B e lg i a n C i v i l A v i at i o n A u t h o r i t y

B e lg i a n C i v i l A v i at i o n A u t h o r i t y Safety Plan 2016-2020 Federal Public Service Mobility and Transport Belgian Civil Aviation Authority

Belgian Plan for Aviation Safety 2016-2020 3

Contents Executive Summary Introduction Content and structure of the Belgian Plan for Aviation Safety Belgian Plan for Aviation Safety - Information Link to the European Plan for Aviation Safety General Aviation OA07: Airspace infringements OA08: Aircraft upset in flight (loss of control) Emerging actions (EA) EA01: Unmanned Aerial Systems EA02: New Business Models Accidents and Serious incidents Commercial Aviation General Aviation Systemic Actions (SA) SA01: Further implementation of the Belgian Aviation Safety Programme SA02: Safety training and safety promotion SA03: Setting up a dialogue with the Belgian aircraft operators on Flight Data Monitoring programmes Appendix A: Acronyms and definitions Appendix B: BCAA risk management process Appendix C: BPAS November 2017 status report Operational Actions (OA) Outline of risks in the Belgian civil aviation sector Commercial Aviation OA01: Ground safety OA02: Targeting of aircraft with lasers OA03: Runway incursions OA04: Unruly passengers OA05: Dangerous goods OA06: Bird strikes 4

Executive Summary Potential threats to aviation safety come in many different forms - specific technical issues, operational and natural events, human errors; the list is long and diverse. By quantifying the relative importance of potential threats, we should be able to create a systematic, effective and proportionate series of actions that will help us to deal with the highest safety risks. The Belgian Plan for Aviation Safety (BPAS) contains safety initiatives to address these key safety risks in aviation. The safety operational risks are identified based on analysis of safety outcomes (i.e. accidents and incidents) at both national and global level. Aviation is a global business and lessons learned from across the globe may be equally applicable in Belgium, so the BPAS is also affected by key safety issues identified by ICAO, the European Aviation Safety Agency (EASA), and even other States national safety plans. The BPAS is consistent with what the Agency is doing at a regional level. We are fully committed to work in partnership with EASA to ensure Europe maintains the highest possible standards of aviation safety. In addition, systemic risks (e.g. regulatory/policy issues) that underlie the operational performance of the civil aviation system are addressed. In 2016, the BCAA has optimized his safety risk processes and procedures regarding the reporting, analysis and follow-up of occurrences. Our attention mainly went out to the exchange of mandatory and voluntarily occurrence reports with the aviation industry using formats compatible with the ECCAIRS software. organization and demands once more a new optimization of our safety risk processes and procedures. The application of the common European Risk Classification Scheme shall contribute to an improvement of our safety information management, allowing continuous identification of potential critical areas to be addressed at both State and Service Providers levels. The new area Emerging Issues mainly addresses the use of Unmanned Aerial Systems (UAS). The popularity and application of UAS better known by the public as drones - continue to grow. The use of UAS remains an emerging risk to both commercial and general aviation. New safety actions have been taken to mitigate this important emerging risk. Each action area in the Belgian Plan for Aviation Safety includes the identification of safety issues as well as the objectives to be achieved. During the duration of this plan, the progress on the actions are monitored and evaluated. This feedback loop ensures effective implementation aiming at continuous improvement. The coordinated actions proposed in this edition of BPAS are expected to make a difference in avoiding accidents and serious incidents, which is the goal that links the activities together. In 2017, the focus is on the further development of a Just Culture climate and on the further implementation of Regulation (EU) 376/2014 on the reporting, analysis and follow-up of occurrences. The encoding of aviation occurrences into ECCAIRS was transferred from the BCAA Aviation Inspectorate to the BCAA Management System Unit to better guarantee the protection and the confidentiality of the safety data in ECCAIRS. The introduction of the common European Risk Classification Scheme is an important challenge for our 5

Introduction Content and structure of the Belgian Plan for Aviation Safety The Belgian Plan for Aviation Safety (BPAS) is the documented output of an evidence based, pro-active approach to safety risks. At the heart of the BPAS is the concept of safety risk management. The improvement of safety is achieved by implementing actions that will best mitigate these risks. This edition of BPAS covers the five-year period between 2016 and 2020. Safety priorities identified in BPAS are addressed by specific actions through national rulemaking activities, through oversight activities performed by the Belgian Civil Aviation Authority (BCAA) or through specific safety promotion activities. Unfinished actions of the previous plan are also included in the 2017 update. The BPAS contains three categories of safety issues: systemic, operational and emerging. BPAS therefore contains three main chapters, each one addressing the main safety areas and risk mitigating actions: The safety actions are therefore divided into 3 different types: Systemic Actions (SA) Operational Actions (OA) Emerging Actions (EA) These safety actions are realised through rulemaking and safety promotion activities, or through focused oversight. The following information is provided for each safety issue in the BPAS: Description - Why has the issue been identified as an important safety issue? Objectives - The expected safety benefits Safety Performance indicators How is the improvement monitored? The safety actions Systemic Issues The action owner(s) Operational Issues The alignment with the European Plan for Aviation Safety (EPAS) Emerging Issues The target date 6

The BPAS is complemented by an Appendix C containing a status report on the progress made until November 2017. The following information is provided for each action item: A summary of the work done The action owner The assessment whether the action is progressing according to the BPAS The identification of the status of the key deliverables. An action is considered closed when the proposed deliverable is achieved This edition of the BPAS applies to commercial air transport (CAT) operations, aerial work (AW) operations and general aviation (GA) operations. Safety actions derived from safety recommendations by the Belgian Air Accident Investigation Unit may also be included in the BPAS. Belgian Plan for Aviation Safety - information The BPAS is annually assessed and available on:http://mobilit.belgium.be/nl/ luchtvaart/belgisch_veiligheidsprogramma/veiligheidsplan Link to the European Plan for Aviation Safety In the European aviation system, rulemaking, oversight and safety promotion activities are shared between the Member States and the European Institutions. The European Aviation Safety Programme (EASP) describes the roles and responsibilities that each of them have while performing these functions. As certain competencies have been transferred from the Member States to the European Union, to obtain a complete picture of safety in any single State, both the EASP and the Belgian Aviation Safety Programme (BASP) need to be considered. The EASP describes among other things the process to develop and update the European Plan for Aviation Safety (EPAS). The safety risks identified in the EPAS are mitigated by safety actions that EASA, the European Commission, the aviation sector and EASA Member States take on board. All the partners work together, streamline their activities and add their efforts to drive the accident rate further down. The implementation of the BASP has resulted in the development of the BPAS. BPAS forms a part of the Belgium aviation safety policy and seeks to eliminate potential sources of safety problems through safety promotion activities and through the optimization of regulatory and supervisory activities. The BPAS is approved by the BCAA Director General and is annually assessed and published. Through the BPAS, the BCAA aims to contribute to the realisation of the EPAS. The alignment between the EPAS and the BPAS is shown for the relevant safety actions. https://mobilit.belgium.be/fr/transport_aerien programme_belge_de_securite/plan_de_securite_belge 7

Accidents and Serious incidents General Aviation This area includes aerial work and GA operations performed by aeroplanes and helicopters as well as operations performed by gliders, balloons and microlights. Commercial Aviation This section addresses all types of commercial air transport (CAT) operations involving aeroplanes (passenger and cargo operators) an also air taxi and other such operations. This chapter also covers operations in the offshore helicopter domain and all other commercial air transport operations involving helicopters such as passenger flights, air taxi and HEMS. In 2016, there were no fatalities or serious injuries because of accidents or serious incidents during general aviation activities in Belgium. In recent years, there were no fatalities or serious injuries because of accidents or serious incidents during CAT operations in Belgium. 8

Systemic Actions This area addresses system-wide problems that affect aviation as a whole. In most scenarios, these problems become evident by triggering factors and play a significant role in the outcome of a safety event. They often relate to deficiencies in organisational processes and procedures. SA01: Further implementation of the Belgian Aviation Safety Programme Description The Belgian State shall further implement the Belgian Aviation Safety Programme (BASP) in compliance with the ICAO Global Aviation Safety Plan (GASP) and the EASP. The BASP describes the various regulations and activities for maintaining and improving aviation safety and ensures that Belgium operates in compliance with EU regulations and the safety management requirements set forth in ICAO Annex 19. Included in the BASP is the requirement for implementation of Safety Management Systems (SMS) by the service providers. The transition to a State Safety Programme requires increased collaboration across operational domains to identify hazards and risks. The analysis of various forms of safety data (safety occurrence reports etc.) is needed to develop effective mitigation actions. This requires that service providers and the BCAA should work closely together on safety risk management. Collaborative efforts between service providers and the BCAA are also essential to the development of safety performance indicators (SPI s). Safety data should be analysed to support the development and maintenance of SPI s related to the risks of the Belgian aviation system. The BCAA is an active member of the Network of Analysts (NoA). This partnership between EASA and other aviation organizations aims to enhance aviation safety in Europe by providing a framework for the collaboration of safety analysis activity throughout the European Aviation Safety Community. The primary mission is to improve aviation safety by identifying safety risks and bringing such risks to the attention of the decision makers. The NoA shall establish appropriate indicators, elaborate a common European risk classification scheme and establish analysis methodologies that will facilitate the sharing of information. The BCAA conducted a new gap analysis in 2017 to determine the remaining gaps and actions for the further implementation of the BASP. This analysis was conducted by means of the ICAO Gap Analysis Tool on istars. This chapter has been reviewed in accordance with the outcome of the latest analysis. Objectives Work with international organisations and service providers to implement safety management Improvement of the Belgian safety performance to enable proportionate and timely corrective actions to be taken 9

Safety Performance Indicator Timely implementation of actions and gaps as identified through the ICAO Annex 19 State Safety Programme (SSP) gap analysis 10

Actions Action Number Action title & objective Owner Alignment EPAS Date SA01.01 Alignment of BCAA s processes and procedures with Regulation (EC) 376/2014 BCAA/S-MAS MST.001 End 2018 To optimize BCAA s safety risk processes and procedures with Regulation (EU) No 376/2014 on the reporting, analysis and follow-up of occurrences in civil aviation. The application of the common European Risk Classification Scheme (ERCS) shall be an important element of this optimization. SA01.02 Revision of the circular CIR/MAS-01 on the reporting, analysis and follow-up of occurrences in civil aviation BCAA/S-MAS MST.001 End 2018 To further develop the topics related to just culture principles and the dissemination of information stored in the common European Central Repository (ECR). SA01.03 Optimization and harmonization of the BCAA s methodology for risk based oversight BCAA/S-MAS MST.001 Continous To prioritize audits and surveys towards the areas of greater safety concern. SA01.04 Development of an Annual Safety Review (ASR) BCAA/S-MAS MST.001 End 2018 To inform the public of the level of safety in civil aviation. SA01.05 Development of a legislative framework for the introduction of just culture principles in accordance with Regulation (EU) No 376/2014 BCAA AAIU(Be) MST.001 End 2018 To determine the designation, establishment, composition and functioning of the body responsible for the implementation of paragraphs 6, 9 and 11 of Regulation (EU) No 376/2014. The protection of the reporter shall also be an important element of this legislative framework. 11

SA02: Safety training and safety promotion Description Safety promotion is identified as one of the four components of a SSP. Therefore, safety promotion is also a major component of the BASP and together with the BCAA s Safety Policy an important enabler for continuous safety improvement. Safety Promotion has two elements, notably: The BCAA organizes or participates in safety seminars and workshops in collaboration with the commercial and general aviation sector, the Air Accident Investigation Unit, the Ministry of Defence and the European Aviation Safety Agency (EASA). Extensive guidance safety promotion material has been developed by teams of the SMICG and EASA (such as the EASA SPN) which among other things addresses SMS principles and implementation. The BCAA is an active member of the EASA SPN. Training/education Objectives Safety communication The BCAA maintains a safety training program that ensures that their staff is trained and competent to perform their BASP duties. Training programs are adapted to fit the needs and complexity of the BCAA s organization. The scope of the safety training is appropriate to each technical functions involvement in the BASP. The provision of appropriate training to all staff, regardless of their level in the organization, is an indication of the BCAA s management commitment to an effective SSP. Employees of the BCAA and the Air Accident Investigation Unit are trained and competent to perform their SSP duties Safety information is communicated and disseminated to the aviation sector Safety Performance Indicator Not applicable The BCAA has also developed formal means for safety communication. Safety communication is an important enabler for improved safety performance and reduces the chances of accident and incident recurrence. The BCAA s safety communication takes various forms. The means of safety communication include, but are not limited to: BCAA s Aviation Safety Information Leaflets (ASIL s) Seminars and workshops The Belgian Aviation Safety Management Group (BASMG) platform The website of the Federal Public Service of Mobility and Transport 12

Actions Action Number Action title & objective Owner Alignment EPAS Date SA02.01 Encourage the implementation of safety promotion material developed by the SMICG and the EASA SPN BCAA/S-MAS MST.002 Continuous To encourage the implementation of the methods, guidance, best practices, etc. presented in the safety promotion material developed by the SMICG and the EASA SPN to the service providers and the general aviation sector. SA02.02 Organize or participate in safety seminars and workshops BCAA AAIU(Be) MST.002 Continuous To organize or participate in safety seminars and workshops to discuss the most important safety risks applicable to the aviation sector. 13

SA03: Setting up a dialogue with the Belgian aircraft operators on Flight Data Monitoring programmes Description Many of the safety performance measures established to monitor safety issues at industry level rely on data from Flight Data Monitoring (FDM) programmes. FDM is the pro-active use of digital flight data from routine operations to improve aviation safety and is mandatory for aeroplanes with a Maximum Certificated Take-Off Mass (MCTOM) more than 27.000 kg. FDM offers the ability to monitor and evaluate operational safety trends, identify hazards and risk precursors, and take appropriate remedial action. Objectives Improve and promote FDM programmes with the objective to bring safety benefits to operators Allow the BCAA to better achieve its national safety objectives and therefore to better manage the BASP Sharing experience between aircraft operators Safety Performance Indicator Not applicable EASA and National Aviation Authorities (NAA s) have formed a group of experts called the European Authorities coordination group on FDM (EAFDM). EASA will foster actions by States to improve FDM programmes by the aircraft operators and assist States to monitor the standardization of FDM events relevant to State Safety Programme top safety priorities. The BCAA is an active member of the EAFDM. The BCAA shall promote the operational safety benefits of FDM and shall foster an open dialogue on FDM programmes. The BCAA shall also encourage aircraft operators to include in their FDM programmes, EADFM, EPAS and Belgian FDM events relevant for the prevention of Runway Excursions (RE), Mid-air Collisions (MAC), Loss of Control in Flight (LOC-I), Controlled Flight Into Terrain (CFIT), Actions Action Number Action title & objective Owner SA03.01 BCAA/OPS Alignment EPAS MST.003 Date Discuss the expected benefits of FDM with Belgian aircraft operators Continuous Meet Belgian aircraft operators on a regular basis to establish a national FDM Forum and to discuss the expected benefits of FDM. 14

Operational Actions Outline of risks in the Belgian civil aviation sector The risk management performed by the Belgian State relates to any occurrence occurring on Belgian territory and in Belgian airspace. In addition, occurrences occurring on foreign territory and foreign airspace involving Belgian aircraft operators are also included. The various aspects of aviation are considered, including aircraft, companies operating in the aviation sector, air traffic control services, airports, ground handling services, etc. Aviation occurrences reported are entered in the ECCAIRS database. The main safety risks can be deduced from the analysis of these occurrences, and the operational actions to be set by the management in view of accident prevention can be determined. These actions concern both general and commercial aviation. The BCAA Safety Committee addresses the aviation risks to be dealt with as a priority, selected by considering factors such as the level of risk-mitigation actions already in place. The improvement of the reporting culture within the aviation sector and the reporting of occurrences using formats compatible with the ECCAIRS software are probably the main reasons for the remarkable increase in the number of occurrences reported to the BCAA. The table below shows the types of occurrences that are considered posing the highest risk derived from the 2016 risk analysis. Commercial Air Transport (CAT) Bird strikes Separation Minima Infringements Unruly passengers Targeting of aircraft by laser Ground handling related events Runway incursions Communication by flight crew with ANS General Aviation (GA) Airspace Infringements Runway incursions 15

COMMERCIAL AVIATION This section addresses all types of CAT operations. Through analysing the accident(s), serious incidents and other incident categories in the national occurrence database ECCAIRS, the following safety risk areas for CAT operations have been identified. OA01: Ground safety Description Ground safety includes both ground handling and ground collisions. According to the EPAS, ground occurrences are the fourth most frequent risk area leading to fatal accidents. This risk area also leads to possibly significant damage to aircraft and equipment, as well as personal injuries to ground staff, highlighting the need for greater safety efforts in ground operations. The analysis of the reported occurrences has demonstrated that problems related to ground handling or RAMP (Region of Aircraft Movement and Parking) are common. These reports comprise a broad spectrum of occurrences, e.g. damage caused to aircraft by ground vehicles, incorrect weight and balance calculations, incorrect loading or fuelling of aircraft etc. This risk area may lead to significant damage to aircraft and equipment, highlighting the need for greater safety efforts in ground operations. De-icing and anti-icing flaws, inadequate de-icing procedures, incorrect loading and weight calculation can also lead to loss of control in flight (LOC-I) which is a main topic in the EPAS. Following occurrences are classified as ground handing incidents and are included in this operational action: aircraft marshalling, aircraft parking, de-icing, line maintenance, servicing (catering, fueling, fluids, other), loading (baggage, cargo, cargo shifted, incorrect loading, overweight take-off, incorrect center of gravity, incorrect fuel balance), as well as collision of towed aircraft with object/obstacles and collision aircraft-vehicle while the aircraft is standing still or being pushed-back or towed. The Belgian State didn t have sufficiently detailed national regulations in place with respect to ground handling. The BCAA has therefore published regulations on the approval of suppliers of ground handling services at Brussels-National airport. Part of the regulation is the introduction of Safety Management Systems (SMS) at the suppliers of ground handling services. An SMS involves a systematic approach that includes the administrative structures, accountability, safety policy and procedures required for safety management. Suppliers of ground handling services shall use their SMS to identify safety threats, ensure corrective action to maintain appropriate levels of safety, carry out continuous monitoring and regular assessment of safety levels, and strive for continuous improvement of the safety management system. The implementation of following actions should result in lower risk levels as well as in a relative decline in the number of occurrences related to ground handling RAMP operations. Objectives Increased supervision and auditing to monitor the ground handling companies 16

Safety Performance Indicator Actions Number of collisions on ground at Belgian aerodromes because of ground handling operations in proportion to the number of movements (SPI-POR-03) Action Number Action title & objective Owner Alignment EPAS Date OA01.01 Continuous oversight of ground handling activities at Brussels-National airport for ground handling companies BCAA/ AAS MST.018 Continuous Improve aviation safety by organizing a continuous oversight of ground handling activities at Brussels-National airport for ground handling companies in accordance with the relevant Ministerial Decree. OA01.02 Continuous oversight of companies using rolling stock and essential stock, as well as the conditions for roadworthiness testing of rolling stock at Brussels-National airport BCAA/ AAS MST.018 Continuous Improve aviation safety by organizing a continuous oversight of companies using rolling stock and essential stock, as well as the conditions for roadworthiness testing of rolling stock at Brussels-National airport. The BCAA shall check if: the rolling stock and essential stock is sufficient, appropriate and safe; the rolling stock and essential stock are maintained, inspected and, where appropriate, undergo a roadworthiness test according to the applicable regulations. Note: the 12-month MA (Moving Average) is the Average calculated over the previous 12 months. OA01.03 Approval of maintenance and renewal programs of centralized infrastructure at the airport Brussels National BCAA/ AAS MST.018 Continous Airlines and their passengers and cargo need safe, functional and affordable airport infrastructure for their operations. This infrastructure should be maintained at a high level to be available for the operators and from time to time, this infrastructure should be renewed as well. In relation to this, Brussels Airport Company should provide a maintenance and renewal program to the BCAA. OA01.04 Develop safety awareness for ground safety (leaflets, video clips ) BCAA/ AAS MST.018 Continous Improve the safety awareness at Brussels Airport by the development of safety promotion material for the prevention of incidents related with ground handling RAMP. 17

OA02: Targeting of aircraft with lasers Description Safety Performance Indicator Number of laser targeting occurrences in proportion to the number of movements (SPI-GEN-01) Laser emitters continue to pose a significant threat to aviation safety and security. The exposure of air crew to laser illumination may cause hazardous effects (distraction, glare, afterimage flash blindness ) which could adversely affect the ability of air crew to carry out their responsibilities and therefore requires adequate countermeasures to mitigate this threat. The BCAA has contacted the Belgian ANSP, the Federal Police and the airport authorities to review and assess the current procedures in place at several Belgian international airports related to the targeting of aircraft with lasers and to share best practices. The BCAA shall continue to monitor the situation in cooperation with the Belgian ANSP, the Federal Police and the airport authorities. Note: the 12-month MA (Moving Average) is the Average calculated over the previous 12 months Actions Objectives Minimize the number of laser attacks as well as the effects they have on flight safety during the critical phases of flight Action Number Action title & objective Owner Alignment EPAS Date OA02.01 Further improve the procedures to follow in the case of laser interference and to share best practices BCAA/SAF MST.004 MID 2018 To improve the cooperation between the ANSP, the Federal Police, the Brussels Airport Company and the BCAA to develop, review and assess the procedures to follow in the case of laser interference and to share best practices. 18

OA03: Runway incursions Description According to the definition provided by ICAO, a Runway Incursion (RI) is defined as any occurrence at an aerodrome involving the incorrect presence of an aircraft, vehicle or person on the protected area of a surface designated for the landing and take-off from aircraft. Safety Performance Indicators Number of RIs by aircraft at Belgian aerodromes in proportion to the number of movements (SPI-POR-01/SPI-ANS-03) Number of RIs by vehicles at Belgian aerodromes in proportion to the number of movements (SPI-POR-01/SPI-ANS-03) Number of RIs by persons at Belgian aerodromes in proportion to the number of movements (SPI-POR-01/SPI-ANS-03) The prevention of runway incursions is a key issue for airport safety. The European Action Plan for the Prevention of Runway Incursions (EAPPRI) is the result of the combined efforts of multiple organizations dealing with safety at airports. It contains recommendations to all airport stakeholders (including regulators, airport operators, ATC, aircraft operators, etc.). The implementation of EAPPRI recommendations will enhance runway safety. The development of mature and performant Local Runway Safety Teams (LRST s) is a key objective for the BCAA. LRST s should be dealing with runway safety and runway incursions based on local risks. Objectives Reduce the number of RIs in fixed-wing commercial air transport Note: the 12-month MA (Moving Average) is the Average calculated over the previous 12 months 19

Actions Action Number Action title & objective Owner Alignment EPAS Date OA03.01 Ensure that Local Runway Safety Teams are in place and effective BCAA/AAS MST.011 Continuous LRST s have been established at each Belgian airport, which comprise representatives from aircraft operators, Air Navigation Service Providers, airport operators and the BCAA. The BCAA is an active member of these teams. LRST s should focus on local solutions for RIs where participating partners have management control. OA03.02 Assess aerodromes operators for compliance with EAPPRI recommendations BCAA/AAS MST.011 MST.014 Continuous The BCAA Airports Department organizes audits on the certified airports to check the application of the EAPPRI aerodrome operator recommendations. OA03.03 Update and recommunicate the Aviation Safety Information Leaflets (ASIL s) on radiotelephony phraseology «Hold short on runway» and Solo call sign suffix for student pilots» BCAA/AAS BCAA/S- MAS MST.014 MID 2018 To reduce the number of runway incursions. A great number of incursions were caused by general aviation traffic at certified airports. Phraseology issues have been identified after analysis of the reported runway incursion occurrences. The BCAA therefore decides to possibly update the ASIL s on radiotelephony phraseology and to recommunicate them to all Belgian pilots. OA03.04 Develop safety promotion material on ground safety (leaflets, video clips ) at Brussels National Airport Brussels Airport Company MST.014 Continous Improve the safety awareness at Brussels Airport by developing safety promotion material on ground safety for the prevention of runway and taxiway incursions. 20

OA04: Unruly passengers Safety Performance Indicator Number of Unruly Passenger Occurrences (SPI-GEN-02) Description An unruly passenger is defined by Annex 17 to the ICAO Chicago Convention as: «A passenger who fails to respect the rules of conduct at an airport or on board an aircraft or to follow the instructions of the airport staff or crew members and thereby disturbs the good order and discipline at an airport or on board the aircraft. And by the Tokyo Convention (1963) as: Acts which, whether they are offences [against the penal law of a State], may or do jeopardize the safety of the aircraft or of persons or property therein or which jeopardize good order and discipline on board.» Basically, unruly passenger refers to a passenger behaviour that jeopardizes or might jeopardize the safety of the aircraft, persons or property therein or the accepted level of good order and discipline on board. Most of the unruly passenger occurrences are related to smoking in the lavatories of the aircraft, the use of mobile devices on board of the aircraft and to drunk passengers. Potential consequences of unruly passengers are the return of the aircraft, flight delay and flight diversion. Actions Note: the 12-month MA (Moving Average) is the Average calculated over the previous 12 months Action Number Action title & objective Owner Alignment EPAS Date Objectives Reduction of the number of occurrences related to unruly passengers OA04.01 Perform a comprehensive analysis of the unruly passenger occurrences BCAA/S-MAS BCAA/SAF - End 2017 To understand the size of the issue at national level and to identify potential safety measures that could reduce the number of unruly passenger occurrences. OA04.02 Optimize the procedures to prosecute unruly passengers BCAA - End 2018 To improve the cooperation between the Federal Police and the BCAA to optimize the prosecution of unruly passengers. 21

OA05: Dangerous goods Safety Performance Indicator Not yet applicable Description Dangerous goods are articles or substances which are capable posing a risk to health, safety, property or the environment. These include obvious things, such as: explosives, radioactive materials, flammable liquids, dangerous or volatile chemicals, strong acids, compressed gases, poisons and aerosols. Everyday items that can cause problems include toiletries, aerosols, tools and lithium batteries. One of the safety actions related to fire, smoke and fumes in the EPAS are aimed to raise awareness on the risks associated with the transportation of lithium batteries. The major risk associated with the transport of lithium batteries and battery-powered equipment is thermal runway, where the batteries heat up and produce toxic and flammable gasses because of short circuit, malfunctioning or mishandling of the batteries. Aircraft operators should be informed of the risks associated with the transport of dangerous goods and more particularly with the transport of lithium batteries. Passenger awareness should also be raised, therefore preventing them from unintentionally carrying non-allowed items while acknowledging the risks posed by lithium batteries. Objectives Actions Action Number OA05.01 Action title & objective Approval of the transport of dangerous goods activities for ground handling companies Owner BCAA/OPS Alignment EPAS Date MST.005 MST.018 End 2017 Approval of the transport of dangerous goods activities for ground handling companies in accordance with the relevant national regulation. OA05.02 Systematic auditing of operators outstations in the field of the transport of dangerous goods BCAA/OPS MST.005 Continuous Improve aviation safety by organizing a systematic monitoring of the transport of dangerous goods at the operators outstations. Further reduce the risks of accidents and serious incidents in this category OA05.03 Transportation of lithium batteries BCAA/OPS Brussels Airport Company MST.005 Continuous Inform all involved parties (operators, ground handlers, forwarders, airport operators, etc.) and raise passenger awareness on the risks associated with lithium batteries. 22

OA06: Bird strikes Objectives Ñ Ñ Reduce the risk of collision with birds The presence of birds and other animals on and near an aerodrome poses a serious threat to aircraft operational safety. Most collisions occur at low altitudes, near an airport during take-off and landing. Annex 14-certified aerodrome operators are required to take the necessary actions to identify, manage and mitigate the risk to aircraft operations posed by wildlife (birds and other animals) by adopting actions likely to minimise the risk of collisions between wildlife and aircraft, to as low as reasonably practicable. Safety Performance Indicator Number of bird strikes including turbine engine ingestion at the Belgian international airports (SPI-POR-02b) The appropriate authorities are required to have in place procedures for the identification and control of wildlife hazards on and near an aerodrome, and to ensure that competent personnel evaluates the wildlife hazard on a continuing basis. At present, hundreds of bird strikes are reported each year in Belgium and the number of bird strike reports continues to increase. The consequences of bird strikes vary between a scared pilot to a severe damaged aircraft. The increasing number of flights and growing bird population will bring new challenges in the future. The BCAA established the Belgian Aviation Wildlife Hazard Committee (BAWiHaC) to exchange information and expertise about wildlife strikes. BAWiHaC members are the airport authorities of the certified aerodromes, the Aviation Safety Department (ASD) of the Ministry of Defence and the BCAA. The BAWiHaC meets at least once a year. The BAWiHaC discusses topics, such as the reporting of wildlife occurrences, the grass management and the reduction of wildlife at the aerodromes. The discussions within the BAWiHaC results in a strong and open collaboration between different airports for Bird Control Unit matters, a higher priority for wildlife issues on all levels of management and a greater respect for the daily work of the Bird Control Unit teams. Note: the 12-month MA (Moving Average) is the Average calculated over the previous 12 months 23

Actions Action Number Action title & objective Owner Alignment EPAS Date OA06.01 Periodic exchange of experiences on specific technical issues in the field of wildlife management through the Belgian Aviation Wildlife Hazard Committee (BAWiHaC) BCAA/AAS - Continuous Create a strong and open collaboration between the international airports for Bird Control Unit matters and to give a higher priority to wildlife issues on all levels of management. OA06.02 Organization of new courses for Bird Control Unit personnel ASD BCAA BAWiHaC - End 2018 Personnel from all civil airports participates in a course on Wildlife Hazard Management organised by ASD to acquire an impact on the competence and motivation of the BCU personnel. 24

GENERAL AVIATION This area includes aerial work and GA operations performed by aeroplanes and helicopters as well as operations performed by gliders, balloons and microlights. OA07: Airspace infringements Description Airspace infringement (AI) is also referred to as an unauthorized penetration of airspace and is generally defined as a flight into notified airspace without previously requesting and obtaining approval from the controlling authority of that airspace in accordance with international and national regulations. Objectives Reduced Risk of Collision Safety Performance Indicator Number of Belgian airspace infringements caused by General Aviation flights (SPI-ANS-06c) The Belgian Air Accident Investigation Unit sends for each reported airspace infringement a standard questionnaire to the pilot. The BCAA then performs an in-depth statistical analysis of the questionnaires to gain insight into the possible hazards that can lead to airspace infringements in the Belgian airspace. The analysis of the reported incidents clearly indicates that most of the infringements are committed by General Aviation flights. Note: the 12-month MA (Moving Average) is the Average calculated over the previous 12 months 25

Actions Action Number Action title & objective OA07.01 Raise awareness of general aviation pilots by periodically reviewing the aviation safety information leaflets on airspace infringements Owner BCAA AAIU(Be) Alignment EPAS Date MST.016 Continuous To periodically revise and communicate the aviation safety information leaflets on airspace infringements for raising awareness of the risks involved with this type of occurrence and for providing correct information to general aviation pilots to avoid airspace infringements in the Belgian airspace. OA07.02 Making of a video clip on the prevention of airspace infringements in the Belgian airspace BCAA EASA SPN MST.016 Mid 2018 To avoid airspace infringements in the Belgian airspace committed by general aviation flights. The BCAA contributes to the implementation of a pan-european Safety Promotion campaign on preventing airspace infringement and reducing the risk of MAC including awareness of the Belgian airspace complexity and the use of technology in cooperation with the EASA SPN. 26

OA08: Aircraft upset in flight (loss of control) Actions Description Aircraft upset or loss of control is the most common accident outcome for fatal accidents in General Aviation airplanes operations. This topic addresses subjects such as flying skills, pilots awareness and the management of the upset or stall at take-off, in flight, or during approach and landing, flight preparation, aborting take-off and going around. Staying in control prevents loss of control accidents. Loss of control usually occurs because the airplane enters a flight regime outside its normal envelope, thereby introducing an element of surprise for the flight crew involved. The BCAA, in close collaboration with the ATO s and flight examiners, shall take a coordinating role in developing a safety information leaflet for the safe execution of simulated engine failure exercises because of some aviation accidents in the past. This leaflet shall contain general practices and pilot procedures on the prevention of piston engine icing in accordance with EGAST Safety Promotion Leaflet GA5. This leaflet shall also advise against the performance of such exercises as solo student pilot away from an aerodrome and without the presence of a flight instructor. Objectives mitigate the risk of loss of control Safety Performance Indicator Action Number Action title & objective Owner OA08.01 Contribute to the EASA SPN campaign on staying in control Alignment EPAS Date BCAA EASA SPN - End 2018 To contribute to the EASA campaign on staying in control by systematically informing general aviation pilots on the availability of new safety promotion materials on the EASA website covering topics such as aircraft performance, flight preparation and management, role of the angle of attack, upset and stall avoidance and recovery, and startle and surprise management. OA08.02 Publication of an ASIL on the safe execution of simulated engine failure exercises BCAA/LIC - End 2018 The BCAA, in close collaboration with all Belgian ATO s and flight examiners, shall take a coordinating role in developing guidelines for the safe execution of simulated engine failure exercises. These guidelines shall highlight the correct use of carburetor heat for the prevention of piston engine icing and advise against the performance of such exercises as solo student pilot away from an aerodrome without the presence of a flight instructor to share important knowledge and experiences and to reduce the likelihood of simulated emergencies becoming real emergencies. Not applicable 27

Emerging Actions (EA) This chapter addresses already emerging issues as well as issues that could potentially emerge in the immediate or near future. Considering safety issues derived from operations or regulations that have not been fully deployed, it incorporates a forward-looking element in BPAS. EA01: Unmanned Aircraft Systems Description The popularity and application of Unmanned Aircraft Systems (UAS) more commonly known as drones - continues to grow. The use of UAS represent an emerging risk to both commercial and general aviation. The BCAA therefore needs to provide clear guidance on the applicable regulations and best practice when using UAS either for leisure or aerial work. The lack of harmonised rules at EU level makes UAS operations dependant on an individual authorisation by every Member State, which is a burdensome administrative process. To remove restrictions on UAS operations at EU level, so that all companies can make best use of the UAS technologies to create jobs and growth while maintaining a high and uniform level of safety, EASA is engaged in developing in the relevant regulatory material. The BCAA is strongly involved in the review of EASA proposals related to future UAS regulations. The BCAA published a Royal Decree regulating the use of UAS in Belgian airspace for professional purposes (aerial work and air transport) and developed an Aviation Safety Information Leaflet (ASIL) to inform on the existing national regulation, highlight the associated risks related to professional drone flying and to provide guidance on the preparation of such flights. The national regulation sets out the rules of the air, the rules for registration of UAS, the conditions for theoretical and practical training of remote pilots and the issuing of the remote pilot license after successful examination and the acceptance of UAS operations in Belgian airspace, based on an operation-oriented and risk based approach. The BCAA is aware of the need to continuously advise the public of the hazards involved in flying these UAS. Therefore, the BCAA launched a campaign in 2017 to encourage recreational users for flying their drones in a safe manner. A video, posters, banners and flyers were developed, communicated and published. The ANSP service provider and the BCAA shall soon make use of a web application to keep track of the drone traffic, to manage the Belgian airspace and flight approvals and to communicate directly with drone pilots in the field. Drone Pilots shall also be able to directly plan their operations through an interactive map. 28

Objectives Actions Fewer accidents, serious incidents or occurrences because of conflict between an UAS and another aircraft in Belgian airspace Action Number Action title & objective Owner Alignment EPAS Date Safety Performance Indicator EA01.01 Apply a web application to keep track of the drone traffic Belgocontrol BCAA - End 2018 Number of reported UAS occurrences 2013 2014 2015 2016 To make use of a web application to keep track of the drone traffic, to manage the Belgian airspace and flight approvals and to communicate directly with drone pilots in the field. Drone pilots shall also be able to directly plan their operations through an interactive map. 1 1 11 24 EA01.02 Participate in the development of an appropriate EU regulatory framework to govern the operation of UAS BCAA - Continuous To govern the operation of UAS to remove restrictions on this kind of operations at EU level, so that all companies can make best use of these technologies to create jobs and growth while maintaining a high and uniform level of safety. EA01.03 Launch a new campaign to promote safe operations of drones to the public in cooperation with the EASA SPN BCAA - End 2018 To continuously advise the public of the hazards involved in flying UAS. EA01.04 Further improve the collaboration with the ANSP, the Federal Police and the BCAA for handling violations with UAS BCAA/SAF - MID 2018 To improve the cooperation between the ANSP, the Federal Police, the Brussels Airport Company and the BCAA to develop, review and assess the procedures to follow in the case of violations with UAS. 29

EA02: New business models Actions Description Due to the increased complexity of the aviation industry, the number of interfaces between organisations, their contracted services and regulators has increased. EASA should evaluate whether the existing safety regulatory system adequately addresses current and future safety risks arising from new and emerging business models. Upon the request of Member States, EASA tasked a working group of Member States to assess airlines emerging new business models and to identify related safety risks posed to the aviation system. This is a strategic priority for EASA. Action Number Action title & objective Owner EA02.01 Better understanding of operators governance structure Alignment EPAS Date BCAA/OPS MST.019 MID 2018 The BCAA should have a thorough understanding of the operators governance structure, the influence of financial stakeholders and the controlling management personnel, where such personnel are located outside the scope of approval. Objectives Continuously assess and mitigate risks posed by the introduction of new business models. EA02.02 Benchmark on the operator s safety culture BCAA MST.023 End 2017 Safety Performance Indicator Number of occurrences reported by operators in proportion to the number of flight hours The BCAA shall provide occurrence reporting data to EASA to benchmark operator s safety culture. The survey shall include raw data on occurrence reports from individual operators to obtain consistency in the type of occurrences analysed. The BCAA shall use the results of their oversight on occurrence reporting as a performance indicator of the safety culture within an operator. 30

Appendix A: Acronyms and definitions Acronyms BASP BAWiHaC BPAS BCAA BCAA AAS BCAA OPS BCAA SAF BCAA S-MAS Belgian Aviation Safety Program Belgian Aviation Wildlife Hazard Committee Belgian Plan for Aviation Safety Belgian Civil Aviation Authority BCAA Airspace, Airports and Supervision Directorate BCAA Operations Directorate BCAA Aviation Safety Inspectorate BCAA Management System Unit AAIU(Be) Air Accident Investigation Unit (Belgium) BSA-ANS Belgian Supervising Authority for Air Navigation Services ANS air navigation service BAWiHaC Belgian Aviation Wildlife Hazard Committee ANSP air navigation service provider CAT commercial air transport ASD Aviation Safety Department of the Ministry of Defence CFIT controlled flight into terrain ASIL Aviation Safety Information Leaflet EA emerging action ASR ATC ATM Annual Safety Review air traffic control air traffic management EAFDM EAPPRI European Authorities Coordination Group on Flight Data Monitoring European Action Plan for the Prevention of Runway Incursions AW aerial work BASMG Belgian Aviation Safety Management Group 31

EASA European Aviation Safety Agency NoA network of analysts EASP European Aviation Safety Program OA operational action EC ECCAIRS EPAS ESSI FDM GA GASP ICAO JARUS JC LOC-I LRST MA MAC MST European Commission European Coordination Centre for Aviation Incident Reporting Systems European Plan for Aviation Safety European Strategic Safety Initiative flight data monitoring general aviation Global Aviation Safety Plan International Civil Aviation Organization Joint Authorities for Rulemaking of Unmanned Systems Just Culture loss of control in flight local runway safety team moving average mid-air collision member state RAMP region of aircraft movement and parking RE runway excursion RI runway incursion SA systemic action SARPs Standards and Recommended Practices SMICG Safety Management International Collaboration Group SMS safety management system SPI safety performance indicator SPN Safety Promotion Network SPOC single point of contact SSP State Safety Program UAS unmanned aircraft systems 32