Pilot Error is an action or decision of the pilot that, if not caught and corrected, could contribute to the occurrence of an accident or incident. Inaction or indecision are also included in the definition. Pilot error does not always imply fault; this particular topic will be further discussed in this section.
An example: A pilot landed on an icy runway at night which lead to a crash. The cause is pilot error but this would only be 100% true is the pilot was aware of the conditions beforehand. If the pilot was given incorrect reports then this would be the error in the chain of events that could have been the underlying cause of the accident.
In 1990, Prof. James T. Reason developed a model to analyze human error. In his model, 5 layers depict one part of the total aviation system. Each layer has holes in it that if lined up could potentially lead to an accident. This model forms the basis for Threat and Error Management and is commonly known as the swiss cheese model.
Decision errors are conscious, goal-intended behaviour that proceeds as designed; yet, the plan proves inadequate or inappropriate for the situation. Commonly referred to as honest mistakes, these unsafe acts typically manifest as poorly executes procedures, improper choices or simply the misinterpretation or misuse of relevant information.
Operational Decision errors are discretionary decisions not covered by procedures, that unnecessarily increase the risk level. Examples include navigation into adverse weather, inappropriate reliance on automation.
Intentional Non-Compliance Errors are conscious violations of SOPs or regulations. Examples would be omitting required briefings, performing checks from memory, not following proper airworthiness procedures and flying outside of weight and balance limits.
Skill Based Errors
These occur with little or no conscious thought like basic rudder skills and scanning techniques. As a result, these errors are often susceptible to attention or memory lapses. As a result, skill-based errors such as the breakdown of an instrument scan or flipping the wrong switch often happen.
Procedural Errors: Procedures are followed but executed incorrectly. This can include slips, lapses or mistakes in the execution of procedure of regulation. The intention is there but execution is incorrect.
Proficiency Errors: Lack of knowledge or poor aircraft handling.
These occur when sensory input is degraded or as often understood as unusual. Faced with acting on imperfect or less information, pilots run the risk of misjudging distances, altitude, and decent rates as well as responding to many sensory illusions.
Communication Errors occur when information is incorrectly transmitted or interpreted within the crew or between the crew and external sources such as ATC or company
All of this information on pilot training and flight training in Canada is also available at www.myflighttraining.ca.