Lembaran Negara Republik Indonesia Nomor...

KEMENTERIAN PERHUBUNGAN

DIREKTORAT JENDERAL PERHUBUNGAN UDARA

PERATURAN DIREKTUR JENDERAL PERHUBUNGAN UDARA

NOMOR: KP 325 TAHUN 2018

TENTANG

PETUNJUKTEKNIS PERATURAN KESELAMATAN PENERBANGAN SIPIL BAGIAN

19-06 {STAF INSTRUCTION PART 19-06) TENTANG PENERIMAAN {ACCEPTANCE}

SISTEM MANAJEMEN KESELAMATAN {SAFETY MANAGEMENT SYSTEM

PENYELENGGARA NAVIGASI PENERBANGAN

DENGAN RAHMAT TUHAN YANG MAHA ESA

DIREKTUR JENDERAL PERHUBUNGAN UDARA,

Menimbang bahwa dalam Peratxiran Menteri Perhubungan Nomor 62

Tahun 2017 tentang Peraturan Keselamatan Penerbangan

Sipil Bagian 19 {Civil Aviation Safety Regulation Part 19)

Tentang Sistem Manajemen Keselamatan pada sub bagian

19.17 mengatur Penerapan dan Penerimaan, Penyedia Jasa

Penerbangan memiliki Sistem Manajemen Keselamatan

yang diterima oleh Direktorat Jenderal Perhubungan Udara;

bahwa berdasarkan pertimbangan sebagaimana dimaksud

pada huruf a, dipandang perlu menetapkan Petunjuk

Teknis Peraturan Keselamatan Penerbangan Sipil Bagian

19-06 {Staf Instruction Part 19-06) tentang Penerimaan

(Acceptance) Sistem Manajemen Keselamatan {Safety

Manajemen System) Penyelenggara Navigasi Penerbangan,

dengan Peraturan Direktur Jenderal Perhubungan Udara;

Mengingat 1. Undang-undang Nomor 1 Tahun 2009 tentang Penerbangan

(Lembaran Negara Tahun 2009 Nomor 1 Tambahan

Lembaran Negara Republik Indonesia Nomor 4956);

-2-

2. Peraturan Pemerintah Nomor 77 Tahun 2012 tentang

Perusahaan Umum (Perum) Lembaga Penyelenggara

Pelayanan Navigasi Penerbangan Indonesia (Lembaran

Negara Republik Indonesia Tahun 2012 Nomor 176);

3. Peraturan Presiden Nomor 7 tahun 2015 tentang

Organisasi Kementerian Negara (Lembaran Negara

Republik Indonesia Tahun 2015 Nomor 5);

4. Peraturan Presiden Nomor 40 Tahun 2015 tentang

Kementerian Perhubungan (Lembaran Negara Republik

Indonesia Tahun 2015 Nomor 75);

5. Peraturan Menteri Perhubungan Nomor PM 49 Tahun

2011 tentang Peraturan Keselamatan Penerbangan Sipil

Bagian 172 Peraturan Lalu Lintas Udara [Civil Aviation

Safety Regulation Part 172) tentang Penyelenggara

Pelayanan Lalu Lintas Penerbangan [Air Traffic Service

Provide?);



Bagian 171 (Civil Aviation Safety Regulation Part 171]

tentang Penyelenggara Pelayanan Telekomunikasi

Penerbangan (Aeronautical Telecommunication Service

Provider) sebagaimana telah diubah terakhir dengan

Peraturan Menteri Perhubungan Nomor PM 29 Tahun

2013; -

7. Peraturan Menteri Perhubungan Nomor PM 9 Tahun 2015

Tentang Peraturan Keselamatan Penerbangan Sipil Bagian

174 [Civil Aviation Safety Regulations Part 174) Tentang

Pelayanan Informasi Meteorologi Penerbangan

[Aeronautical Meteorological Information Services)

sebagaimana diubah terakhir dengan Peraturan Menteri

Perhubungan Nomor PM 138 Tahun 2015;



Bagian 176 (Civil Aviation Safety Regulation Part 176)

tentang Pencarian dan Pertolongan (Search and Rescue);

-3-


2015 tentang Organisasi dan Tata Kerja Kementerian

Perhubungan (Berita Negara Republik Indonesia tahun

2015 Nomor 1844) sebagaimana telah beberapa kali

diubah, terakhir dengan Peraturan Menteri PerhubunganNomor 44 Tahun 2017 tentang Perubahan Kedua atas

Peraturan Menteri Perhubungan Nomor 189 Tahun 2015;


2017 tentang Peraturan Keselamatan Penerbangan SipilBagian 170 (Civil Aviation Safety Regulation Part 170)tentang Peraturan Lalu Lintas Penerbangan (Air Traffic

Rules];


2015 tentang Peraturan Keselamatan Penerbangan SipilBagian 175 [Civil Aviation Safety Regulations Part 175)Tentang Pelayanan Informasi Aeronautika (Aeronautical

Information Service);


2015 tentang Peraturan Keselamatan Penerbangan SipilBagian 176 [Civil Aviation Safety Regulation Part 176)Tentang Pencarian Dan Pertolongan Pada Kecelakaan

Pesawat Udara (Search And Rescue);



Bagian 19 (Civil Aviation Safety Regulation Part 19)Tentang Sistem Manajemen Keselamatan (Safety

Manajemen System);

MEMUTUSKAN :

Menetapkan : PETUNJUK TEKNIS PERATURAN KESELAMATAN

PENERBANGAN SIPIL BAGIAN 19-06 (STAR INSTRUCTION

PART 19-06) TENTANG PENERIMAAN (ACCEPTANCE)SISTEM MANAJEMEN KESELAMATAN (SAFETY

MANAGEMENT SYSTEM) PENYELENGGARA NAVIGASI

PENERBANGAN.

-4-

Pasal 1

Dalam peraturan ini yang dimaksud dengan:

1. Direktur adalah Direktur Navigasi Penerbangan.

2. Direktur Jenderal adalah Direktur Jenderal Perhubungan

Udara.

3. Sistem manajemen keselamatan (safety management system),

yang untuk selanjutnya disebut SMS adalah pendekatan

sistematis untuk mengelola keselamatan, termasuk struktur

organisasi, akuntabilitas, kebijakan, dan prosedur yang

diperlukan.

4. Penerimaan (acceptance) SMS adalah penerimaan dan

pengakuan DGCA terhadap rencana implementasi sms

penyelenggara pelayanan dari fase inisial hingga mature

sesuai peraturan perundang-undangan.

5. Penilaian pelaksanaan SMS adalah mekanisme yang

dilaksanakan oleh Direktorat Jenderal Perhubungan Udara

untuk menilai rencana tahapan implementasi SMS pada

penyelenggara pelayanan Navigasi Penerbangan.

Pasal 2

Penyelenggara Pelayanan Navigasi Penerbangan wajib

melaksanakan SMS sesuai dengan peraturan perundang-

undangan.

Pasal 3

Pelaksanaan SMS sebagaimana dimaksud dalam Pasal 2 hams

dilakukan penilaian untuk mendapatkan pengakuan

penerimaan (acceptance) SMS dari Direktur Jenderal.

Pasal 4

(1) Penilaian pelaksanaan SMS Penyelenggara Pelayanan Navigasi

Penerbangan sebagaimana dimaksud dalam Pasal 3,

menggunakan tata cara sebagai berikut:

-5-

a. pemeriksaan hasil GAP Analisis, rencana implementasi SMS

dengan mengacu pada ketentuan yang tercantum dalam

Lampiran Peraturan ini;

b. pemeriksaan pedoman SMS, dokumen data dukung lainya

dan bukti terkait dengan pelaksanaan SMS mengacu pada

ketentuan peraturan perundang-undangan.

(2) Setelah dilakukan penilaian sebagaimana dimaksud pada ayat

(1), dilanjutkan dengan pengawasan guna mengetahui

pelaksanaan SMS di lapangan.

Pasal 5

(1) Penilaian pelaksanaan SMS Penyelenggara Pelayanan Navigasi

Penerbangan dilakukan setelah Penyelenggara Pelayanan

Navigasi Penerbangan mengajukan. permohonan Penerimaan

(Acceptance) Pelaksanaan SMS secara tertulis kepada Direktur

Jenderal.

(2) Setelah dilakukan evaluasi terhadap permohonan sebagaimana

dimaksud pada ayat (1), Direktur menerbitkan Penerimaan

(Acceptance) Pelaksanaan SMS Penyelenggara Pelayanan

Navigasi Penerbangan.

(3) Direktur dapat menolak penerbitan Penerimaan (Acceptance)

SMS Penyelenggara Pelayanan Navigasi Penerbangan apabila

hasil penilaian tidak memenuhi persyaratan yang sesuai

ketentuan peraturan perundang-undangan.

Pasal 6

(1) Penilaian sebagaimana dimaksud dalam Pasal 5 dilakukan oleh

Tim Penilai yang ditetapkan oleh Direktur.

(2) Tim sebagaimana dimaksud pada ayat (1), beranggotakan

Inspektur Navigasi Penerbangan.

(3) Direktur menerbitkan Penerimaan (Acceptance) 14 (empat belas)hari keija setelah penilaian pelaksanaan SMS dinyatakan dapat

diterima dan menerima rencana implementasi yang telahdisahkan oleh akuntabel eksekutif.

-6-

Pasal 7

Direktur melakukan pengawasan terhadap pelaksanaan peraturan

ini.

Pasal 8

Peraturan ini mulai berlaku sejak tanggal ditetapkan.

Ditetapkan di Jakarta

Pada tanggal 31 OKTOBER 2018

DIREKTUR JENDERAL PERHUBUNGAN UDARA

Pelaksana Tugas,

ttd

Ir. M. PRAMINTOHADI SUKARNO, MSc.

SALINAN Peraturan ini disampaikan kepada :

1. Menteri Perhubungan;2. Sekretaris Jenderal, Inspektur Jenderal, Para Kepala Badan di lingkungan

Kementerian Perhubungan;3. Para Direktur di Lingkungan Ditjen Perhubungan Udara;4. Para Kepala Otoritas Bandar Udara;5. Para Kepala Bandar Udara di lingkungan Ditjen Perhubungan Udara;6. Kepala Balai Besar Kalibrasi Penerbangan;7. Kepala Balai Teknik Penerbangan;8. Direktur Utama Perum LPPNPI.

Salinan sesuai dengan aslinya,

KEPALA BAGIAN HUKUM

,,p, K:

* I ri ; I,

-O ENDAH PURNAMA SART

Pembina Tk. I (IV/b)^^-.NIP. 19680704 199503 2 001

Lampiran Peraturan Direktur Jenderal Perhubungan Udara

Nomor : KP 325 TAHUN 2018

Tanggal : 31 OKTOBER 2018

SI 19 - 06

GUIDANCE MATERIAL AND PROCEDURES FOR AIR NAVIGATION SAFETYMANAGEMENT SYSTEMS (SMS) ACCEPTANCE

Amendment : 0

Tanggal :

REPUBLIK INDONESIA - KEMENTERIAN PERHUBUNGANDIREKTORAT JENDERAL PERHUBUNGAN UDARAJAKARTA - INDONESIA

-IJ-

AMENDMENT RECORD LIST

Amendment

Nomor

Issue Date Inserted by Page

-III-

FOREWORD

1. PURPOSE This Staff Instruction prescribes responsibilitiesguidance to be used by the Air Navigation Inspectorfor evaluating Service Provider's SafetyManagement System Manual and Implementation.

2. REFERENCES This Staff Instruction should be used

accordance with the applicable regulations.in

3. CANCELATION This Staff Instruction do not replace any previouspublications.

4. AMENDMENT The amendment of this Staff Instruction shall be

approved by the Director General of Civil Aviation.

ACTING DIRECTOR GENERAL OF CIVIL AVIATION

ttd


Salinan sesuai dengan aslinya,

-KSPALA BAGIAN HUKUM

Ar

dirik: }

f t-H' ■

-o

ENDAH PURNAMA SARI

^ PembinaTk. I (IV/b)^ '.-19680704 199503 2 001

-IV-

ABBRBVIATIONS

DGCA : Directorate General of Civil Aviation

ERP : Emergency Response Plan

HIRM : Hazard Identification and Risk Management

ICAO : International Civil Aviation Organization

SMS : Safely Management System

SPIs : Safety Performance Indicators

SRB : Safety Review Board

SRC : Safety Review Committe

SRM : Safety Risk Management

-V-

TABLE OF CONTENT

AMENDMENT RECORD LIST i

FOREWORD ii

ABBREVIATIONS iii

TABLE OF CONTENT iv

CHAPTER I

GENERAL 1

1. Applicability 1

2. Definitions 1

3. Regulatory References 3

CHAPTER II

SAFETY MANAGEMENT SYSTEM ACCEPTANCE 4

1. SMS Acceptance Procedure 4

2. SMS Implementation Plan Monitoring 7

3. Documentation 7

CHAPTER III

ROUTINE SMS ASSESMENT 8

1. Objective 8

2. Procedure 8

3. Documentation 8

APPENDIX A, SMS Acceptance Procedure 9

APPENDIX B. Four Phase of SMS Implementation 10

APPENDIX C. SMS Acceptance Checklist 11

APPENDIX D. Acceptance Report Format 29

APPENDIX E. SMS Acceptance Format 30

APPENDIX F. Routine SMS Assesment Checklist 32

APPENDIX G. Phase of SMS Implementaion Description 40

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CHAPTERI

GENERAL

1. Applicability

These staff instruction are intended for use by the Air Navigation Inspectorto :

a. acceptance of the air navigation Safety Management System;b. surveillance of the Safety Management System implementation plan of

the air navigation service provider.

2. Definitions

Accident. An unplanned event or series of events that results in death,injury, or damage to, or loss of, equipment or property.

Accountable executive. A single, identifiable person having responsibilityfor the effective and efficient performance of the State's SSP or of theservice provider's SMS.

Audit. A systematic, independent and documented process for obtainingrecords, statements of fact or other information and evaluating itobjectively to determine the extent to which policies, procedures, orrequirements are met.

Control, is one of the managerial functions like planning, organizing,staffing and directing.

Corrective Action. Action to eliminate or mitigate the cause or reduce theeffects of a detected nonconformily or other undesirable situation.

Director. Director of Air Navigation

Director General. Director General of Civil Aviation

Errors. An action or inaction by an operational person that leads todeviations from organizational or the operational person's intentions orexpectations.

Evaluation. Denotes the process whereby data is assembled, analyzed, andcompared to expected performance to aid in making systematic decisions.

High-consequence indicators. Safety performance indicators pertaining tothe monitoring and measurement of high-consequence occurrences, suchas accidents or serious incidents. High-consequence indicators aresometimes

referred to as reactive indicators.

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Hazard. A condition that could foreseeably cause or contribute to anaccident.

Incident. An occurrence other than an accident that affects or could affect

the safety of operations.

Likelihood. The estimated probability or frequency, in quantitative orqualitative terms, of a hazard's effect or outcome.

Lower-consequence indicators. Safety performance indicators pertainingto the monitoring and measurement of lower-consequence occurrences,events or activities such as incidents, non-conformance findings ordeviations. Lower-consequence indicators are sometimes referred to asproactive/predictive indicators.

Management of Change. A formal process to manage changes within anorganization in a systematic manner, so that changes which may impactidentified hazards and risk mitigation strategies are accounted for, beforethe

implementation of such changes.

Product/Service Provider. An organization engaged in the delivery ofaviation products or services.

Risk. See Safety Risk. The terms Risk and Safety Risk are usedS3Tionymously.

Safety. The state in which the risk of harm to persons or property damageis acceptable.

Safety Assurance. Processes within the SMS that function systematicallyto ensure the performance and effectiveness of safety risk controls and thatthe organization meets or exceeds its safety objectives through thecollection, analysis, and assessment of information.

Safety Management System (SMS). A systematic approach to managingsafety, including the necessary organizational structures, accountabilities,policies and procedures.

Safety Objective. A measurable goal or desirable outcome related tosafety.

Safety Performance. A State's or service provider's safety achievement asdefined by its safety performance targets and safety performanceindicators.

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Safety Performance Indicator. A data-based safety parameter used formonitoring and assessing safety performance.

Safety Policy. The documented commitment to safety of an organisation orstaff office, or an aviation service/product provider, organization, orcertificate holder, which defines its safety objectives and theaccountabilities and responsibilities of its employees with regard to safety.

Safety Promotion. A combination of training and communication of safetyinformation to support the implementation and operation of an SMS in anorganization.

Safety Risk. The composite of predicted severity and likelihood of thepptential effect of a hazard.

Safety Risk Control. A means to reduce or eliminate the effects ofhazards.

Safety Risk Management (SRM), A process within the SMS composed ofdescribing the system, identifying the hazards, and analyzing, assessing,and controlling risk.

Severity. The consequence or impact of a hazard's effect or outcome interms of degree of loss or harm.

Violation. A deliberate act or omission to deviate from established

procedures, protocols, norms or practices.

3. Regulatory References

a. CASR 19

b. CASR 170

c. CASR 171

d. CASR 172

e. CASR 173

f. CASR 174

g. CASR 175h. CASR 176

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CHAPTER II

SAFETY MANAGEMENT SYSTEM ACCEPTANCE

1. SMS Acceptance Procedure:

This chapter provides guidance on the assessment and acceptance of theimplementation of the Safety Management System for service provider,such as:

a. Preparation of SMS acceptance

1) Director receives letter of application for SMS acceptance from AirNavigation Service provider.

2) The Director sets the schedule for the SMS acceptance.3) The Director deliver a notification letter to the service provider at

least 30 (thirty) days prior to the SMS acceptance assessment alongwith the assessment protocol as contained in Appendix C. SMSAcceptance Checklist

4) The Director specifies the number and composition of the SMSacceptance team

5) Assessment team of SMS acceptance consists of:a) Team Leaderb) Team Member

6) Assessment team of SMS acceptance prepares reference documentsrelated to SMS acceptance including:a) SMS acceptance Checklistb) CASR 19, CASR 170, CASR 172, CASR 171, CASR 173, CASR

174, CASR 175, CASR 176, AC 69-01, AC 69-03, AC 170-01, AC170-02, AC 143-01 , AC 172 -01, MOS 170-01, MOS 171-01MOS 172-02, MOS 175- 01, MOS 175-02, MOS 175-03, MOS175-04, MOS 175-05, SI 69-01 , SI 143-01 and otherregulations relating to air navigation services.

c) Other relevant data7) The team leader conducts the initial briefmg to the SMS acceptance

team at least 1 (one) day prior to the SMS acceptance at thelocation.

8) The initial direction as referred to in paragraph (7) discusses thefollowing matters:a) Introduction of team membersb) The scope of the SMS acceptancec) On site work plan programd) Distribution of tasks and responsibilities of the teame) Preparation of opening and closing meetings with service

providers

b. On Site SMS Acceptance

1) The SMS acceptance team together with the service providersconducts the opening meeting.

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2) The opening meeting as referred to in paragraph (1) intended to:a) Introduction of members of the SMS assessment teamb) Submission of the scope of the SMS acceptance of the Service

Provider

c) Agreement of work plan program of SMS assessment onlocation

d) Submission of documents required for the conduct of theassessment

e) other related matters.3) The team leader conducts daily briefing of the assessment team

before and / or after the daily assessment at the site.4) The daily briefing referred to in particle (3) shall aim at:

a) Updating list fo checklist fulfilmentb) Identify the difficulties encountered in conducting the

assessment

c) Improve coordination and support of assessment teams5) To ensure of valid, qualified, and accountable assessment. The

assessment team is guided by the checklist of SMS acceptance.6) On site of SMS acceptance by:

a) Collecting data through interviews, review of related materials,surveys, and testing of the implementation of the safetymanagement system of service providers. Fulfillment of eachchecklist element is recorded with a clear information of how the

checklist elements are met.

b) If the service provider already has a SMS manual, then theassesment of the content of SMS manual according tolegislation.

c) Evaluate the implementation of SMS GAP analysis for serviceproviders

d) Assess the SMS implementation phase of service providerse) After on site SMS acceptance activity is completed, the

assessment team reviews all the input of the checklist elementsto ensure that the assessment is conducted objectively.

7) The evaluation of the SMS manual in particle 6 (b) that the SMSmanual should cover at least the follovdng sections: (referring to theAC SMS Manual)a) Document control;b) SMS regulatory requirements;c) Scope and integration of the safety management systemd) Safety policy;e) Safely objectives;f) Safety accountabilities and key personnel;g) Safety reporting and remedial actions;h) Hazard identification and risk assessment;i) Safety performance monitoring and measurement;j) Safety-related investigations and remedial actions;k) Safety training and communication;1) Continuous improvement and SMS audit;m) SMS records management;n) Management of change; ano) Emergency/contingency response plan.

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8) The Review SMS GAP implementation conducted by the airnavigation services provider in particle 6 (c) by:a) Check the SMS GAP element analysis in accordance with the

applicable provisions.b) check implementation task made in accordance with the results

of SMS GAP analysisc) check implementation schedule based on SMS GAP analysisd) Making of the implementation schedule is based on the SMS

implementation phase as in appendix B. four phases of SMSimplementation phase.

e) The service provider shall update the SMS implementation planif there is a revision of the SMK implementation schedule.

9) Review phase of SMS implementation as referred to in particle 6 (d)is intended to determine the extent to which service providers haveimplemented SMS.

10) SMS implementation consists of 4 phases as stated in Appendix B.11) The fuliiUment time of each phase is estimated as follows:

a) Phase I for 12 Monthsb) Phase II for 12 monthsc) Phase III for 18 Monthsd) Phase IV for 18 Months

12) To determine the SMS service provider's phase, use the checklist inappendix C part C. The phase determination depends on the extentto which the service provider can meet each element phase.

13) Any elements of SMS implementation that have not fullfilled, will beincluded in the SMS implementation schedule;

14) In the initial SMS service Provider, then only need to do assessmentin phase I only.

15) SMS Service provider declared to have reached phase mature if ithas fulfilled element to four phase.

16) Description of the fulfillment of the elements of the four phases ofSMS can be found in Appendix G. Phase of SMS ImplementaionDescription

17) The assessment team made the acceptance report of the SMSacceptance of the air navigation service provider. ( see Appendix DAcceptance Report Format)

18) The assessment team and service providers conducts closingmeetings;

19) Closing meeting as referred to in particle (18) aims to:a) Provide information to the head of the service provider related to

the SMS acceptance and the improvement of the SMSimplementation plan (if any).

b) Explain that service providers must submit revised SMSimplementation plans (if any) and have been authorized by theaccountable executive service provider to the Director.

c) Explain that the obligations of service providers in implementingthe implementation of SMK will be contained in the SMSacceptance of service providers.

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c. Issuance of acceptance of SMS service providers

1) The service provider submits the document of the SMSimplementation plan which has been authorized by the accountableexecutive of the service provider as the guideline for the SMSimplementation until the mature phase, to the Director.

2) The Director shall publish the acceptance of the SMS for the serviceprovider and require the service provider to implement theVocational Implementation Plan according to the agreed schedule,(format in attachment E).

2. SMS Implementation Plan Monitoringa. After DGCA perform acceptance on SMS service provider

implementation plan. Then DGCA will monitor the implementation ofthe plan until mature phase.

b. Monitoring is conducted based on implementation plan schedule.c. The purpose of monitoring to ensure service providers implement

implementation plans on schedule.d. The Director shall deliver a notification letter to the service provider at

least 14 (fourteen) days prior to the monitoring of the SMSimplementation plan.

e. The Director determines team for the monitoring SMS implementation.f. The monitoring team update the fulfillment of SMK implementation

elements.

g. After service providers SMS's reach the mature phase, the Director willconduct a routine SMS assessment to monitoring operational of serviceproviders's SMS.

3. Documentation

DGCA performs documentation on SMS process of accepetance serviceprovider.

-8-

CHAPTER III

ROUTINE SMS ASSESSMENT

1. Objective

After an organization's SMS has satisfied the regulator's initial assessmentand acceptance process, there will be many assessment questions from theinitial assessment checklist that will no longer be expedient or necessaryfor routine assessment purposes. A routine SMS assessment checklist needonly focus on the operational aspects of an SMS and evidence of thesatisfactory implementation of its supporting processes.

2. Procedure

a. Routine SMS assessment only can be conducted if service provider'sSMS reach mature phase.

b. Routine SMS assessment may be conducted on a stand-alone basis orincorporated as part of a routine organization/systems audit.

c. Routine SMS assessment do at the service providers headquarters andbranches with a focus on operational SMS.

d. The Director shall deliver a notification letter to the service provider atleast 14 (fourteen) days prior to the routine SMS assessment.

e. Routine SMS assessment checklist can be seen in Appendix F Checklistroutine SMS assessment

f. The normal Corrective Action Notice (CAN) protocol of the regulator canalso be applied to the routine SMS assessment.

3. Documentation

DGCA performs documentation on Routine SMS assessment serviceprovider.

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APPBNDIX A. SMS Acceptance Procedure

Start

ISMS GAP Analisis report,SMS Implementation Plan

Yes

Review SMS GAP

Analisis and SMS

Implementation plan

need

correction ?

NO

assess phase of SMS

Implementation

SMS Acceptance from

DGCA

End

-10-

APPENDK B. FOUR PHASES OF SMS IMPLEMENTATION

Phase 1 (12 nionlhs'}

1. SMS Benienll.l (i}:

a) {dentify the SMS accountable

execulhite;

b) estat>nsh an SMS

implementation team;

c) derme the scope of the SMS;

d) perform an SMS gapanalysis.

2. SMS Bement 1.5(1);

a) develop an SMS

implementatton plan.

3. SMS Bement 1.3:

a] estat>n^ a key person/officeresponsible for theadmlrristraQon ciidmaintenance of the SMS.

4. SMSBemenl4.1 (i);

a) establish an SMS trainingprogramme for personnel,with pn'orrty for the SMS

implementation team.

5. SMS Bement 4.2 (i);

a) initiate SMS/safetycoimnunicotion channels.

Phase 2 (12 monlhs)

1. SMSBemenll.1 (n):

a) estabfish the safety policy andobjectives,

2. SMS Bement 1.2;

a) define safety managementresponsibilities andaccountabilities acrossrelevant deportments of theorganization;

b) establish an SMS/safetycoordination mechanism/

committee;

c) establish departmental/divlslortal SAGs whereapplicable.

3. SMS Bement 1.4:

a) establish an emergencyresponse plan.

4. SMS Bement 1.5 (li):

a) initiate progressivedevelopment of an SMSdocument/manual and othersupportir>o documentation.

Phase 3 (16 months)

1. SMS Efement2.1 (0:

a) eslatrllsh a voluntary hazard

reporting procedure.

2. SMS Element Z2:

a) establish safety riskmanogement procedures.

3. SMSEIemenl3.1 (f):

a) establish occurrencereportlrrg and Investigalionprocedures;

b) establish o safety datacollection and processingsystem for high-consequenceoutcomes;

c) develop high-consequenceSPis and assocfaled targetsand alert setllrtgs.

4. SMS Element 3.2:

a) establish a marrageraent ofclangs procedure thatincludes safety risk

assessment.

5. SMS Element 3.3 (i):

a) establish an Internal quaCtyaudit programme;

b) establish an external qualtyaudit programme.

Phase 4 (18 months)

1. SMS Bement 1.1 (ill):

a) enhance the existingdisciplinary procedure/ policywith due consideration ofunintenUono] errors or

mistakes from deliberate orgross vfolattons.

2. SMSBemenl2.1 (Q):

a) Integrate hazards hfenGfied

from occurrerKe investigationreports vyilh the voluntaryhazard reporting system;

b) Integrate hazard idenbficationand risk management

procedures with the

»it>cantractor's or customer'sSMS Where applicable.

3. SMS Element 3.1 (D):

a) chance the safety datacollection and processingsystem to Include lower-

consequence events;

develop lower-consequertceSPIs and associated

(argets/aierl selfings.

4. SMSErement3.3 (ii):

a) estat>llsh SMS audit

programmes or integratethem into existing Internal andextern:^ audit programmes;

b) establish other operationalSMS review/surveyprogrammes whereappropriate.

5. SMS Element 4.1 (Q):

a) ensure that the SMS trainingprogramme for an relevantpersonnel has beencompleted.

SMS Bement 4.2 (S):

a) promote safety tnfofmationshailrtg and exchangeInternally arxf externally.

SMS Bement 1.5: SMS documentation (Phases 1 to •

SMS Elements 4.1 and 4.2: SMS training, education and communicallon (Phases 1 and IhereafteO»»»»»>»»»»»»»>»»»»»»»

'itPfemenfal/OT period indicated Is an appmximolion. The actual Implementation period Is dependent on the scope of actionsrequired for each element a//ocafedand Ihe sIzeAxmplexity ofthe organizaOon.

correspond to the tCAO SUS element numbers. SuflixBs such as e). b) and e) Indicate that theelement has t>een subdivided to fociSlate the phased implementation approach.

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APPBNDIX C. SAFETY MANAGEMENT SYSTEM (SMS) ACCEPTANCECHECKLIST

Company Name

Address

Date of Assement

No SubjectRemarkYes No Not

/Applicable

PART A. SAFETY MANAGEMENT SYSTEM MANUAL

Does SMS Manual

include at least the

following sections:

1. Document control;

2. SMS regulatoryrequirements;

3. Scope and integrationof the safetymanagement system

4. Safety policy;

5. Safety objectives;

6. Safety accountabilitiesand key personnel;

7. Safety reporting andremedial actions;

8. Hazard identification

and risk assessment;

9. Safety performancemonitoring andmeasurement;

10. Safety-relatedinvestigations andremedial actions;

11. Safety training andcommunication;

12. Continuous

improvement and SMSaudit;

13. SMS records

management;

14. Management of change;an

15. Emergency/ contingency

response plan.

-12-

No Subject

PART B. SMS GAP ANALISYS IMPLEMENTATION

1 Has the ANSP make gap

analysis ?

2 Has the ANSP make

implementation taskidentification plan

based on gap analysis?

3 Has the ANSP make

SMS implementationschedule

based on

implementation task

identification plan?

-13-

PART C. PHASE OF IMPLEMENTATION SMS

PHASE I (12 Month)

No

Cor

Ref

nponent I — SI

Aspect to be analysed

^TETY policy AND OR.TFPTn

GUIDANCE

JT?Q

Status of

ImplementationYes 1 No 1 Partial

Remark

lEle

1. CASR 19 /19.21

nagement^^^Identify the accountableexecutive and the safetyaccountabilities of managers

Check organizationalstructure for identifyaccountable executive

responsibility

■ -Li.

2. CASR 19 /19.23

Establish an SMS

implementation team.Check organisation decreefor SMS implementationteam

3. CASR 19 /19.23

Define the scope of theorganization's activities(departments/divisions) towhich the SMS wiU be

applicable

Check scope SMS inImplementation plan

4.

h.

CASR 19 /19.23 (g)

lement 1.3 — /

Conduct a gap analysis ofthe organization's currentsystems and processes inrelation to the ICAO SMS

framework requirements (orthe relevant SMS regulatoryrequirements)

appointment of key safety pei

Check Gap Analysis result

'sonnel

-14-

CASR 19

19.21 (e)Has [Organization] appointeda qualified person to manageand oversee the day-to-dayoperation of the SMS?

1. Check organisationaldecree of Safety Managerand responsibilities

2. Check organisationstructure

8.

CASR 19

19.21 (h)

CASR 19

19.21

Does the qualified personhave direct access or

reporting to theaccountable executive

concerning theimplementation andoperation of the SMS?

Does the managerresponsible for administeringthe SMS hold other

responsibilities that mayconflict or impair his role asSMS

manager.

Has [Organization] establishthe safety services office?


2. Check safety report toaccountable executive


2. Check safety managerresponsibilities

1. Check safety servicesoffice

2. Check organisationstructure and

Erle^uent 1.5 — SMS dnmiTn«»nfafiAvi

9. CASR 19

19.23 (c)Develop an SMSimplementation plan on how

Check SMS implementationplan

-15-

EUiment 4.1 — Tr

the organization willimplement the SMS on thebasis of the identified systemand process gaps resultingfrom the gap analysis

fining and education10. CASR 19

19.45

Has training needs analysisbeen conducted ?

Check training programme

11. CASR 19

19.45

19.47

Is there a programme toprovide SMStraining/familiarization topersonnel involved in the

implementation or operationof the SMS?

Check personal trainingprogramme

12. CASR 19

19.45

Develop safety trainingconsidering:a. initial (general safety) job-

specific training; andb. recurrent training.

Check training programme

13.

i

CASR 19

Appendix A -1.5 and 4.1

#lement 4.2 — £

Has the organisationestablished a safety trainingrecords system?

iafety commuiiication

Check training records.

14. CASR 19

19.43 and

19.47

Has the organisationinitiated a mechanism ormedium for safetycommunication?

Check the safetycommunication mechanism

-16-

15. Has the organisationestablished a means toconvey safety informationthrough any of;1) safety newsletters, notices

and bulletins;2) websites;3) email.

Check medium to conveysafety information

Air Navigation Inspector and Teamsignature

SMS Manager and Teamsignature

Full Name

NIPFull Name

NIK

-17-

PHASB 11 (12 Month)

No Ref Aspect to be analysed CHECKLIST Status of RemarkGUIDANCE Implementation

Yes No PartialComponent 1

Element 1.1 —SAFETY POLICY AND OBJECTIVESVlanagement commitment and responsibilityHas [Organization] establishthis safety policy andobjectives

Check SafetyPolicy/ 19.19

AppendixA 1.1

Element 1.2 —

2. CASR 19 /19.27 (c)

Safety accountabilitiesHas [Organization] definesafety management (Allaviation safety-relatedpositions) responsibilitiesand accountabilities?

Check safetyaccoutabilities inSMS Manual

CASR 19 /19.21

Is there a safety reviewcommittee (SRC) or reviewboard for the purpose ofreviewing SMS and safetyperformance?

Check

organisationdecree for safetycommite

CASR 19 /19.21

Does Organisation establishthe safety action group(SAG)?

Has the organisation definedclear functions for the SAGand the safety/SMScoordination committee?

Check

organisationaldecree for SAG

Check

organisationdecree for safetycommite and SAG

-18-

function6. CASR 19 /

19.21

Has the organisationestablish lines of

communication between the

safely services office, theaccountable executive, theSAG and the safety/SMScoordination committee ?

Check lines of

communication for

coordination

/. CASR 19

AppendixA 1.2

Is the safety committeechaired by the accountableexecutive or

by an appropriatelyassigned deputy, dulysubstantiated in the

SMS manual?

Check

organisationdecree for safetycommite

8. CASR 19

AppendixA 1.1

Has the organisationdeveloped a schedule ofmeetings for the safetyservices office to meet with

the safety/SMScoordination committee andSAG as needed?

Check SAG and

SRC meetingschedule

Eleiment 1,4 — Coordination of emergency response planning9. CASR 19 /

19.25

Has the organisationreviewed the outline of theERP related to the

delegation of authority andassignment of emergencyresponsibilities ?

Check ERP

Manual

-19-

10. CASH 19 /19.25

Has the organisationestablished coordination

procedures for action by keypersonnel during theemergency and the return tonormal operations ?

Check ERP

Manual

11. CASR 19 /19.25

Has the organisationidentifed external entitiesthat will interact with the

organization duringemergency situations ?

Check ERP

Manual

12. CASR 19 /19.25

Has the organisation assessthe respective ERPs of theexternal entities ?

Check ERP

Manual

13. CASR 19 /19.25

Has the organisationestablished coordinationbetween the different ERPs ?

Check ERP

Manual

14. CASR 19 /19.25

Has the organisationincorporated informationabout the coordination

between the different ERPsin the organization's SMS

documentation

Check SMS

Manual

check ERP Manual

Eleiment 1.5 —!SMS documentation

15. CASR 19 /19.27

Does [Organization]Establish manual documentsms stand alone or a unitywith the operation manual

Check sms manual

-20-

(minimum 5 years)?

16. CASR 19 /19.27

17. CASR 19 /19.27

Does [Organization]establishing an SMS filingsystem to collect and

maintain current recordsrelating to the organization'songoing SMS processes?

Does [Organization]maintaining records toprovide a historical

reference as well as thecurrent status of all SMS

processes?

Check doc recording

Check doc

recording



Full Name

NIPFull Nflmp

NIK

-21-

PHASE III (18 Months)

Aspect to be analysed CHECKLIST

GUIDANCEStatus of Implementation Remark

Yes NoComponent 2

Element 2.1 -SAFETY RISK MANAGEMENT

Hazard identificationCASH 19

19.31

19.59

CASR 19

19.31

19.59

Is there a process forvoluntary hazards/threatsreporting by allemployees?

Has the organisationestablished a

programme/schedule forsystematic review of all

applicable aviation safety-related processes/equipment that are eligiblefor the HIRM process?

Check voluntaryreport procedure

1. Check schedulefor HIRM process

2. Check HIRM

procedure

CASR 19

19.31

19.59

Has the organisationestablished a process forprioritization andassignment of identifiedhazards for risk mitigation?

Check HIRM

procedure

-22-

19.33 established a safety riskmanagement procedure,including its approval andperiodic review process?

management

procedure onmanual sms

5. CASR 19

19.33

Has the organisationdeveloped and adopt safetyrisk matrices relevant to

the organization'soperational or productionprocesses?

Check manual

SMS;

6. CASR 19

19.33

Has the organisationincluded adopted safetyrisk matrices and

associated instructions in

the organization's SMS orrisk

management trainingmaterial?

Check SMS trainingprogramme;

Component 3 — SAFETY ASSURANCE

Element 3.1 — Safety performance monitoring and measurement7. CASR 19

19.57

Has the organisationestablished an internal

occurrence reporting andinvestigation procedure.This may includemandatory or major defectreports (MDR) whereapplicable?

1. Check SMS

Manual

2. Check

mandatory ormajor defectreports

8. CASR 19

19.57

Has the organisationestablished safety datacollection, processing andanalysis of high-

1. Check SDCPS

(Safety DataCoUection and

Processing

-23-

consequence outcomes? Systems)2. Check SPI high

consequence

9. CASR 19

19.57

AppendixA

3.1.2

Has the organisationestablished highconsequence safetyindicators (initial ALoSP)and their associated targetand alert

settings?

1. Check SMS

Manual

2. Check SPI - highconsequence

10. CASR 19

19.35

Has the organisationreached an agreement withthe State oversightauthority on safetyperformance indicators andsafetyperformance targets ?

Check agreement ofsafety performancetarget

Elenlent 3.2 — The management of change11, CAS R 19

19.39

AppendixA

Butir 3.2

Has the organisationestablished a formal

process for the

management of change thatconsiders:

a. the vulnerability ofsystems and activities;

b. the stability of systemsand operationalenvironments;

c. past performance;

1. Check SMS

Manual

2. Check safety riskassesment

procedure

-24-

d. regulatory, industryand technologicalchanges.

12. CASR 19

19.39

AppendixA

Butir 3.2

Is the management ofchange procedures addressthe impact on existingsafely performance and riskmitigation records beforeimplementing new changes

1. Check SMS

Manual

2. Check safety riskassesment

procedure

13.

Elen

CASR 19

19.31

19.33

lent 3.3 — C

Has the organisationestablished procedures toensure that safetyassessment of new aviation

safety-related operations,processes and equipmentare conducted (oraccounted for) asapplicable, before they arecommissioned ?

3. Check SMS

Manual

4, Check safetyassessment

report

14. CASR 19

19.39

AppendixA

Point 3.3

Is there a procedure forperiodic internal qualityaudit programme ?

Check internal

audit procedure

15. CASR 19

19.39

Is there a procedure forperiodic external quality

Check external

audit procedure

-25-

Appendix audit programme ?A

Pomt 3.3

CASH 19

19.39

AppendixA

Point 3.3

Is there a schedule for

evaluation of facilities,equipment, documentationand procedures to becompleted through auditsand surveys ?

Check facilities/equipmentevaluation

schedule



Full Name

NIPFull Name

NIK

-26-

PHASE IV (18 Months)

No Ref Aspect to be analysed CHECKLIST

GUIDANCE

Status of Implementation Remark

Yes No PartialComponent 1 — SAFETY POLICY AND OBJECTIVESElement 1.1 — Management commitment and responsibility

1. CASR 19

AppendixA

Point 1.1

Is the existing disciplinaryprocedure/policy enhancedwith due consideration of

unintentional

errors/mistakes fromdeliberate/gross violations?

1. check SMS

Manual

2. Check SafetyPolicy

Component 2 — SAFETY RISK MANAGEMENTElement 2.1 — Hazard identification2. CASR 19

19.31

19.33

19.37

Are there procedures toensure that hazards/threatsidentified or uncoveredduring incident/accidentinvestigation processes areappropriately accounted forand integrated into theorganisation's hazardcollection and risk

mitigation procedure?

1. Check SMS

Manual

2. Check SOP

Accident/ incident

3. Check

investigationreport

integration withHIRM data

collection

3. CASR 19

19.31

Are there procedures toreview hazards/threats from

1. Check SMS

Manual

-27-

19.33

19.37

relevant industry reports forfollow-up actions or riskevaluation where

applicable?

2. Check reportingsystem from

subcontractor

3. Check corrective

action^^omponent a — SAFETY ASSURANCE

EXertient 3.1 — 6Jalety performance monitoring and measurement

4. CASR 19

19.57Has the organisationenhanced the safety datacollection and processingsystem to include lower-

consequence events ?

Check SDCPS

(Safety DataCollection and

ProcessingSystems)

5. CASR 19

19.57

AppendixA

3.1.2

Has the organisationestablished lower-

consequence safety/qualityindicators with target/alertlevel monitoring asappropriate (mature ALoSP)

Check SPI - low

consequence

6.

Com

CASR 19

19.57

AppendixA

3.1.2

ponent 3 —

Has the organisationreached an agreement withthe State oversight authorityon lower-consequence safetyperformance indicators andsafety performancetarget/alert levels ?

SAFETY ASSURANCE

Check agreementof safetyperformance target

Elen

7.

lent 3.3 Con

CASR 19

19.41

tinuous improvement of theHas the organisationestablished SMS audits or

SMS

Check SMS audit

programme

-28-

AppendixA -3.3

integrate them into existinginternal and external auditprogrammes?

o.

Elen

CASR 19

19.41

AppendixA - 3.3

nent 4.1—1

Has the organisationestablished other

operational SMSreview/survey programmeswhere appropriate ?raining and education

Check other surveyprogram if any

9.

Eler

CASR 19

19.45

lent 4.2 — S

Has the organisationensured that the SMS

trainingprogramme for all relevant

personnel has

beencompleted.

afetv communication

Check trainingprogramme

10. CASR 19

19.47

Does [Organization]participate in sharing safety-information with

relevant external industryproduct and serviceproviders or organizations,including the relevantaviation regulatoryorganizations?

1. Check sms

publication2. Check safety data

exchange



Full Name

NIPPull Name

NIK

-29-

Appendix D Acceptance Report Format

BERITA ACARA ASSESMENT PENERIMAAN (ACCEPTANCE] SISTEMMANAJEMEN KESELAMATAN (nama service provider)

Pada hari tanggal .... bulan ... tahun ..., telah dilakukan asesmenpenerimaan (acceptance) Sistem Manajemen Keselamatan .... (nama serviceprovider) .... berdasarkan Surat Permohonan Direktur (nama serviceprovider) Nomor : tanggal ...(DD/MM/YYYY ) ...Perihal

1. Dasar

Dasar Regulasi

2. Hasil Assesment

Berdasarkan asesmen Sistem Menejemen Keselamatan yang telahdilakukan pada ... (nama service provider), tahapan implementasi SMKberada pada Tahap (phase) 1 (satu)/Tahap (phase) 2 (dua)/Tahap (phase)3 (tiga)/Tahap (phase) 4 (empat) {*sesuai ketentuan tahapan implementasiSMK).

Pada dasarnya sistem manajemen keselamatan pada ... (nama serviceprovider) dapat diterima dengan menjalankan rencana implementasi SistemMenejemen Keselamatan secara berkelanjutan hingga Sistem MenejemenKeselamatan mencapai phase mature.

3. Hasil assesment Sistem Manajemen Keselamatan terlampir

4. Demikian Berita Acara ini dibuat untuk digunakan sebagaimana mestinya

Inspektur Navigasi Penerbangan Pimpinan Service Provider

XXXXXXXXXX XXXXXXXXXXXX

•30-

Appendix E SMS Acceptance Format

HEADER

Directorate General of Civil Aviation

SAFETY MANAGEMENT SYSTEM ACCEPTANCE

ON (NAME OF SERVICE PROVIDER)

Ref: SMS.DNP/..../month/year

The Safety Management System ... (name of provider) .... refers to the AviationAct Number 1 Year 2009 Republic of Indonesia and Civil Aviation SafetyRegulation number 19 about Safely Management System.

The Director of Air Navigation accepts the implementation plan of the safetymanagement system ... (name of provider) .... based on safety policy, riskmanagement, safety assurance, and safety promotion on Air Navigation

Services.

The Air Navigation Service Provider must execute the implementation plan ofthe Safety Management System continuously until the Safety Management

System reaches the mature phase.

The Air Navigation Service Provider shall maintain the implementation of the

Safety Management System in accordance with civil aviation safety regulations.

The implementation of Safety Management System on Air Navigation Service

Provider which has been accepted, supervised by Director of Air Navigation.

Place, Date Month Year

On behalf Director General of Civil Aviation

Director ofAir Navigation

XXXXXXXXXX

Pangkat dan Gol XXXXXNIP..XXXXXX

-31-

KOP SURAT

Direktorat Jenderal Perhubungan Udara

PENERIMAAN (ACCEPTANCE) SISTEM MANAJEMEN KESELAMATAN (SAFETYMANAGEMENT SYSTEM) PADA(NAMA SERVICE PROVIDER)

Nomor ; SMS.DNP/nomor/b"ulan romawi/tahun

Sistem Manajemen Keselamatan ... (nama provider) .... mengacu pada Undang- undang Republik Indonesia Nomor 1 Tahun 2009 tentang Penerbangan danCASR {Civil Aviation Safety Regulation^ 19 tentang Sistem ManajemenKeselamatan {Safety Management System).

Direktur Navigasi Penerbangan menerima rencana implementasi sistemmanajemen keselamatan ... (nama provider) .... berdasarkan kebijakankeselamatan, manajemen resiko, jaminan keselamatan, dan promosikeselamatan pada penyelenggaraan pelayanan navigasi penerbangan.

Penyelenggara Navigasi Penerbangan harus menjalankan rencanaimplementasi Sistem Menejemen Keselamatan secara berkelanjutan hinggaSistem Menejemen Keselamatan mencapai phase mature.

Penyelenggara Navigasi Penerbangan harus menjaga pelaksanaanimplementasi Sistem Manajemen Keselamatan sesuai dengan peraturankeselamatan penerbangan yang berlaku.

Pelaksanaan Sistem Manajemen Keselamatan penyelenggara NavigasiPenerbangan yang telah diterima {accepted), diawasi oleh Direktur NavigasiPenerbangan.

Tempat, Tanggal Bulan Tahun

a.n Direktur Jenderal Perhubungan UdaraDirektur Navigasi Penerbangan

xxxxxxxxxx

Pangkat dan Gol XXXXXN1P..XXXXXX

-32-

Appendix F Routine SMS assesment checklist

Company NameAddress

Date of Assement

Yes No PartialManagement commitment and responsibilities [1.1]

Checklist

lidanceAnswer Recomend

ationRemark

3.

CASR 19

19.19

Appendix A1.1

CASR 19

19.19

CASR 19

19.19

Is the safety policy relevant tothe scope and complexity of theorganization'sOperations?Is there evidence that the safetypolicy is communicated to allemployees withthe intent. that they are madeaware of their individual safetyobligations?

Is there a periodic review of thesafety policy by seniormanagement or the

safety committee?Do the accountable manager'sterms of reference indicate hisoverall responsibilityfor all safety issues?

Check SafetyPolicy

Check SMS

communication

channel

Check safetycommite schedule

CASR 19

19.19Check

accountable

manager'sresponsibility

-33-

Safety accountabilities [1.2] ■

0. CASR 19 /19.21

Is there a safety committee (orequivalent mechanism) thatreviews the SMS and

ts safety performance?

Check

organisationaldecree for safetycommitee

5. CASR 19 /19.21

Is the accountable manager'sfinal authority over all operationsconducted under his

organization's certiricate(s)indicated in his terms ofreference.

Check

organizationalstructure for

identifyaccountable

executive

responsibility

Check example offinal authority byaccountable

manager

Appointment c: Key saiety personnel [1.3]

7. CASR 19

19.21 (e)Does the manager performingthe SMS role has relevant SMSfunctions included in his termsof reference?

Check

organisationaldecree of SafetyManager

8. CASR 19

19.21 (h)Does the manager responsiblefor administering the SMS nothold other responsibilities thatmay conflict or impair his role asSMS manager?

Check

organisationstructure

Check safetymanager

responsibilitis

-34-

9. CASR 19

19.21 (h)Does the SMS manager hasdirect access or reporting to theaccountable executive

concerning the implementationand operation of the SMS?

Check


check safetyreport to

accountable

executive10. CASR 19

19.21 (h)Is the SMS manager's positionnot lower than or subservient toother operational or productionpositions?

Check


Emergency resjponse planning [1.4J

11. CASR 19 /19.25

Does the ERP address possibleor likely emergency/crisisscenarios relating to theorganization's aviation servicedeliveries?

Check ERP

Manual

12. CASR 19 /19.25

Does the ERP include proceduresfor the continuing safeproduction, delivery orsupport of its aviation productsor services during emergenciesor contingencies?

Check ERP

Manual

13. CASR 19 /19.25

Are ERP drills or exercisescarried out according to plan andthe result of driUs

carried out are documented?

Check report anddocumentation ofERP excercises

14. CASR 19 /19.25

Does the ERP address relevantintegration with externalcustomer or subcontractor

organizations where applicable"?

Check ERP

Manual

-35-

15. CASR 19 /19.25

Is there evidence of periodicreview of the ERP to ensure its

continuingrelevance and effectiveness?

Check review ERP

Manual

8MS documentation [1.5]

16. CASR 19 /19.27

Are the organization's SMScomponents and elements

adequately manifested inthe SMS document?

Check sms

document

17. CASR 19 /19.27

Are the organization'sdocumented SMS componentsand elements in line with

the aviation authority's SMSrequirements?

Check SMS doc

recording

18. CASR 19 /19.27

Is there evidence of relevant SMS

coordination or integration withexternal

customer or subcontractor

organizations where applicable?

Check doc

recording

19. CASR 19 /19.27

Is there evidence of proceduresfor periodic review of the SMSdocument and

supporting documentation toensure their continuingrelevance?

Check doc

recording

Check review log

20. CASR 19 /19.27

Are records pertaining toperiodic review of existingsafety/risk assessmentsavailable?

Check doc

recording

-36-

Hazard identification [2.1]

21. CASR 19

19.31

19.59

Is the number or rate of the

organization'sregistered/collected hazardreports

commensurate with the size and

scope of the organization'soperations?

Check amount of

hazard reportbased on

operation activity

22. CASR 19

19.71

Is the hazard reporting systemconfidential and has provisionsto protect the reporter's identity?

Check hazard

report protection

23. CASR 19

19.31

19.33

Is there evidence that

hazards/threats uncoveredduring the incident/accidentinvestigation process areregistered with the HIRMsystem?

Check

investigationreport and HIRMdatabase

24. CASR 19

19.31

19.59

Is there evidence that registeredhazards are systematicallyprocessed for riskmitigation where applicable?

Check HIRM

report

Safety risk assessment and mitigation [2.2]

25. CASR 19

19.33

Is there evidence that operations,processes, facilities andequipment withaviation safety implications areprogressively subjected to theorganization's HIRM process.

Check periodicHIRM report

26. CASR 19

19.33

Are completed risk assessmentreports approved by an

Check HIRM

report approval

-37-

appropriate level ofManagement?

27. CASR 19

19.33

Is there a procedure for periodicreview of completed riskmitigation records?

check safety riskmanagement

procedure onmanual sms

Safety performance monitoring and measurement [3.1]

28. CASR 19

19.57

Appendix A3.1.2

Have the organization's SMSsafety performance indicatorsbeen agreed with the relevantnational aviation authority?

Check safetyperformanceindicators

29. CASR 19

19.57

Appendix A3.1.2

Are there high-consequencedata-based safety performanceindicators (e.g.accident and serious incident

rates)?

Check SDCPS

(Safely DataCollection and

ProcessingSystems)

30. CASR 19

19.57

Appendix A3.1.2

Are there lower-consequencesafety performance indicators(e.g. noncompliance, deviationevents)?

Check SDCPS

(Safety Data ■

Collection and

ProcessingSystems)

31. CASR 19

19.57

Appendix A3.1.2

Are there alert arid/or targetlevel settings within the safetyperformance indicators whereappropriate?

Check SPI targetlevel and alert

32. CAS R 19

19.39

Does the organization'smanagement of changeprocedure include the

Check SMS

manual

-38-

requirement for a safety riskassessment to be conducted

whenever applicable?33. CASR 19

19.57

Is there evidence of corrective or

follow-up action taken whentargets are not

achieved and/or alert levels arebreached?

Check analysisroot cause report

The management of change [3.2]

34. CAS R 19

19.39

Is there evidence that relevant

aviation safety-related processesand operationshave been subjected to theorganization's HIRM process asapplicable?

Check example ofHIRM report

35. CAS R 19

19.39

Does the organization'smanagement of changeprocedure include therequirement for a safety riskassessment to be conducted

whenever applicable?

Check sms

manual

Continuous improvement of the SMS [3.3]

36. CASR 19

19.39

Appendix AButir 3.3

Is there evidence that an internal

SMS audit/assessment has beenplanned andcarried out?

Check SMS audit

schedule

Check SMS audit

report

-39-

Training, education and communication [4.1, 4.2]

37. CASR 19

19.45

Is there evidence that all

personnel involved in SMS

opei-ations have undergoneappropriate SMS training orfamiliarization?

Check personaltraining recordCheck

familiarization

report38. CASR 19

19.45

Are personnel involved inconducting risk evaluationprovided with appropriaterisk management training orfamiliarization?

Check personaltraining record

39. CASR 19

19.47

Is there evidence of a safety(SMS) publication, circular orchannel for

communicating safety and SMSmatters to employees?

Check sms

publication

Check safety dataexchangeimplementation



Full Name

NIP.Pull Name

NIK.

-40-

Appendix G Phases of SMS Implementation Description

Phases of SMS

Implementation

Phase 1

(12 month)

Elemen

SMS

Element

i.i(i)

a) Identify theSMS

accountable

executive;

b) Establish anSMS

implementationteam;

What to do and description

See the Organizational Structure to identify the AE with the followingaccountability and obligations:

a. provision and allocation of human, technical, financial or other resourcesnecessary for the effective and efficient performance of SMS;

b. direct responsibility for the conduct of the organization's affairs;c. final authority over operations under the certificate/approval of the

organization;d. establishment and promotion of the safety policy;e. establishment of the organization's safety objectives and safety targets;f. acting as the organization's safety champion;g. having final responsibility for the resolution of all safety issues; andh. establishing and maintaining the organization's competence to leam from

the analysis of data collected through its safety reporting system.Check organisational decree for SMS Implementation team and responsibilityThe team should be comprised of representatives from the relevantdepartments. The team's role is to drive the SMS implementation from theplanning stage to its final implementation. Other functions of theimplementation team will include but not be limited toa. developing the SMS implementation plan;b. ensuring the adequate SMS training and technical expertise of the team in

order to effectively implement the SMS elements and related processes;and

c. monitoring of and reporting on the progress of the SMS implementation,providing regular updates and coordinating with the SMS accountableexecutive.

-41-

c) Define t±iescope of theSMS;

d) Perform anSMS gapanalysis.

SMS

Element

1.5(1)

a) Develop anSMS

implementationplan.

SMS

Element

1.3

a) Establish akey person/office

responsible forthe

administration

an

maintenance of

the SMS.

Check scope of sms in implementation plan fair navigation provider)Define the scope of the organization's activities (departments/divisions) towhich the SMS will be applicable. The scope of the organization's SMSapplicability vdll subsequently need to be described in the SMS document asappropriate.

Check Gap Analysis result

Conduct a gap analysis of the organization's current systems and processesin relation to the ICAO SMS framework requirements (or the relevant SMSregulatory requirements)GAP analisys dilakukan berdasarkan panduan SMM appendix 7 chapter 5Evidence : Dokumen SMS implementation planDevelop an SMS implementation plan on how the organization will implementthe SMS on the basis of the identified system and process gaps resulting fromthe gap analysis.

Check organisational decree of Safety manager and responsibilitiesIdentify the key SMS person (safety/quality function) within the organizationwho will be responsible for administering the SMS on behalf of theaccountable executive.

a. managing the SMS implementation plan on behalf of the accountableexecutive;

performing/facilitating hazard identification and safety risk analysis;monitoring corrective actions and evaluating their results;providing periodic reports on the organization's safety performance;maintaining records and safety documentation;planning and facilitating staff safety training;providing independent advice on s^ety matters;monitoring safety concerns in the aviation industry and their perceivedimpact on the organization's operations aimed at service delivery;coordinating and communicating (on behalf of the accountable executive)with the State's oversight authority and other State agencies as necessary

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on issues relating to safety; andj. coordinating and communicating (on behalf of the accountable executive)

with international organizations on issues relating to safety.

The selection criteria for a safety manager should include, but not be limitedto, the following:a. safety/quality management experience;b. operational experience;c. technical background to understand the systems that support operations;d. people skills;e. analytical and problem-solving skills;f. project management skills; andg. oral and written communications skills.

b) Establish thesafety servicesoffice.

Safety services office is a place where safety manager and team work for :a. collection and analysis of safety datab. distribution of safety informationc. other activity related to sms implementation

4 SMS

Element

4.1 (i)

a) Establish anSMS trainingprogramme forpersonnal, withpriority for theSMS

Implementation

Check SMS training program

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team. a)b)

Phase 2

(12 month)

SMS

Element

4.2 (i)

SMS

Element

1.1 (U)

a) InitiateSMS/safetycommunication

channels.

a) establishthis safetypolicy andobjectives

Conduct a training needs analysis.Organize and set up schedules for appropriate training of all staffncror'.hng to md:vi.duol ?-''rpon.sibilities and involvement in ih^ SMS.

c) Develop safet}'" training considering:" initial (general safety) job-specific training; and■ recurrent training.

d) Identify the costs associated with training.e) Develop a validation process that measures the effectiveness of training.f) Establish a safety training records system.

check mechanism or medium for safety comrmi^cationa) Initiate a mechanism or medium for safety communication.b) Establish a means to convey safety information through any of:

1) safety newsletters, notices and bulletins;2) websites;3) email.

a) Establish this safety policy and objectivesb) Accountable executive signed the Organization's safety poUcvc) Establish Communicate the safety policy throughout the organizationd) EstabUsh a review schedule for the safety poUcy to ensure it remains

relevant and appropriate to the organization.e) Establish safety objectives for the SMS by developing safety performance

standards in terms ofi) Safety performance indicatorsii) Safety performance targets and alert levelsiii) Action plans

f) Establish the SMS requirements for subcontractors :i) EstabUsh a procedure to write SMS requirements into the contractingprocess

ii) EstabUsh the SMS requirements in the bidding documentation

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SMS

Element

1.2

a) define safetymanagement

responsibilitiesand

accountabilities

SMS

Element

1.4

SMS

Element

1.5 (ii)

a) Emergencyresponse plan

a) Defme safety management (All aviation safety-related positions)responsibilities and accountabilities accross relevan departemens of theorgani7:ation ( example operations, manufarti.iring, maintenance,engineering, training and dispatch than for support functions (humanresources, administration, legal and financial 1

b) Establish an SMS/Safety coordination mecanism/committeE

d)stablish departmental/ divisional SAGs were applicable

Ensure clear functions for the SAG and the safety/SMS coordinationcommittee

e) Establish lines of communication between the safety services office, theaccountable executive, the SAG and the safety/SMS coordinationcommittee

f) Appoint the accountable executive as the chairperson of the safety/SMScoordination committee

g) Develop a schedule of meetings for the safety services office to meet withthe safety/SMS coordination committee and SAG as needed

Create an SMS

documentation

system to

describe, store.

a) Review the outline of the ERP (contingency plan, crisis management planand continuing airworthiness support plan.) related to the delegation ofauthority and assignment of emergency responsibilities.

b) Establish coordination procedures for action by key personnel during theemergency and the return to normal operations.

c) Identify external entities that will interact with the organization duringemergency situations.

d) Assess the respective ERPs of the external entities.e) Establish coordination between the different ERPs.f) Incorporate information about the coordination between the different

ERPs in the organization's SMSdocumentation.a) Establish manual document sms stand alone or a unity with the

operation manual

b) establishing an SMS filing system to collect and maintain current recordsrelating to the organization's ongoing SMS processes

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Phase 3

(18 month)SMS

Element

2.1 (i)

retrieve and

archive all

vSMS-related

inlbrmation

and records by

a) HazardIdentification.

c) maintaining records to provide a historical reference as well as thecurrent status of all SMS processes such as: a hazard register; an indexof completed safetj'-assessments; SMS/safety''training records; currentSPIs and associated safety objectives; internal SMS audit reports;SMS/safety committee meeting minutes and the SMS implementationplan;

d) maint^ing records that will serve as evidence of the SMS operation andactivities during internal or external assessment or audit of the SMS

a establish a voluntary hazard reporting procedur :i) The objective of the reporting system;

SMS

Element

2.2

ii) The scope of the aviation sectors/areas covered by the system;iii) Who can make a voluntary report;iv) When to make such a report;v) How the reports are processed;

b)

vi) Contacting the [Name of system] manager;^^ 4__ /

E

Safety riskassessment

and mitigation

stablish a programme/schedule for systematic review of all applicableaviation safety-related processes/equipment that are eligible for the HIRMprocess.process.

c) Estabfish a process for prioritization and assignment of identified hazardsfor risk mitigation.

a) establish safety risk management procedures.i) Hazard identification;ii) The scope of the aviation sectors/areas covered by the system;iii) Risk analysis (probability);iv) Risk analysis (severity);v) Risk assessment and tolerabilit;vi) Risk control / mitigation;Develop and adopt safety risk matrices relevant to the organization'soperational or production processes.

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SMS

Element

3.1 (i)

Safetyperformancemonitoring andmeasurenicnt

a j^stablish occnrrence reporting and investigation procedures:>11 AA ^ ^ ^ _■Occurence reporting may range from thc' highest-consequence occurrences

(accidents, serious incidents) to lower-consequencc events such asoperational incidents, sysiiem/equipment failures or defects

txi: _ _i . ■ 11 ..b) Establish a safety data collection and processing system for high-consequence outcomes;i) Accident investigation data;ii) Mandatory incident investigation data;iii) Voluntaiy reporting data;iv) Continuing airworthiness reporting data;v) Operational performance monitoring data;vi) Safety risk assessment data;vii) Data from audit findings/reports;vih) Data from safety studies/reviews; and

SMSElement3.2

Themanagement ofchange

/TPQ/^ Safety data from other States, regional safety oversight organizations(RSOOs) or regional accident and incident investigation organizations(RAIOs), etc

—Develop high-consequence SPIs and associated targets and alert settinffs.i) Accident ratejii) Serious incident rate;iii) Monitoring of high risk, regulatory, non compliance outcome fe g

ICAO audit finding): ^ ^d) Reach an agreenient with the State oversight authority on safety

performance indicators and safety performance targets.a) Establish a management of change procedure that includes safety risk

assessment.

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b) Ensure that management of change procedures address the impact onexisting safety performance and risk mitigation records before

SMS

Element

3.3 (i)

ncv/ cb'T^no-pfj

Continuous

improvement ofthe SMS

c) Establish piocedures to ensure tiiai safety assessment of new aviationsafet^^-related operations, processes and equipment are conducted (or3-Ccounted for) as applicable, before they are commissioned.

a) Develop forms for internal evaluations.

b) Establish an internal quality audit programme

c) Establish an external quality audit programme

d) Define a schedule for evaluation of facilities, equipment, documentationand procedures to be completed through audits and surveys.

e) Develop documentation relevant to operational safety assurance.

Phase 4

(18 month) SMS

Element

1.1 (iii)

SMS

Element

2.1 fii)

Managementcommitment

and

responsibility

Hazard

a) Enh^ce the existing disciplinary procedure / policy with dueconsideration of unintentional errors or mistakes from deliberate or grossviolations.

SMS

Element

3.1 (u)

identification

b] Integrate hazards identified from occurence investigation reports with thevoluntaiy hazard reporting systems.

c) Integrate hazard identification and risk management procedures with thesubcontractors or customers SMS where applicable.

Safety-performancemonitoring andmeasurement

d) Enhance the safety data collection and processing system to includelower-consequence events;

e) Develop lower-consequence SPIs and associated targets/alert settings.

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4 SMS

Element

3.3 (ii)

Continuous

improvement ofthe SMS

f) EstebUsh SMS audit programmes or integrate them into existing internaland external audit programmes.

g) Establish other operational SMS review/survey programmes whereappropriate.

5 SMS

Element

4.1 (ii)Training andeducation

h) Ensure that the SMS training programme for all relevant personnel hasbeen completed.

0 SMS

Element

4.2 (ii)

Safetycommunication

i) Promote safety information sharing and exchange internally andexternally.

Salinan sesuai dengan asUnya,

, . KEPALA BAGIAN HUKUM//

'v'/

f, ■

r. i ,

ENDAH PURNAMA RAPT

Pembina Tk. I (IV/b)NIP. 19680704 199503 2 001

ACTING DIRECTOR GENERAL OF CIVIL AVIATION

ttd


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