NTSB · Safety Recommendation
Safety Recommendation A-93-091
Recommendation
THE NTSB RECOMMENDS THAT THE DEPARTMENT OF TRANSPORTATION: REQUIRE THAT, AS A CONDITION FOR LICENSE FOR COMMERICAL SPACE LAUNCHES, AS A MINIMUM, THE COMPANY APPLYING FOR THE LICENSE INCLUDE IN ITS LICENSE APPLICATION A COMMUNICATIONS PLAN FOR: A PROVISION THAT INTERPHONE OR OTHER COMMUNICATION ASSIGNMENTS BE APPORTIONED TO ALLOW DECISION MAKERS FROM EACH PARTY DIRECT ACCESS TO THE DECISION MAKERS OF OTHER PARTIES AND THAT PROPER RADIO-TELEPHONE COMMUNICATION PHRASEOLOGY IS USED, AND A PROVISION THAT KEY PARTICIPANTS IN THE LAUNCH MONITOR A COMMON INTERCOM CHANNEL AT AN ESTABLISHED POINT IN THE COUNTDOWN AND THAT THESE PARTICIPANTS CONTINUE TO MONITOR THIS CHANNEL DURING THE FINAL COUNTDOWN SEQUENCE AND AFTER LAUNCH.
Safety Issue and Context
ON FEBRUARY 9, 1993, ABOUT 0930 EASTERN STANDARD TIME, THE LAUNCH SEQUENCE FOR AN ORBITAL SCIENCES CORPORATION (OSC) PEGASUS EXPENDABLE LAUNCH VEHICLE (ELV) WAS ABORTED BY THE NATIONAL AERONAUTICS AND SPACE ADMINISTRATION (NASA) RANGE SAFETY OFFICERS, IN ACCORDANCE WITH A PREVIOUSLY ESTABLISHED LAUNCH CONSTRAINT. SEVERAL SECONDS LATER, THE LAUNCH SEQUENCE WAS REINITIATED BY THE OSC TEST CONDUCTOR, AND THE MISSILE SEPARATED UNEVENTFULLY FROM ITS CARRIER AIRCRAFT. THE IGNITION AND STAGING OF THE PEGASUS AND ITS SUBSEQUENT DEPLOYMENT OF TWO SATELLITES INTO LOW EARTH ORBIT WERE ALSO UNEVENTFUL. THERE WERE NO INJURIES TO PERSONNEL INVOLVED IN THE MISSION AND NO DAMAGE TO MISSION ASSETS.
Response History
August 26, 1999 · NTSB Correspondence · DOT
THE SAFETY BOARD NOTES THAT THE FAA'S FINAL RULE MEETS THE INTENT OF OUR RECOMMENDATIONS. THEREFORE, A-93-87, -88, -91 AND -92 ARE CLASSIFIED "CLOSED--ACCEPTABLE ACTION."
May 25, 1999 · Recipient Response · DOT
THE FAA RESPONSE LETTER DOES NOT ADDRESS THIS RECOMMENDATION, RATHER THE INCLUDED FEDERAL REGISTER FINAL RULE (14 CFR PARTS 401 ET AL.
FINAL RULE) PART 415 (LAUNCH LICENSE) SUBPART C SAFETY REVIEW,,,,SECTION 37 (B) COMMUNICATION PLAN REQUIREMENTS: (1) COMMUNICATIONS NETWORKS ARE ASSIGNED SO THAT PERSONNEL IDENTIFIED UNDER PARAGRAPH (B) OF THIS SECTION HAVE DIRECT ACCESS TO REAL TIME SAFETY CRITICAL INFORMATION REQUIRED FOR ISSUING HOLD/RESUME, GO/NO GO AND ABORT DECISIONS AND COMMANDS (2) PERSONNEL IDENTIFIED UNDER PARAGRAPH (1) OF THIS SECTION MONITOR COMMON INTERCOM CHANNELS DURING COUNTDOWN AND FLIGHT: (3) A PROTOCOL IS ESTABLISHED FOR UTILIZING DEFINED RADIO TELEPHONE COMMUNICATIONS TERMINOLOGY.
September 4, 1997 · Recipient Response · DOT
It was previously reported to the Board that changes were incorporated into the launch applications guidelines. The FAA has now published a notice of proposed rulemaking (NPRM) in the Federal Register proposing to clarify license application procedures and requirements for conducting space launches. This NPRM addresses the requirements for launch operations at federally operated launch ranges. I have enclosed a copy of the NPRM for the Board's information. Additionally, the FAA is initiating a separate rulemaking action proposing similar requirements to address launches from non-Federal sites.
I will provide the Board with a copy of the final regulatory document as soon as it is issued.
April 22, 1994 · NTSB Correspondence · DOT
THE BOARD NOTES THAT THE OCST, AS A PART OF ITS LICENSING PROCESS, REQUIRES APPLICANTS TO SUBMIT A DESCRIPTION OF THEIR SAFETY ORGANIZATION & PERSONNEL REQUIREMENTS. THE OCST IS ALSO STUDYING THE NEED TO EXPLICITY REQUIRE THAT APPLICANTS PROVIDE CLEARLY DELINEATED STATEMENTS OF AUTHORITY FOR ALL PARTIES & KEY INDIVIDUALS INVOLVED IN THE LAUNCH. THE BOARD NOTES THAT THE OCST REQUIRES, THROUGH THE LICENSING PROCESS, ALL APPLICANTS TO DEMONSTRATE THEIR CAPABILITY TO CONDUCT SAFE LAUNCH OPERATIONS.
DUE TO THE APPARENT DEFICIENCIES IN PRELAUNCH OPERATIONS FOR THE PEGASUS/SCD-1 LAUNCH, THE OCST IS EVALUATING WHETHER TO REQUIRE THAT LAUNCH LICENSE APPLICANTS PROVIDE MORE SPECIFIC DETAILS & CRITERIA FOR LAUNCH READINESS REVIEWS & DRESS REHEARSALS, & THAT THOSE CRITERIA BE INCORPORATED AS CONDITIONS OF LICENSING. THE BOARD NOTES THAT ALTHOUGH THE OCST'S LICENSING PROCESS INCLUDES A REVIEW OF CRITERIA FOR DETERMINING READINESS TO LAUNCH, THE OCST IS STUDYING THE NEED TO REQUIRE THAT APPLICANTS EXPLICITLY DESCRIBE THEIR PROCESS FOR APPROVING CHECKLISTS FOR A LAUNCH, & TO INCLUDE A PROVISION FOR ENSURING THE CURRENCY & CONSISTENCY OF EACH PARTICIPANT'S CHECKLIST DURING DRESS REHEARSALS.
THE BOARD NOTES THAT THE OCST IS STUDYING THE NEED TO EXPLICITLY REQUIRE, AS A CONDITION FOR A LICENSE, THE MANDATORY REST PERIODS DESCRIBED ABOVE. ADDITIONALLY, IF THE OCST DETERMINES THAT SUCH A CONDITION IS NECESSARY, IT WILL USE HUMAN PERFORMANCE EXPERTS TO DEVELOP QUANTITATIVE CRITERIA FOR SUCH REST PERIODS TO ENSURE APPLICABILITY TO THE ASSIGNED TASKS. THE BOARD NOTES THAT THE OCST IS STUDYING THOSE LAUNCH SCENARIOS & TECHNOLOGIES WHERE IT WOULD BE APPROPRIATE TO REQUIRE FROM APPLICANTS, AS A CONDITION FOR A LICENSE, A COMMUNICATION PLAN INCLUDING THE TWO PROVISIONS IDENTIFIED IN A-93-091.
THE BOARD NOTES THE AT THE OCST IS INCORPORATING INTO ITS LICENSING REVIEW PROCESS THE REQUIREMENT FOR SAFETY DIRECTIVE HAVING STRICT CONFIGURATION CONTROL REQUIREMENTS THAT CLEARLY LISTS AND CONSOLIDATES ALL OPERATIONS INVOLVING THE SAFETY OF THE LAUNCH. THE BOARD NOTES THE OCST IS RESEARCHING THE COMMUNICATION ISSUE IN GENERAL & IS ALSO ASSESSING OPERATIONAL ISSUES IN THE CONTEXT OF AN ORBITAL SCIENCES CORPORATION PROPOSAL TO LAUNCH THE PEGASUS FROM COMMERICAL L-1011 AIRCRAFT.
THE BOARD APPRECIATES YOUR RESPONSE TO RECOMMENDATIONS A-93-87 THROUGH -93 & HAS PLACED THE RECOMMENDATIONS IN AN "OPEN--ACCEPTABLE RESPONE" STATUS PENDING COMPLETION OF THE ACTIONS INITIATED BY THE OCST AS DESCRIBED IN YOUR JANUARY 11, 1994, LETTER.
January 11, 1994 · Recipient Response · DOT
OCST AGREES THAT COMMUNICATION ASSIGNMENTS SHOULD, IN MOST INSTANCES, ALLOW DECISION MAKERS FROM EACH PARTY DIRECT ACCESS TO THE DECISION MAKER OF OTHER PARTIES, & THAT PROPER RADIO-TELEPHONE COMMUNICATION PHRASEOLOGY BE USED. THIS IS COMMON PRACTICE IN THE LAUNCH INDUSTRY. THE USE OF A COMMON INTERCOM CHANNEL DURING THE TERMINAL COUNT IS ALSO A COMMON PROCEDURE. THE PEGASUS LAUNCH WAS COMPLICATED BY THE FACT THAT A NUMBER OF DIFFERENT ORGANIZATIONS WERE INVOLVED IN KEY SAFETY AREAS, & THE USE OF AN AIRCRAFT REQUIRED GROUND-TO-AIR COMMUNICATION UNIQUE TO AIRBORNE LAUNCHES, AS WELL AS THE NORMAL GROUND COMMUNICATION.
OCST IS STUDYING THOSE LAUNCH SCENARIOS AND TECHNOLOGIES WHERE IT WOULD BE APPROPRIATE TO REQUIRE FROM APPLICANTS, AS A CONDITION FOR A LICENSE, A COMMUNICATION PLAN INCLUDING THE TWO PROVISIONS IDENTIFIED ABOVE.