Spanish editions by the INTERNATIONAL CIVIL AVIATION ORGANIZATION 999 University Street, Montral, Quebec, Canada H3C 5H7 For ordering information and for a complete listing of sales a

3、gents and booksellers, please go to the ICAO website at www.icao.int Second edition 2009 ICAO Doc 9859, Safety Management Manual (SMM) Order Number: 9859 ISBN 978-92-9231-295-4 ICAO 2009 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted i

4、n any form or by any means, without prior permission in writing from the International Civil Aviation Organization. Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-(iii) AMEN

5、DMENTS Amendments are announced in the supplements to the Catalogue of ICAO Publications; the Catalogue and its supplements are available on the ICAO website at www.icao.int. The space below is provided to keep a record of such amendments. RECORD OF AMENDMENTS AND CORRIGENDA AMENDMENTS CORRIGENDA No

6、. Date Entered by No. Date Entered by Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-(v) TABLE OF CONTENTS Page ACRONYMS AND ABBREVIATIONS . (ix) Chapter 1. OVERVIEW OF THE

7、MANUAL 1-1 1.1 General. 1-1 1.2 Objectives. 1-1 1.3 Concept 1-1 1.4 Contents . 1-1 1.5 Structure . 1-3 Chapter 2. BASIC SAFETY CONTENTS . 2-1 2.1 Objective and contents . 2-1 2.2 The concept of safety . 2-1 2.3 The evolution of safety thinking 2-2 2.4 Accident causation The Reason model 2-5 2.5 The

8、organizational accident 2-6 2.6 People, context and safety The Shel model. 2-9 2.7 Errors and violations. 2-15 2.8 Organizational culture. 2-23 2.9 Safety investigation. 2-31 Chapter 3. INTRODUCTION TO SAFETY MANAGEMENT 3-1 3.1 Objective and contents . 3-1 3.2 The safety stereotype . 3-1 3.3 The man

9、agement dilemma . 3-2 3.4 The need for safety management. 3-5 3.5 Strategies for safety management 3-9 3.6 The imperative of change . 3-13 3.7 Safety management Eight building blocks . 3-13 3.8 Four responsibilities for managing safety . 3-14 Chapter 4. HAZARDS 4-1 4.1 Objective and contents . 4-1 4

10、.2 Hazards and consequences . 4-1 4.3 First fundamental Understanding hazards . 4-2 4.4 Second fundamental Hazard identification. 4-4 4.5 Third fundamental Hazard analysis 4-6 4.6 Fourth fundamental Documentation of hazards . 4-7 Copyright International Civil Aviation Organization Provided by IHS un

11、der license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-(vi) Safety Management Manual (SMM) Page Appendix 1 to Chapter 4. Safety information analysis . 4-APP 1-1 Appendix 2 to Chapter 4. Management of safety information 4-APP 2-1 Chapter 5. SAFETY RISK

12、S 5-1 5.1 Objective and contents . 5-1 5.2 Definition of safety risk 5-1 5.3 First fundamental Safety risk management 5-2 5.4 Second fundamental Safety risk probability . 5-5 5.5 Third fundamental Safety risk severity . 5-6 5.6 Fourth fundamental Safety risk tolerability . 5-8 5.7 Fifth fundamental

13、Safety risk control/mitigation 5-9 5.8 The five fundamentals of safety risk management Summary. 5-13 Appendix 1 to Chapter 5. Anycity International Airport construction plan 5-APP 1-1 Appendix 2 to Chapter 5. Converging runway operations . 5-APP 2-1 Appendix 3 to Chapter 5. Commercial operations at

14、Andes City International Airport. 5-APP 3-1 Chapter 6. ICAO SAFETY MANAGEMENT SARPs 6-1 6.1 Objective and contents . 6-1 6.2 ICAO safety management SARPs General 6-1 6.3 State safety programme (SSP). 6-2 6.4 Acceptable level of safety (ALoS). 6-3 6.5 Safety management system (SMS) 6-8 6.6 SMS safety

15、 performance 6-9 6.7 Management accountability 6-13 6.8 Relationship between an SSP and an SSM 6-13 6.9 Compliance and conformance 6-16 Chapter 7. INTRODUCTION TO SAFETY MANAGEMENT SYSTEMS 7-1 7.1 Objective and contents . 7-1 7.2 Introductory concepts . 7-1 7.3 SMS features 7-4 7.4 System descriptio

16、n . 7-4 7.5 Gap analysis. 7-6 7.6 SMS and QMS 7-8 7.7 SSP/SMS and the accident investigation process 7-11 7.8 Integration of management systems 7-11 7.9 Clarifying terms. 7-12 7.10 The difference between safety slogans and safety principles. 7-12 Appendix 1 to Chapter 7. Guidance on system descripti

17、on . 7-APP 1-1 Appendix 2 to Chapter. 7 Guidance on the development of an SMS GAP analysis for service providers . 7-APP 2-1 Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-T

18、able of Contents (vii) Page Chapter 8. SMS PLANNING. 8-1 8.1 Objective and contents . 8-1 8.2 The components and elements of an SMS. 8-1 8.3 The ICAO SMS framework . 8-3 8.4 Management commitment and responsibility 8-3 8.5 Safety accountabilities 8-6 8.6 Appointment of key safety personnel 8-9 8.7 C

19、oordination of emergency response planning 8-11 8.8 SMS documentation . 8-12 8.9 SMS implementation plan. 8-12 Appendix 1 to Chapter 8. Framework for safety management systems (SMS) . 8-APP 1-1 Appendix 2 to Chapter 8. Sample job description for a safety manager 8-APP 2-1 Chapter 9. SMS OPERATION 9-

20、1 9.1 Objective and contents . 9-1 9.2 Safety risk management General. 9-1 9.3 Hazard identification . 9-2 9.4 Risk assessment and mitigation . 9-3 9.5 Safety assurance General 9-3 9.6 Safety performance monitoring and measurement. 9-4 9.7 Protection of sources of safety information. 9-8 9.8 The man

21、agement of change. 9-11 9.9 Continuous improvement of the SMS . 9-12 9.10 The relationship between safety risk management (SRM) and safety assurance (SA) . 9-13 9.11 Safety promotion Training and education. 9-15 9.12 Safety promotion Safety communication 9-16 Chapter 10. PHASED APPROACH TO SMS IMPLE

22、MENTATION 10-1 10.1 Objective and contents . 10-1 10.2 Why adopt a phased approach to SMS implementation. 10-1 10.3 Phase I Planning SMS implementation 10-2 10.4 Phase II Reactive safety management processes . 10-3 10.5 Phase III Proactive and predictive safety management processes 10-3 10.6 Phase I

23、V Operational safety assurance . 10-4 Appendix 1 to Chapter 10. Guidance on the development of a States regulation on SMS. 10-APP 1-1 Appendix 2 to Chapter 10. Guidance on the development of an SMS implementation plan for service providers 10-APP 2-1 Chapter 11. STATE SAFETY PROGRAMME 11-1 11.1 Obje

24、ctives and contents . 11-1 11.2 The components and elements of an SSP . 11-1 Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-(viii) Safety Management Manual (SMM) Page 11.3 T

25、he ICAO SSP framework 11-2 11.4 SSP development. 11-3 11.5 SSP implementation . 11-4 11.6 The role of the SSP in supporting SMS implementation. 11-5 Appendix 1 to Chapter 11. Framework for the State safety programme (SSP) . 11-APP 1-1 Appendix 2 to Chapter. 11 Guidance on the development of a State

26、safety policy statement. 11-APP 2-1 Appendix 3 to Chapter 11. Guidance on the development of a State safety programme (SSP) gap analysis . 11-APP 3-1 Appendix 4 to Chapter 11. Guidance on the development of a States enforcement policy and enforcement procedures in an SMS environment. 11-APP 4-1 Appe

27、ndix 5 to Chapter 11. Guidance on the development of an SSP implementation plan 11-APP 5-1 Attachments: A ICAO accident/incident data reporting (ADREP) system ATT A-1 B Emergency response planning . ATT B-1 C Related ICAO guidance material ATT C-1 _Copyright International Civil Aviation Organization

28、 Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-(ix) ACRONYMS AND ABBREVIATIONS ADREP Accident/incident data reporting (ICAO) AEP Aerodrome emergency plan AIRPROX Aircraft proximity ALARP As low as reasonably practicable ALoS

29、 Acceptable level of safety AMJ Advisory material joint AMO Approved maintenance organization AOC Air operator certificate ASDE Airport surface detection equipment ASR Air safety report ATC Air traffic control ATCO Air traffic controller ATM Air traffic management ATS Air traffic service(s) CAA Civi

30、l aviation authority CDA Constant descent arrivals CEO Chief executive officer CFIT Controlled flight into terrain CIP Commercially important person Cir Circular CMC Crisis management centre CRDA Converging runway display aid CRM Crew resource management CVR Cockpit voice recorder DME Distance measu

31、ring equipment Doc Document ERP Emergency response plan FDA Flight data analysis FDM Flight data monitoring FDR Flight data recorder FOD Foreign object (debris) damage ft Feet GPS Global positioning system ILS Instrument landing system IMC Instrument meteorological conditions ISO International Organ

32、ization for Standardization kg Kilogram(s) Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-(x) Safety Management Manual (SMM) LOFT Line-oriented flight training LOSA Line ope

33、rations safety audit m Metre(s) MDA Minimum descent altitude MEL Minimum equipment list MOR Mandatory occurrence report MRM Maintenance resource management NM Nautical mile(s) OJT On-the-job training PC Personal computer QA Quality assurance QC Qualit control QMS Quality management system RVSM Reduc

34、ed vertical separation minimum SA Safety assurance SAG Safety action group SARPs Standards and Recommended Practices (ICAO) SDCPS Safety data collection and processing systems SHEL Software/Hardware/Environment/Liveware SMM Safety management manual SMS Safety management system(s) SMSM Safety managem

35、ent systems manual SOPs Standard operating procedures SRB Safety review board SRM Safety risk management SSP State safety programme TLH Top level hazard TRM Team resource management USOAP Universal Safety Oversight Audit Programme (ICAO) VIP Very important person VMC Visual meteorological conditions

36、 VOR Very high frequency omnidirectional range _Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-1-1 Chapter 1 OVERVIEW OF THE MANUAL 1.1 GENERAL This manual is intended to pr

37、ovide States with guidance to develop the regulatory framework and the supporting guidance material for the implementation of safety management systems (SMS) by service providers. It also provides guidance for the development of a State safety programme (SSP), in accordance with the International St

38、andards and Recommended Practices (SARPs) contained in Annex 1 Personnel Licensing, Annex 6 Operation of Aircraft, Annex 8 Airworthiness of Aircraft, Annex 11 Air Traffic Services, Annex 13 Aircraft Accident and Incident Investigation and Annex 14 Aerodromes. 1.2 OBJECTIVES The objective of this man

39、ual is to provide States with: a) knowledge of safety management concepts, the ICAO Standards and Recommended Practices (SARPs) on safety management contained in Annexes 1, 6, 8, 11, 13 and 14, and related guidance material; b) guidance on how to accept and oversee the implementation of the key comp

40、onents of an SMS in compliance with the relevant ICAO SARPs; and c) guidance on how to develop and implement an SSP in compliance with the relevant ICAO SARPs. 1.3 CONCEPT The concept underlying this manual is that of a continuous loop (see Figure 1-1). The manual initially presents basic safety con

41、cepts, as the foundation upon which to understand the need for both an SMS and an SSP. The manual then discusses how these safety concepts are embodied in the ICAO SARPs contained in Annexes 1, 6, 8, 11, 13 and 14. The manual thereafter outlines a principled approach to the implementation of an SMS

42、by service providers and the progressive implementation and maintenance of an SSP, with emphasis on the role civil aviation authorities play in supporting SMS implementation by service providers. 1.4 CONTENTS 1.4.1 The manual include is comprised of eleven chapters, as follows: a) Chapter 1 Overview

43、 of the manual; b) Chapter 2 Basic safety concepts; Copyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-1-2 Safety Management Manual (SMM) c) Chapter 3 Introduction to safety man

44、agement; d) Chapter 4 Hazards; e) Chapter 5 Safety risks; f) Chapter 6 ICAO safety management requirements; g) Chapter 7 Introduction to safety management systems (SMS); h) Chapter 8 SMS planning; i) Chapter 9 SMS operation; j) Chapter 10 Phased approach to SMS implementation; and k) Chapter 11 Stat

45、e safety programme (SSP). 1.4.2 The manual also contains several appendices with practical examples and information directly linked to the implementation and maintenance of an SMS and an SSP. These appendices are included immediately following the chapter discussing the activity they support and sho

46、uld be considered as “must know”. 1.4.3 The manual also includes attachments containing useful information not directly linked to SMS or SSP implementation. These attachments are included at the end of the manual and should be considered as “nice to know”. Figure 1-1. Continuous-loop concept used in

47、 this manualICAOSARPsSafetyconceptsSMS/SSPimplementationCopyright International Civil Aviation Organization Provided by IHS under license with ICAONot for ResaleNo reproduction or networking permitted without license from IHS-,-,-Chapter 1. Overview of the Manual 1-3 1.5 STRUCTURE 1.5.1 The manual f

48、ollows a building-block approach. Chapter 2 sets the foundation, by discussing contemporary safety concepts. Chapter 3 introduces the basics of safety management, with emphasis on why safety must be managed. Chapters 4 and 5 introduce the dogmatic framework that underlies safety risk management and explain its two basic concepts: hazards and safety risks. Lastly, Chap