Snook and Civil Aviation Safety Authority [2010] AATA 582 | Case summary

Snook and Civil Aviation Safety Authority [2010] AATA 582 | Case summary | Zoe

[19]

On 25 June 2008 Mr Snook lodged an application seeking review of CASA's decision by the Tribunal. Therefore, in accordance with s 31A of the Civil Aviation Act 1988 (the Act), the operation of CASA's decision was automatically stayed for a period of five business days after the day CASA notified Mr Snook of the decision. Upon making an application to the Tribunal for review, pursuant to s 31A(5) of the Act, the automatic stay continued in effect until the end of the 90th day after CASA notified Mr Snook of its decision. The statutory stay of CASA's decision ceased to have effect on 22 September 2008.
On 12 September 2008 Mr Snook lodged an application with the Tribunal pursuant to s 41(2) of the Administrative Appeals Tribunal Act 1975 (the AAT Act). He sought an order that the Tribunal stay the operation and implementation of CASA's decision until the final hearing and determination of his application to the Tribunal. On 25 September 2008 the Tribunal granted the stay order sought by Mr Snook, which was to remain effective until 12 December 2008. The stay order was limited to this date because on 4 September 2008 CASA issued a second show cause notice to Mr Snook, requiring him to show why his private pilot licence, AME licence and the CoA should not be varied, suspended or cancelled.
The second show cause notice arose out of a number of matters which came to the attention of CASA after it decided to suspend Mr Snook's private pilot licence, AME licence and his CoA on 24 June 2008. However, at the time of hearing Mr Snook's stay application, he had not yet responded to the 4 September 2008 show cause notice. The Tribunal anticipated he would do so and that CASA would make a decision by 12 December 2008.
On 27 November 2008 CASA decided to cancel Mr Snook's AME licence and CoA. On 1 December 2008 Mr Snook lodged with the Tribunal an application for review of that decision. Because of the effect of s 31A(5) of the Act, CASA's decision of 27 November 2008 was stayed until 26 February 2009.
When this matter came back before the Tribunal on 12 December 2008, Mr Snook urged the Tribunal to extend the stay. The Tribunal granted this extension to 26 February 2009, so that it expired on the same date as the statutory stay under the second show cause decision. CASA urged the Tribunal not to extend the stay made on 25 September 2008 and submitted that it should consider, on the material before it at that time, whether it would agree to further stay the 27 November 2008 CASA decision taking effect after the statutory stay period had expired. Because the applicant objected to that course being taken, the Tribunal decided to extend the stay granted on 25 September 2008 to 26 February 2009.
After hearing submissions from both parties on 25 February 2009, the Tribunal ordered, on 26 February 2009, that the stay in matter number 2008/2804 be extended until its conclusion. It also ordered that the statutory stay which was then in effect in matter number 2008/5682 be extended until the conclusion of that matter. The Tribunal did so on the conditions that: (a) Mr Snook provide to CASA's regional manager in Perth, on a weekly basis, a schedule of planned maintenance; and (b) that he permit CASA's officers to attend the premises of Aeronautique on reasonable notice to inspect maintenance conducted by Mr Snook and any relevant maintenance records. At that time, the Tribunal anticipated the final hearing of both matters would take place in March 2009. However, for various reasons, it was not possible to commence the hearing in both applications until 9 February 2010.
The first matter, number 2804, relates to the operation and maintenance of an SUD Aviation aircraft model GY 80-150, which is registered as VH-YOG (aircraft YOG). Matter number 5682 involves maintenance activity conducted by Mr Snook under his CoA and his involvement in the maintenance of an aircraft for another AOC holder, Airfast Pty Ltd (Airfast).
In respect of matter number 2804, we are required to determine:

[30]

Mr Dennis Coxall, the pilot of aircraft YOG, provided a statement which was admitted into evidence. He said that on 15 January 2008, shortly after takeoff from Bunbury, he smelt and saw smoke in the cockpit. He thought it smelt like an electrical fault and therefore he turned off all of the electrics, but the smoke persisted. He then turned back towards clear ground in case he needed to perform a forced landing. The smoke continued to develop in the cockpit and he reduced the throttle to idle, then subsequently turned the engine off completely. When he turned the engine off, the smoke stopped. He continued to glide towards clear ground descending at about 500 feet per minute. At about 500 feet above ground level, he restarted the motor to climb back to a safe altitude but the smoke reappeared in the cockpit. He climbed to about 1500 feet and turned the engine off again. He continued this process of gliding with the engine turned off, restarting the engine and climbing back to altitude before gliding again.
When he was within landing distance of a paddock which he thought was suitable for a forced landing, he put the aircraft down. After landing, he could not find any fault with the aircraft but decided to leave the aircraft in the paddock and continued his journey to Kalgoorlie by road. He telephoned a friend, Mr Blair Howe, and asked him to assist in organising a means of getting the aircraft out of the paddock while he was away in Kalgoorlie.
On the following day, 16 January 2008, Mr Coxall received a telephone call (presumably from Mr Howe) to say that Mr Snook (who had come down from Perth) had found that the problem was a missing tailpipe. Mr Snook had considered the aircraft safe to fly and he flew the aircraft the short distance back to Bunbury airport. In his written statement, Mr Coxall did not say that he spoke directly with Mr Snook at any time between 15 and 16 January 2008.
Mr Coxall's account of the incident was in accordance with the evidence of Mr Hadyn Siggins, a flying operations inspector in the Western Region office of CASA. According to Mr Siggins' statement dated 17 August 2009, on 17 January 2008 he received a telephone call from Mr Coxall who recounted essentially what was set out in his statement. Mr Siggins provided some additional evidence. Attached to Mr Siggins' statement was a file note, which he said he recorded on 17 January 2008 from handwritten notes made in the course of his conversation with Mr Coxall. The file note states:

[42]

Mr Green also asked Mr Coxall if he had endorsed the maintenance release with the details of the defect. Mr Coxall said he had not. Mr Green subsequently received a telephone call from Mr Coxall on 29 January 2008. Mr Coxall told him he had returned from his work commitments in Kalgoorlie and that he had the aircraft maintenance release with him. Mr Coxall said he had just made an entry regarding the smoke in the cockpit incident and the forced landing at Brunswick Junction, which is about 10 nautical miles from Bunbury.
On 30 January 2008 Mr Green attended Aeronautique's hanger at Jandakot airport and had a discussion with Mr Snook. Mr Snook handed to him the front right side floor carpet, which Mr Green described as burnt right through. Mr Snook also gave Mr Green the muffler, aircraft logbooks, the illustrated parts catalogue and two maintenance manuals for the aircraft. Mr Green took photographs of the aircraft parts and those were in evidence.
On 1 February 2008 Mr Green went to Bunbury airport to inspect the aircraft and he met Mr Coxall. He took some further photographs of the aircraft (which are also in evidence) and he examined how the muffler fitted into the exhaust system of that aircraft. The illustrated parts catalogue discloses that a tailpipe should be attached to the rear of the muffler. The tailpipe is angled at about 45 degrees from the point where the pipe exits the muffler, so as to direct exhaust gases away from the cockpit firewall into the slipstream beneath the aircraft.
The photographs taken by Mr Green showed the replaced muffler inserted into the exhaust pipes from the engine. Across the centre of the muffler appeared to be a bracket system, which was attached to what appeared to be a rubber strap, connected above the muffler vertically to either the airframe or some other part of the aircraft. The rear of the muffler was close to the firewall on the co-pilot's side (RHS) of the cockpit. The firewall slopes downwards at an angle of about 45 degrees from the horizontal in a rearwards direction. The rear of the muffler was close to the firewall, with the exit pipe being no more than 10 to 12 centimetres from the firewall. The muffler itself is not horizontal, as it slopes slightly downwards, which results in the rear end of the muffler being at a slight angle to the horizontal, although not significantly so. It is immediately apparent that the missing tailpipe is designed to attach to the rear of the muffler and then project downwards at about the same angle as the firewall, thereby directing hot exhaust gases away from it and underneath the aircraft into the slipstream.
The photographs taken by Mr Green also show the very clear effect that the exhaust gases, impacting on the cockpit firewall, had on the carpet and insulating material inside the cockpit. The carpet was extensively damaged and in fact had a large hole in the centre of it, where the rubberised backing and carpet material had completely disappeared. The photographs also reveal the effect of extreme heat on the external firewall in the engine compartment. The metal surface was seriously scorched, indicating the application of intense heat.
On examining the aircraft maintenance records, Mr Green became aware that Mr Snook had reinstalled the exhaust assembly on the aircraft at the periodic inspection before the aircraft was returned to service on 19 December 2007. Further enquiries also revealed that the muffler had cracks welded at the point at which the tailpipe attached to the muffler. The nature of the cracks was consistent with vibration, as small cracks had emanated from the major break. Mr Green obtained this information from Mr Gavin Trotter, who performed the welding. Mr Green also found that the tailpipe itself was not supported in any way apart from being welded to the rear of the muffler.
CASA's investigations of this incident revealed two major concerns. The first related to Mr Snook exercising the privileges of his private pilot licence to fly the aircraft from the paddock at Brunswick Junction to Bunbury to enable repairs to be undertaken. The second was directed to the maintenance conducted by Mr Snook 3.2 hours before the tailpipe failure.

[44]

Mr Snook testified that on 15 January 2008 he received a message that aircraft YOG had landed in a paddock after the pilot reported smoke in the cockpit, which he believed was caused by an electrical fault. Mr Snook was asked if he could go to where the aircraft had landed and rectify the problem. In his witness statement dated 12 November 2009, Mr Snook said that on inspecting the aircraft, he determined that the muffler had failed in exactly the same place it had previously failed and been subsequently repaired. He said he conducted a very thorough inspection of the aircraft and could find no fault with the electrical system.
Because he had no contact with Mr Coxall before inspecting the aircraft, Mr Snook said that an electrical fault might have been the problem and that was on his mind rather than the exhaust system. Nevertheless, he said he gave the aircraft an extremely thorough inspection, particularly the engine compartment. Mr Snook disconnected the battery when he was examining the aircraft and so he reconnected it and switched the master switch on. He waited to see if there was any smoke or if any circuit breakers popped. He said that all was normal. He then did an engine run including what he described as a full power run for about three to five minutes and, to his amazement, there was no sign of any problems at all. He was aware that the tailpipe was missing. He said that he was asked only to inspect the aircraft and not to fly it to Bunbury.
After conducting a ground test of the aircraft, Mr Snook telephoned Mr Bob Mann at Bunbury airfield and told him that in his opinion, it was possible to fly the aircraft out of the paddock to Bunbury. According to Mr Snook's evidence, he suggested to Mr Mann that the chief flying instructor from the Bunbury Flying Club could come and fly the aircraft back to Bunbury. However, he was told that the chief flying instructor was not available and Mr Mann suggested that he fly the aircraft. Mr Snook's evidence was:

[46]

Having decided to fly the aircraft to Bunbury, Mr Snook said he went back to the aircraft, started the engine and gave it a good run. He said he taxied up to a fence, which was hedged by some large trees, and then gave the engine a full power run while standing on the brakes. According to Mr Snook, he held it for at least a couple of minutes before releasing the brakes and conducting a short-field takeoff. Mr Snook said there was no problem with the aircraft in the course of his full power run. He said the aircraft became airborne very quickly and at about 100 feet altitude, he started a gentle turn to the left.
At the commencement of the turn, he said that he experienced a significant amount of foul air and smoke in the cockpit. Mr Snook said his first reaction was to land the aircraft straight ahead but there were some obstacles which prevented him from doing so. He said he then opened a small storm window to make sure he could continue breathing. He continued the climb and when he reached sufficient altitude, he started to reduce power and noticed that the smoke also began to reduce.
In his written statement, Mr Snook said that the smoke largely dissipated when he opened the small storm window and, rather than land the aircraft back in the paddock, he considered the safest decision was to continue the short flight to Bunbury rather than to complete a circuit and land in the paddock. However, in his evidence-in-chief, he significantly altered his account at this point.
In his evidence-in-chief, he said that when the smoke began to reduce, he nevertheless completed a circuit including a downwind leg and, when lined up on finals, thought that the trees on the approach path were very high and he became aware that the paddock was short. He said he then reassessed the conditions, including the amount of smoke in the cockpit and he decided to continue a gentle climb over the field and completed several circuits of it. He said he remained overhead the field, flying quite slowly with reduced power and believed he was more in control of the situation as there was little smoke from then onwards. He said that he opened the co-pilot's side door and all the remaining smoke disappeared out of the door. He then decided that: I was now like flying a plane without any problem - any issues, and concerned about landing in the paddock from which he had taken off, he elected to continue the flight to Bunbury.
In his evidence-in-chief, Mr Snook said that after landing at Bunbury, he remained unaware of the origin of the smoke in the cockpit. He said he looked in the engine compartment again and saw no signs of anything amiss. On going back to the cockpit, he noticed that the carpet against the co-pilot's side firewall was damaged. It was only then that it dawned on him that it was the cause of the smoke. He then said:

[48]

Mr Snook was highly critical of the fact that glued to the underside of the carpet was a foam insulating material which he described as unauthorised. It is not clear what Mr Snook meant by that expression. Under cross-examination, Mr Snook made it clear he thought that the unauthorised material was the cause of the problem. He believed that CASA was now blaming him for somebody else's mistake. When it was put to Mr Snook that he made no mention of the foam material in the defect report he finally submitted on or about 29 January 2008, Mr Snook said he could not remember but thought he would have. When the contents of that report were shown to him, Mr Snook simply said he should have put it in. When the question was put to him again in cross-examination, he said that in any event, he considered it to be incorrect maintenance and not a defect.
Mr Siggins, in a site inspection surveillance report dated 17 January 2008, recorded what Mr Coxall told him about his forced landing in YOG. Mr Siggins recorded that Mr Coxall told him that he shut down the electrics but it had no effect on the smoke he was experiencing in the cockpit. He also noted that Mr Coxall told him that the carpet on the right hand side floor appeared to be burning. After Mr Coxall shut down the engine, the fire/smoke stopped. He also recorded that Mr Snook came and inspected the aircraft and flew it back to Bunbury. His report stated it appeared from initial reports, that the exhaust was faulty and had directed hot air at the underside of the aircraft causing the carpet/structure to burn/smoke.
In his evidence-in-chief, Mr Snook said that where the rear of the muffler pointed towards the firewall, it was angled at about 45 degrees, being a similar angle to that of the firewall itself. That statement is not correct. If that were the case, exhaust gases exiting the muffler would not impact on the firewall at all. Not only was there clear evidence of severe scorching of the firewall, but the photographs in evidence clearly indicate that the muffler is angled at only about five to 10 degrees below the horizontal at the point where it is about 10 to 12 centimetres from the firewall. If we were to accept that the angle was 10 degrees, then the angle at which the exhaust gases exiting the muffler would impact the firewall is about 35 degrees. It is nothing like that suggested by Mr Snook in his evidence. In other words, there was a direct blast from exhaust gases against the firewall of the aircraft.
In his written statement, Mr Snook said he had intended to record the defective muffler and the total time of the flight in the maintenance release. However, Mr Coxall had taken the maintenance release with him to Kalgoorlie. As a result, Mr Snook did not have access to it when he arrived to inspect the aircraft and decided to fly it to Bunbury.
CASA submitted that in flying the aircraft from the paddock near Brunswick Junction to Bunbury, Mr Snook failed in his duty as a pilot with respect to a matter affecting the safe navigation or operation of an aircraft. That was because:

[53]

In its statement of facts and contentions, CASA alleged that Mr Snook had contravened s 20AA(4) and s 20A of the Act; and CAR 50 and 133(1)(d). However, these contraventions did not become part of CASA's final submissions. Although not expressly stated, we understood that to be because CASA could not rely on CAR 269(1)(a) for the decision to cancel Mr Snook's private pilot licence.
Although CAR 269(1)(a) can form the basis for a suspension decision, without conviction by a court of an offence against a provision of the Act or the CARs, CASA cannot cancel a licence. Nevertheless, those breaches did form one of the grounds upon which CASA made the first decision in matter number 2804 to suspend Mr Snook's private pilot licence.
As we understood Ms Macdonnell of counsel, who appeared on behalf of CASA, CASA now considers that its decision to suspend Mr Snook's private pilot licence was incorrect and instead, the Tribunal should decide to cancel that licence. It seems to us that if we arrive at a decision favourable to Mr Snook on the cancellation decision, we should return to the suspension decision in order to determine whether that was the preferable decision.
Mr Snook's decision to fly aircraft YOG from the paddock near Brunswick Junction to Bunbury does cause us grave concern about his suitability to hold a private pilot licence.
Mr Snook initially went to Bunbury and then to Brunswick Junction to examine the aircraft and to identify, and possibly repair, a defect reported by Mr Coxall. The very fact that Mr Coxall made a forced landing in a paddock some 10 miles from Bunbury after reporting smoke in the cockpit is ample evidence that the aircraft was suffering from a serious defect. If that were not the case, there is no apparent reason why Mr Coxall would not have returned to Bunbury. According to Mr Snook, he thoroughly examined the aircraft but could not identify the cause of the smoke Mr Coxall said he experienced. This examination was carried out in Mr Snook's capacity as a LAME. At this point in time, as we understood Mr Snook's evidence, he had not made a decision to fly YOG to Bunbury. Mr Snook said that in the course of his inspection, he did observe the tailpipe was missing from the rear of the muffler.
Furthermore, in his evidence-in-chief, Mr Snook said he inspected the firewall and noticed it was damaged (presumably by heat). We have no doubt that the scorching on the firewall would have been evident to Mr Snook upon his examination, given the fact that Mr Coxall reported smoke in the cockpit. To produce that outcome, significant heat must necessarily have been applied to the firewall. In fact, Mr Green's evidence was that the peak exhaust gas temperature for an engine of the type fitted to aircraft YOG was in the region of 1,450 degrees Fahrenheit. This evidence was undisputed. As an engineer, we believe Mr Snook was either aware of that or, if not, he most certainly should have been.
Having observed that the tailpipe was missing; that very hot exhaust gases had scorched the firewall; and that Mr Coxall decided to make an emergency landing in a paddock as a result of smoke in the cockpit, it is inconceivable to us that a competent LAME would not have connected the reported smoke with the extensive signs of extreme heat applied to the firewall.
In our view, it would have been obvious to a LAME and a pilot that the cause of the severe scorching on the firewall was due to the missing tailpipe. Its very purpose was to direct hot exhaust gases away from the firewall. Without any further information, it is our view that a competent licensed private pilot, conducting a daily inspection, would not have even considered flying the aircraft in that condition. Schedule 5 of the CAR requires that the exhaust system be checked to ensure that it is secure and free from cracks. In our opinion, if part of the exhaust system is missing, the aircraft most certainly has a defect; which of course should be entered on the maintenance release.
Had the defect been entered on the maintenance release and that document inspected by a pilot intending to fly that aircraft, it would have been immediately apparent that unless the defect had been rectified and certified as having been correctly rectified, the aircraft was not airworthy. That is because, as is set out in CAR 47, a maintenance release ceases to be in force where a flight crew member or a person engaged in the maintenance of an aircraft in respect of which a maintenance release is in force, becomes aware that the aircraft has suffered major damage or has developed major defect, other than damage or a defect that is a permissible unserviceability.
The expressions major damage and major defect are defined in the CAR as damage or a defect of such a kind that it may affect the safety of the aircraft or cause the aircraft to become a danger to persons or property. Particular attention should be directed to the word may. In the context in which it is used, it expresses a subjective possibility (see The Shorter Oxford English Dictionary).
We have no doubt that Mr Snook was aware or should have been aware that the defect should have been entered on the maintenance release and that the aircraft could not be flown until the defect was rectified. When the issue of the maintenance release was put to Mr Snook in cross-examination, his response was that he did not think that the maintenance release was involved. We found this response deeply disturbing. When asked to explain the circumstances in which a maintenance release ceased to be in effect, Mr Snook was unable to answer. His attention was directed to CAR 47(1) and he asked that it be read to him. After it was, he said that he didn't think that it applied. CAR 47(1) provides:

[58]

We also found Mr Snook's explanation regarding the material glued to the underside of the carpet being the cause of the problem to be a transparent attempt to justify his decision to fly the aircraft out of the paddock. In Mr Presneill's file note of 11 February 2008, made after speaking with Mr Snook, Mr Snook admitted that he knew the tailpipe was missing. He said that based on his 40 years of aviation engineering experience, a proper firewall would not be affected because of the available gap and the airflow that he expected to be passing in this area. Again, that explanation defies logic.
High velocity exhaust gases at a temperature of about 1,450 Fahrenheit blasting directly onto a metal surface from a distance of 10 - 12 cms must cause substantial heating of that surface. That was apparent even when Mr Snook first inspected the aircraft in the paddock. The firewall was discoloured, indicating that it had been significantly heated. For an engineer to suggest that the airflow resulting from the aircraft's forward motion would cool that metal surface which was being impacted by high velocity, extremely high temperature exhaust gases, is fanciful to say the least. It is, in our opinion, unbelievable that Mr Snook was not alerted to the fact that the extreme heat applied to the metal surface might affect any material which was in contact with that metal surface on its other side.
Although Mr Snook said he did not see any evidence of damage to the carpet on the co-pilot's side, he also said that he did not attempt to lift the carpet to look at its underside. That would have been a simple task because it was fixed to the metal surface by Velcro. Whether he did so or not, we find that Mr Snook's decision to fly the aircraft out of the paddock to Bunbury for repair was either the result of dangerously flawed logic or an exaggerated sense of being able to cope. Although Mr Snook downplayed the seriousness of his situation in the course of his oral evidence before the Tribunal, that was clearly not his view shortly after the incident when he told Mr Presneill that he believed his life was in jeopardy. In our view, that statement was clearly correct. Not only was Mr Snook's life in jeopardy, but if he had been incapacitated and the aircraft had struck the ground in an uncontrolled manner, it certainly posed a risk to other persons and property.
CASA also submitted that once Mr Snook experienced smoke in the cockpit shortly after takeoff from the paddock, he should have made an emergency landing in a suitable area rather than continue the flight to Bunbury. While that may be a valid criticism, in our view matters should never have reached that point. Mr Snook should never have attempted to fly the aircraft out of the paddock. He was fortunate that having taken off from the paddock, he was able to continue the flight without becoming incapacitated.
In his evidence-in-chief, Mr Snook said that with the benefit of hindsight, he should have contacted CASA and obtained a special flight permit. In his written statement of evidence, Mr Snook said that he was sure that if he had contacted CASA for a special flight permit, it would have been granted. This recognition by Mr Snook, with the benefit of hindsight, does not assist his case. There are two reasons for that.
The first is that in coming to that conclusion after the event, Mr Snook has simply acknowledged that the flight should never have taken place in the first place. The second is that Mr Green, who is airworthiness inspector, said in his written statement of evidence that he was confident that an application for a permissible unserviceability or special flight permit would not have been approved for a flight to Bunbury for repairs. This was because the reported cause of the smoke in the cockpit had not been identified and because Mr Snook had identified that the aircraft's tailpipe was missing. According to Mr Green, this meant the aircraft was subject to two defects with significant implications for its safe operation.
Mr Siggins, in his written statement made on 17 August 2009, explained that a CASA airworthiness inspector would sometimes confer with a flying operations inspector about the authorisation or permit which may be issued under regulation 21.197(1) of the Civil Aviation Safety Regulations 1998 (CASR). Mr Siggins was of the view that no airworthiness inspector would have issued a special authorisation or permit, or even considered it necessary to confer with a flying operations inspector before coming to that decision. Mr Siggins said that if the application had come before him, he would have opposed the issue of such authorisation or permit. In our opinion, the views expressed by Mr Green and Mr Siggins are correct. If Mr Snook had made an application under CAR 135A(1) for special flight authorisation or a special flight permit under CASR 21.197(1), we have no doubt it would have been refused. That is because the cause of the smoke in the cockpit which necessitated a forced landing had not been established.
The final issue regarding this flight is the fact that Mr Snook failed to lodge with CASA a major defect report after landing at Bunbury airport. In his 21 July 2009 statement of evidence, Mr Green said that Mr Snook was required, by CAR 51 and 51A, to report the missing tailpipe to CASA as a major defect. Apparently Mr Snook did not do so until 30 January 2008, and only after Mr Green had reminded him of his obligations regarding that report.
The CARs impose obligations on aircraft maintenance engineers and other persons connected with the operation of Australian aircraft to report a major defect to CASA immediately the defect becomes apparent. As far as Mr Snook's private pilot licence is concerned, CAR 51A(2) applies. It provides that if a person connected with the operation of an Australian aircraft discovers a defect in an aircraft, being a defect of a kind to which the CAR applies, that person must report the defect to CASA immediately. CAR 51A(1) makes it clear that the regulation applies to major defects which, relevantly, have caused or that could cause a fire in an aircraft. The expression major defect is defined in CAR 2 in the following way:

[65]

The photographs in evidence disclose that not only had any foam or backing material completely disappeared, but the central part of the entire carpet had disappeared. In other words, where there should have been ordinary carpet material, there was simply a gaping hole.
Mr William Cain, a LAME, gave evidence on behalf of Mr Snook, purportedly as an expert. Ms Macdonnell objected to Mr Cain giving opinion evidence because she did not consider he was expert. We nevertheless accepted his statements into evidence on the basis that he had significant experience as a LAME.
In his written evidence, Mr Cain said that in his view, the separation of the tailpipe from the exhaust system did not constitute a major defect within the meaning of CAR 51A. He testified that it was unreasonable to believe that the muffler would have caused a fire in the aircraft. When it was put to Mr Cain in cross-examination that the smouldering carpet was in fact a fire, Mr Cain rejected that proposition and said that the carpet had only melted. There was no fire. Mr Cain was asked what he would have done had he seen the heat blast effects on the firewall on the engine compartment side. He said he would have conducted further inspections on both sides of the firewall.
Mr Cain attempted to distinguish between a substance melting and a substance burning. In his opinion, there was no fire unless one could see flames. Mr Cain admitted he was no expert in combustion. That, in our opinion, was apparent. The ordinary meaning of the word melt is to become liquefied by heat (The Shorter Oxford English Dictionary). When used as a transitive verb it means to reduce to a liquid condition by heat or to form a molten material. Therefore, if the material in question on the floor on the co-pilot's side of the aircraft melted, one would have expected to see some remains in the way of molten material. However, much of the material was totally absent. The word fire is defined in The Shorter Oxford English Dictionary as: to set on fire, so as to destroy; to ignite, kindle. Chamber's 21st Century Dictionary defines fire as:

[71]

There may be some doubt about the Tribunal's power to vary CASA's decision to suspend Mr Snook's private pilot licence given that the show cause notice issued to him indicated that CASA was seeking the suspension of his licence rather than its cancellation. Nevertheless, we are satisfied that the Tribunal may vary the decision to suspend Mr Snook's private pilot licence despite the fact that the show cause notice did not indicate CASA's intention to cancel it. That is because CAR 269(3) provides that before taking an action under CAR 269, CASA must give notice to the holder of the licence or certificate or authority of the facts and circumstances that, in the opinion of CASA, warrant consideration being given to the variation, suspension or cancellation of the licence, certificate or authority.
The facts and circumstances giving rise to CASA's initial decision were set out fully in the show cause notice issued to Mr Snook. They have not altered, even though CASA now is of the view that the decision should be varied so that the licence is cancelled. Furthermore, as CASA pointed out in its final submissions, it placed Mr Snook on notice in its statement of facts and contentions that it would be seeking cancellation of his private pilot licence. Although CASA did not expressly state that it would be seeking cancellation of his private pilot licence, as we understood the final submissions, that followed from the fact that CASA considered Mr Snook not to be a fit and proper person to hold a private pilot licence. This is despite the fact that in its notice of decision dated 24 June 2008, CASA, relying on the fit and proper ground (CAR 269(1)(d)), decided to suspend his private pilot licence rather than cancel it.
The facts and circumstances giving rise to CASA's decision to now seek cancellation of his private pilot licence are precisely the same as those which initially led to CASA's decision to suspend Mr Snook's private pilot licence. Therefore, it is our view that if we find the circumstances are such as to warrant cancellation rather than suspension of Mr Snook's private pilot licence, he has been given adequate opportunity to address the claims made by CASA in respect of the facts and circumstances giving rise to the decision which CASA now asks the Tribunal make.
We are required to determine whether the preferable decision in respect of Mr Snook's private pilot licence is that it be suspended or cancelled. We will first examine whether it should be cancelled. This is because if we find that his licence should be cancelled, we need not proceed with an examination of whether a suspension is appropriate. If we arrive at the conclusion that his licence should not be cancelled, then we would need to further consider CAR 269(1)(a), which includes determining whether Mr Snook has contravened a provision of the Act or the CAR. Due to the restrictions placed on cancellation of a licence by CAR 269(1A), we cannot rely on CAR 269(1)(a) for the purpose of considering cancellation of his licence. However, those restrictions do not apply to a suspension.
We do not think that Mr Snook's conduct in relation to the flight of aircraft YOG enlivens any of the provisions set out in CAR 269(1)(b). There was nothing in the evidentiary material indicating he failed to satisfy or continued to satisfy any requirement prescribed by, or specified under, the CARs in relation to the obtaining or holding of a private pilot licence. However, his conduct certainly enlivens the provisions set out in CAR 269(1)(c) and (d).
As far as CAR 269(1)(c) is concerned, we find that Mr Snook has failed in his duty with respect to a number of matters affecting the safe navigation or operation of an aircraft.
As a pilot conducting a daily inspection prior to flight, Mr Snook was required to check that the exhaust system was secure and free from cracks, as is set out in Section 1 of Part 1 of Schedule 5 of the CAR. It is not an adequate response to state that the tailpipe was missing but otherwise the exhaust system was secure and free from cracks. Clearly, the exhaust system was not secure and cracking had occurred to such a degree that the tailpipe had fallen off. Although we accept Mr Snook identified this problem when conducting the daily inspection, his subsequent actions constituted a breach of his duty.
Having observed the tailpipe was missing; that the muffler was now directing extremely high temperature, high velocity exhaust gasses onto a metal firewall some 10 to 12 centimetres from the end of the muffler; and having observed the severe discolouration caused by heating of the firewall coupled with the explanation given by Mr Coxall (experiencing smoke in the cockpit) for conducting a forced landing, Mr Snook's clear duty was to enter that defect in the maintenance release. Although Mr Coxall had removed the maintenance release and taken it with him to Kalgoorlie, Mr Snook's duty was to contact Mr Coxall to ensure that an entry was made in the maintenance release specifying the defect.
The fact that Mr Coxall made an emergency landing should have been sufficient indication to Mr Snook that until the cause of smoke in the cockpit had been positively identified, the aircraft was simply not airworthy. CAR 50(1)(c) makes it abundantly clear that CAR 50 applies to a flight crew member of an Australian aircraft. CAR 50(2) provides:

[73]

In our opinion, the aircraft had suffered major damage because an essential part of its exhaust system had separated from the aircraft. Mr Snook was aware that extremely hot exhaust gasses at high velocity were impacting on the metal firewall some 10 to 12 centimetres behind the muffler. He was aware of discolouration to the firewall due to excessive heating. Furthermore, the aircraft had made an emergency landing due to what was described as smoke in the cockpit. With all due respect to Mr Snook, it did not require the benefit of hindsight to determine that the aircraft had suffered a defect which caused the tailpipe to fall off and, as a result of the departure of the tailpipe, the aircraft had suffered major damage.
The expression major damage is defined in CAR 2 and it means damage of such a kind that it may affect the safety of the aircraft or cause the aircraft to become a danger to persons or property. Clearly, this failure did affect the safe navigation and operation of the aircraft. It caused the pilot to make a forced landing in a paddock. The aircraft should not have been flown again until the defect was repaired.
Although Mr Snook attempted to play down the seriousness of his decision to fly the aircraft out of the paddock, the fact that he experienced sufficient smoke in the cockpit to cause him to open the aircraft door in flight in order to exhaust the smoke, speaks for itself. There can be no question that Mr Snook, by taking off in an aircraft which was unserviceable, must have known that he would experience some smoke in the cockpit because Mr Coxall had done so on its previous flight and Mr Snook had not conducted any repairs on the aircraft in the interim.
Mr Snook's evidence that he had no idea of the source of the smoke in the cockpit after examining the aircraft on the ground defies logic. All of the aircraft maintenance engineers who gave evidence said that upon seeing the discolouration on the engine side of the cockpit firewall, they would have immediately examined the floor area inside the aircraft on the other side of the discolouration. Had Mr Snook done that, and we must say we are not certain that he did not, he would have immediately identified the source of the smoke which was the subject of Mr Coxall's complaint. The fact that Mr Snook is also a LAME simply compounds his problem.
When Mr Snook was taken to CAR 47, which deals with when a maintenance release ceases to be in force, he seemed to be unaware of its provisions. When he was asked if he was aware of CAR 47, he asked that it be read to him. He then responded that he did not think it applied. When asked whether, if the maintenance release had been in the aircraft, he would have endorsed it, he said that he would have expected the pilot to have endorsed it and he would have carried out rectification and signed it off. He gave no indication as to what rectification he would have carried out. Mr Snook's apparently limited awareness of the provisions in the CAR dealing with maintenance releases caused us great concern.
As best we could determine, following his examination of the aircraft, Mr Snook was satisfied that the aircraft was airworthy despite the missing tailpipe. To put it at is lowest, that is extraordinary coming from a pilot who also holds an AME licence. CAR 47 provides that where a flight crew member of an aircraft in respect of which a maintenance release is in force becomes aware that the aircraft has suffered major damage or has developed a major defect, and there is a likelihood that the aircraft will be flown before the damage or defect has been remedied, then that person must enter on the maintenance release, signed by that person, a statement setting out the facts of the situation and that the aircraft is not airworthy. Upon doing so, the maintenance release ceases to be in force. For reasons which remain unexplained, Mr Snook appeared not to be aware of this very basic requirement in respect of determining the airworthiness or otherwise of an aircraft.
The final matter for concern in respect of the failure of duty question is whether Mr Snook was required to comply with the defect reporting provisions set out in CAR 51A(1) and (2). As is stated in that regulation, a major defect which has caused a fire in an aircraft must be reported immediately by a person connected with the operation of that aircraft. The explanation given by Mr Snook and supported by Mr Cain was that there was no fire in the cockpit but rather the material on the floor of the co-pilot's side of the cockpit simply melted. As we have explained above, such an interpretation does serious damage to the English language.
A large portion of the insulating material behind the carpet and the carpet itself had disappeared. That was because its contact with the very high temperature of the firewall caused it to smoulder, resulting in a fire which burnt a hole in the insulation material, the backing of the carpet and the carpet itself. The solid material had completely disappeared. That is not a case of melting but, quite clearly, a case of combustion, where the solid material was heated to such a degree that it vaporised and disappeared. Though Mr Cain suggested that you cannot have a fire without a flame, quite clearly, a smouldering fire does not have a flame but it is nevertheless a fire. The vapour given off will contain particles of carbon (giving rise to visible smoke) and also a number of noxious gasses depending on the type of material which is burning. The consequences of that could easily have been catastrophic, not only for Mr Snook but for persons and property on the ground.
In our opinion, the breaches of duty displayed by Mr Snook were extremely serious and he was very fortunate that no one was injured or killed. In our opinion, breaches of that degree should attract the cancellation of his private pilot licence.
In addition, CASA submitted that Mr Snook was not a fit and proper person to hold a private pilot licence. The meaning of the expression fit and proper person was explained by the High Court of Australia in Australian Broadcasting Tribunal v Bond and Ors [1990] HCA 33; (1990) 94 ALR 11. Toohey and Gaudron JJ said, at 56:

[77]

In Re Gerald Keith Repacholi and Civil Aviation Safety Authority [2003] AATA 573, the Tribunal held that in deciding whether a person is fit and proper for the purposes of CAR 269(1)(d), the matters which the Tribunal should take into account in determining that question may be wider than those matters which appear in CAR 5.09(3). With respect, we cannot agree. There are several reasons for this.
The first is that CAR 269(1)(d) refers to a person not being a fit and proper person to have the responsibilities and exercise and perform the functions and duties of a holder of a licence, certificate or an authority. In other words, the context in which Mr Snook must be assessed to determine if he is a fit and proper person is in exercising and performing his functions and duties as a private pilot licence holder.
The two matters set out in CAR 5.09(3) also direct attention to the operation of an aircraft during flight and other matters that relate to the safety of air navigation. In other words, CAR 269(1)(d) is consistent with what is set out in CAR 5.09(3). Therefore, taking into consideration matters which fall outside CAR 5.09(3) in the course of making a decision under CAR 269(1)(d) would have unintended consequences. For example, if CASA was to take into account matters of character which have nothing to do with the safety of air navigation, and cancel a person's flight crew licence under CAR 269(1)(d) on that basis, then there would be no reason why the holder of that licence could not immediately seek reissue of the licence under CAR 5.09(3). On doing so, CASA must disregard the very matter upon which the previous licence was cancelled and reissue the licence.
In Mr Snook's case, we must consider the actions he took which relate to his operation of aircraft YOG from the paddock and the flight to Bunbury and the impact they had on flight safety.
In our opinion, Mr Snook is not a fit and proper person to hold a private pilot licence. His decision to fly aircraft YOG from the paddock to Bunbury was not merely a poor decision. We were very concerned with Mr Snook's evidence about that event. While it is understandable that Mr Snook would attempt to cast that decision in the best light possible, his evidence regarding the reasons for making the decision to fly the aircraft are illogical.
That raises at least two concerns. The first is that Mr Snook may not have comprehended the seriousness of the mechanical defect which the aircraft suffered when the tailpipe became disconnected from the muffler and fell from the aircraft. The obvious signs of heat having been applied to the firewall of the aircraft and the explanation by Mr Coxall that he experienced such smoke in the cockpit that he performed an emergency forced landing would, logically, have led the average pilot to conclude there was a connection.
In this case, the pilot also held an AME licence. If, as Mr Snook put forward as an explanation, he did not make the connection and carried out a thorough inspection of the aircraft, then his inability to comprehend situations which may and probably will give rise to serious safety considerations clearly indicates he is not a fit and proper person to hold a licence. On the other hand, if in fact Mr Snook did make the connection between the missing tailpipe, the discoloured firewall and the smoke in the cockpit, then he clearly made a decision which was foolhardy and dangerous.
Mr Snook's lack of knowledge of the regulations was also disturbing. In particular, when asked about CAR 47 which deals with when a maintenance release ceases to be in force, it was apparent to us that Mr Snook was unaware of its provisions. He did not understand that it was his responsibility to ensure that the maintenance release was endorsed with the defect and that the aircraft should not have been flown until the defect was rectified. He identified the missing tailpipe. Mr Coxall did not. Rectification of the defect clearly required a tailpipe to be fitted to the muffler. As a pilot and a LAME, Mr Snook must have been aware of this. Furthermore, by suggesting that Mr Coxall was responsible for endorsing the maintenance release, Mr Snook appeared to have no understanding of his obligations under CAR 50.
The final matter which leads us to the conclusion that Mr Snook is not a fit and proper person to hold a private pilot licence is the action he failed to take after landing at Bunbury. Mr Snook's reasons for not submitting a defect report until CASA insisted he do so was that he did not consider that the aircraft had suffered a major defect. That was Mr Snook's opinion because he did not consider that the missing tailpipe caused or could cause a fire in an aircraft. This is despite the fact that Mr Coxall experienced so much smoke in the cockpit that he had to make an emergency landing in the paddock.
The problem also occurred on Mr Snook's flight, when he experienced substantial smoke in the cockpit and he became seriously concerned for his life. Then, because there were no flames apparent in the cockpit, Mr Snook maintained that there was no fire but merely a melting of material on the cockpit side of the firewall. If Mr Snook sincerely believed that to be the case, his understanding of the purpose and function of regulations which are made to ensure the safety of air navigation, is seriously flawed.
In his final submissions, Mr Ribbands of counsel, who appeared on behalf of Mr Snook, submitted that we should take into account the effect the cancellation of Mr Snook's private pilot licence would have on his ability to earn his income from his aircraft maintenance activities. While we are concerned with the effect this decision will have on Mr Snook's ability to continue to earn his livelihood, we cannot elevate that concern above our concern for the safety of air navigation.

[79]

CASA's concerns about Mr Snook's capacity and fitness to continue to hold an AME licence and CoA arise out of a number of matters which CASA has investigated. The first of these involves the aircraft YOG which has been referred to above. On 19 December 2007 Mr Snook carried out a periodic inspection (100 hourly) on YOG and found cracking around the muffler where the tailpipe was attached. Following repair and reinstallation of the muffler and tailpipe, after 3.2 hours of recorded flight, the tailpipe fell off. CASA contended that Mr Snook had not reassembled the exhaust system for the aircraft using the appropriate components as specified in the manufacturer's approved parts catalogue. CASA also contended that following the forced landing of YOG on 15 January 2008, Mr Snook's initial inspection of the aircraft was for the purpose of identifying the fault and conducting rectification work. Because Mr Snook decided that the aircraft was airworthy and fit to fly when it was not, and because he failed to report a major defect which caused a fire in the aircraft, he had not satisfactorily carried out the duties of a LAME or a CoA holder.
There were some further matters, discovered following an audit of Mr Snook's maintenance activities, which also gave CASA reason for concern. The first of these related to a PZL MA-18 Dromader aircraft, registration number VH-NIN. The second aircraft which caused CASA concern was a Piper PA36 Brave, registration number VH-TVU. CASA claimed that Mr Snook's CoA did not authorise him to carry out maintenance on that aircraft and that he conducted maintenance under his AME licence which he was not authorised to perform. CASA noted a number of concerns with the maintenance Mr Snook carried out on an Aerobatic Fuji, registration VH-FJU. There were issues about the number of aerobatic hours the aircraft had flown and repairs conducted on its windscreen. CASA also identified maintenance problems with a Piper PA-28R-201, registration VH-EHK; a Cessna 152, registration VH-CRP; a Cessna A188B, registration VH-ZRR; a Cessna A188B, registration VH-KZE; and, following an audit of another CoA holder, Airfast Pty Ltd, aircraft registration VH-XAT.

[80]

In the course of conducting a routine 100-hourly inspection on YOG on 19 December 2007, Mr Snook detected cracks at the point where the tailpipe exits the muffler. Mr Snook removed the muffler and sent it to Mr Trotter, who apparently held an aircraft welding authority. Mr Green, an airworthiness inspector with CASA, when investigating the loss of the tailpipe from the aircraft, visited Mr Trotter and spoke with him about the welding that he performed. Mr Trotter told Mr Green that the muffler had sufficient parent metal to weld and that the cracking, because of its style and the direction of the cracks, was typical of an engine with vibration.
When Mr Trotter returned the muffler with its release note certifying it had been properly repaired, Mr Snook said he re-installed the muffler in exactly the same manner in which it had been attached when the aircraft came into his workshop for its periodic inspection. That is, the muffler was supported from above by a rubberised strap attached to a metal clamp, which had been placed at about the centre point of the length of the muffler. The tailpipe itself had no support whatsoever.
Concerned by the way the muffler was attached to the airframe, Mr Green obtained an illustrated parts catalogue for the aircraft muffler system. There are two illustrations for the exhaust and muffler system and Mr Green was uncertain as to which one applied to YOG. Nevertheless, both illustrations clearly disclose the tailpipe being supported by a sprung clamp, which is bolted to the tailpipe and the airframe. The sprung clamp appears to be designed to act as a damper to smooth out any vibrations emanating from the engine. According to Mr Green, the incorrect mounting of the muffler with its clamp and rubber support in the middle of the muffler was likely to have been a significant contributing factor in the initial cracking of the muffler and tailpipe which resulted in its failure after 3.2 flying hours.
The reason appears elementary. Even a small vibration at the engine where the exhaust is attached to it would exhibit itself as a fairly large movement at the end of that exhaust system where the exhaust gasses exit the tailpipe. In other words, unless the tailpipe is secured, a vibrating engine would significantly amplify the oscillations at that point, thus leading to the cracking. The exhaust pipe and muffler system clearly has a degree of flexibility throughout its length because the pipes themselves necessarily flex; and this is particularly so where relatively heavier muffler systems are attached to those pipes.
CASA was critical of Mr Snook for not recognising the way in which the muffler with its attached tailpipe was secured to the aircraft and for not taking any action to ascertain for himself the correct means by which these components should have been attached to the aircraft.
According to Mr Green, this should have been apparent to Mr Snook because Mr Trotter had told Mr Snook that engine vibration had caused the cracking around the point where the tailpipe entered the muffler. Mr Snook's response was that the muffler fitted to the aircraft was non-standard and that the aircraft had been out of production for some 40 years. He said that the muffler had been attached to the aircraft in the same way for some 200 hours without incident and he saw no reason not to refit the repaired muffler in the same manner as it was fitted before he conducted the inspection. He said he did not consider whether the tailpipe should have been supported in any way. Mr Snook said the 100-hourly inspection was routine and there was no need for him to refer to a parts catalogue to determine whether the correct parts had been fitted.
When it was put to Mr Green in cross-examination that there could be no issue where parts were refitted as they had been previously fitted, he disagreed. He also disagreed that the muffler fitted to YOG was not a standard muffler. In fact, the diagram in the illustrated parts catalogue showing the exhaust system components does bear a close resemblance to the muffler shown on the photographs which were in evidence.
According to Mr Green, the way in which the muffler was secured to the aircraft by the rubber strap should have alerted Mr Snook to the fact that this was unlikely to be the authorised way of mounting and securing the muffler and exhaust system. Mr Green was of the opinion that, were he confronted with the situation, he would have looked further into it in order to determine whether the way in which the muffler system was attached to the aircraft contributed to the cracking around the tailpipe area.
Mr Green was also of the opinion that if Mr Snook was unable to obtain the correct parts for the proper securing of the muffler and tailpipe system, he should have applied to CASA under CAR 35 for approval of a modification or repair to that system. Under CAR 35, where an application is made for a modification or repair of an aircraft component, CASA may authorise the making of the modification or repair. According to Mr Green, Mr Snook should have undertaken that procedure. We agree with Mr Green.
In our opinion, an experienced and competent aircraft maintenance engineer would certainly have enquired into the cause of the cracking where the tailpipe joined the muffler when he or she first observed this, some 3.2 hours before the tailpipe fell off. The fact that Mr Trotter explained that the cracking was consistent with engine vibration would, in our opinion, have alerted a competent and experienced aircraft maintenance engineer to the makeshift attachment of the muffler to the airframe. That attachment quite clearly would not provide any damping of the vibrations transmitted to the exhaust system from the engine, the amplitude of which would be significantly increased at the end of that system. Had Mr Snook made enquiries, and had he been unable to obtain the approved component to secure the tailpipe to the airframe, he should have applied to CASA under CAR 35 for an approved modification to that component.
We should not be understood to be suggesting that in every case where periodic maintenance is conducted on an aircraft, an aircraft maintenance engineer should conduct a thorough examination of components to ensure that they have been approved by the aircraft manufacturer. However, where a problem occurs, such as cracking due to metal fatigue, we would expect a LAME to make reasonable enquiries about its cause and the possibility of defective components or non-approved components being fitted, which may have caused the cracking. Clearly, Mr Snook did not consider that to be his duty, even though the conduct of a periodic inspection is clearly maintenance as that expression is defined in CAR 2.
As for the inspection Mr Snook carried out after the tailpipe had become dislodged from the muffler when the aircraft was forced to land in a paddock some 10 kms from Bunbury, we have already expressed concern about Mr Snook's lack of logic when he considered that aircraft to be serviceable.
He admitted that he noticed the tailpipe missing on first inspection. That observation, by itself, required entry in the maintenance release. There was no evidence that Mr Coxall, who was flying the aircraft, was aware that the tailpipe had fallen off. CAR 47 makes it very clear that when an authorised person engaged in the maintenance of an aircraft, in respect of which a maintenance release is in force, becomes aware that the aircraft has suffered major damage or has developed a major defect, other than damage or a defect that is permissible serviceability, and there is a likelihood that the aircraft will be flown before the damage or defect is remedied, that person must enter on the maintenance release (or another document approved for use as an alternative to the maintenance release) an endorsement signed by the person setting out the facts of the situation and stating that the aircraft is not airworthy. Having done that, the maintenance release would cease to be in force.
Mr Snook said in evidence that he did not consider the missing tailpipe to be major damage or that the aircraft had developed a major defect. An aircraft from which a component has fallen during flight could not reasonably be said not to have suffered major damage as that expression is defined in CAR 2. The fact that the absence of that component then caused a fire in the cockpit, necessitating an emergency forced landing, in our opinion, satisfies the description major defect as defined in CAR 2.
In our opinion, an experienced and competent LAME, on detecting the loss of the tailpipe, would immediately have conveyed that information to Mr Coxall with the instruction that it must be endorsed on the maintenance release. That having been done, the aircraft was then not in an airworthy state and therefore could not be flown. At that point, Mr Snook had no decision to make at all. In fact, it would have been a relatively simple matter to remove the muffler from the aircraft and take it back to his workshop in order to conduct repairs.
Mr Snook's assessment that the aircraft was airworthy was dangerously flawed. It causes us to have very serious concerns about Mr Snook's ability to comprehend the potential seriousness of a maintenance problem when confronted with it. In fact, as will become evident below, when explaining the actions which he took from time to time in respect of maintenance, Mr Snook displayed an alarming lack of logic and cognition.
Finally, in respect of aircraft YOG, CAR 51(2) requires a person engaged in maintenance of Australian aircraft to report a major defect in the aircraft to the holder of the certificate of registration for the aircraft and to CASA if that person becomes aware of the existence of such a defect. As we have explained above, the loss of the tailpipe in flight constitutes a major defect. Mr Snook did not report that defect to CASA until instructed to do so.
In his report, Mr Snook made no mention of the allegedly defective insulation beneath the carpet. As Ms Macdonnell submitted, but for Mr Coxall telephoning Mr Siggins and giving him an account of what happened, CASA may never have become aware of this incident. In addition, Mr Snook's evidence was that he did not so much as turn his mind to whether he had an obligation to report the defect. This, again, highlights what we have said about Mr Snook's apparent lack of cognitive skills. When told to make a defect report, Mr Snook expressed his unwillingness to do so until Mr Green told him he must furnish a report to CASA.

[85]

Plainly, neither Mr Snook's AME licence nor his CoA authorised him to carry out maintenance on a turbine engine.
On 14 August 2008 Mr Darren McDonnell attended Aeronautique's hangar in order to discuss maintenance issues regarding NIN. He said that he saw TVU and that the aircraft appeared to be fitted with a gas turbine engine. He asked Mr Snook whether he was performing maintenance on TVU and Mr Snook said that he was carrying out a periodic inspection on the aircraft and an engine change. Mr McDonnell said that Mr Snook then told him that the engine category maintenance was being carried out and certified by another CoA holder, Premiair Aviation. Mr McDonnell said that he asked Mr Snook whether he was authorised by his CoA to perform maintenance on a turbine engine and Mr Snook replied that he was. Mr McDonnell then asked Mr Snook if he could look at his CoA. After checking that document, Mr McDonnell said he confirmed that his CoA did not cover turbine engine aeroplanes and explained that to Mr Snook.
Mr McDonnell said that Mr Snook appeared to be shocked and said that he considered himself to be authorised to perform work on this aircraft because the aircraft had initially been type certificated as a piston engine aircraft. Mr Snook did not tell Mr McDonnell that he was authorised to maintain TVU (i.e. the aircraft as opposed to its engine) in accordance with an arrangement with Premiair Aviation or any other maintenance organisation. In fact, Mr McDonnell noted (and exhibited to his written statement of evidence) a job register maintained by Aeronautique which disclosed that TVU was booked in under job number 2321 for repairs, engine controls, engine change and a 100 hourly inspection on 21 August 2007. The job register describes the aircraft as a PA36-375/turbine.
In a signed statement dated 12 November 2008, Mr Paul Montauban, the engineering manager and managing director of Premiair Aviation Pty Ltd (Premiair), said that Premiair received a fax from Aeronautique on 24 August 2007 seeking Premiair's technical manuals, data, tools and an engineer to work on the removal and installation of a PT6A engine on aircraft TVU. Mr Montauban said Mr Snook told him that a replacement PT6A-21 engine had been sourced and was at Aeronautique. The engine was a different model to that currently installed and Mr Montauban encouraged Mr Snook to obtain an engineering order from a qualified aeronautical engineer.
Mr Montauban said that he asked one of his licensed engineers, Mr Scott Harvey, to attend the premises of Aeronautique with him. They both saw aircraft TVU with the engine already installed within the engine frame and they could see that the engine mounts and bolts had been connected. He said that he assigned Mr Harvey to the job to ensure that the engine had been mounted correctly and to continue with its installation.
Mr Montauban said Mr Harvey spent some time working on TVU between 24 July 2008 and 31 July 2008. He was asked by Mr Harvey to see Mr Snook around the end of July and he met Mr Snook in the presence of Mr Long, who he knew was the owner of the aircraft. He said Mr Long appeared to be anxious and stressed. Mr Montauban told Mr Snook that if he could not do the work under his CoA, then he should let Premiair know to see if something could be worked out. Mr Snook then asked him whether the work could be done under Premiair's CoA and Mr Montauban said it could, but it had to be in Premiair's hangar. On 18 August 2008 a job order was raised by Premiair for the work on TVU and the aircraft was brought into Premiair's hangar, where worked commenced, including researching logbooks and performing a 100 hourly inspection.
Given the account of events by Mr Montauban, Mr Snook's response to Mr McDonnell's question on 14 August 2008 was clearly contrived.
In his statement of evidence to the Tribunal, Mr Snook said that his CoA covered piston powered aircraft and not turbine-powered aircraft but that he had an arrangement with Premiair, which held approvals to conduct maintenance on that aircraft. However, the evidence of Mr Montauban, which was not contradicted, proves that this statement is incorrect. At the time Mr Montauban attended the premises of Aeronautique, Mr Snook had already installed the turbine engine in TVU. It was only after this event that Mr Harvey spent time at the Aeronautique premises ensuring that the engine had been correctly mounted and he continued with the installation. Premiair commenced work on TVU on 18 August 2008, some four weeks after Mr Green observed Mr Snook working on the turbine engine.
CAR 30 deals with CoAs. CAR 30(1) relevantly provides that a person engaged or intending to engage in any stage of maintenance of an aircraft, aircraft component or aircraft material, may apply to CASA for a CoA in respect of those activities. CAR 30(2A) provides that CASA must grant an applicant a CoA covering the activities to which the application relates, if CASA is satisfied that the applicant is able to carry out the activities in a satisfactory manner. It is important to note that a CoA only covers the activities to which the application relates. It is also important to note that CAR 30(2C) sets out the conditions to which a CoA is subject. CAR 30(2C)(a) provides that it is a condition of a CoA that each activity which is covered by the certificate must only be carried out at a place where the facilities and equipment necessary for the proper carrying out of the activity are available to the holder of the certificate.
Schedule 1 of Mr Snook's CoA states that the approved activities may only be conducted at 26B Compass Road, Jandakot Airport, WA 6164. The approved activities are the maintenance of Class B aircraft not classified as non-type certificated historical and ex-military aircraft and not classified as Group 20, being piston engine aeroplanes with a maximum take off weight not exceeding 3500 kgs, and PZL MA18 Dromader series aeroplanes.
Schedule 2 of Mr Snook's CoA sets out a further condition, whereby Mr Snook may carry out maintenance at temporary locations in accordance with the provisions of Chapter 3 of Aeronautique's procedures manual. Because of the above, it should have been clear to Mr Snook that under his CoA, he was only entitled to conduct maintenance, as that term is defined in the CAR, on piston engine aeroplanes not exceeding 3500kgs maximum take off weight and the Dromader aircraft, at Aeronautique's hangar in Jandakot. He could also, subject Chapter 3 of Aeronautique's procedures manual, carry out maintenance at temporary locations. He could not, however, conduct maintenance at Premiair's maintenance hangar under his CoA.
Mr Snook's evidence regarding the maintenance carried out on TVU was disturbing. Mr Snook was asked to explain to the Tribunal what was required of him as the holder of a CoA. Although objection was taken to the width of that question, he was subsequently asked to state what he understood were the conditions attached to his CoA by reason of CAR 30. This was his answer:

[87]

Subsequently, Mr Snook was taken to his CoA at Schedule 1 and asked to look at the approved activity under Item 1(a)(i). That item was read to him. He was asked if that approved activity was the same in 2000. Mr Snook said he could not remember. He was then asked if his approved activity was restricted to aircraft with a maximum take off weight of 3500 kgs and he agreed it was. Mr Snook then complained about the questioning and Ms Macdonnell took him to another topic.
However, she later returned to the matter of aircraft TVU and put to Mr Snook that his CoA did not cover turbine engines. He agreed with that. He agreed that his AME licence did not cover turbine engines. He also agreed that the original engine in TVU, when it arrived at his hangar in August 2007, was a turbine engine. Mr Snook agreed that he had asked Premiair to provide him with an engineer who was licensed to conduct maintenance on a turbine engine aircraft as well as technical data and tooling. He agreed with Mr Montauban's statement that as the aircraft was in Aeronautique's hangar, and he had only asked for an engineer with licence coverage, the work was being performed under his (Mr Snook's) CoA. He agreed that was, as he described it, the assumption at the time. He agreed that when Mr Montauban and Mr Harvey attended his hangar in July 2008, a turbine engine was already installed in aircraft TVU. He also agreed that Mr Montauban assigned Mr Harvey to ensure that the engine had been mounted correctly and to continue with the installation of the engine.
Mr Harvey's time sheets were in evidence and they indicated that he worked on the engine on 24 July 2008, 25 July 2008, 29 July 2008 and 31 July 2008. Mr Snook agreed that Mr McDonnell saw TVU being maintained in Mr Snook's hangar on 14 August 2008. He also confirmed that on 14 August 2008, he was carrying out a periodic inspection of the aircraft and the engine change. He agreed that he told Mr McDonnell that the work was covered by his CoA. When it was put to him that he did not now dispute that his CoA did not in fact cover the work, Mr Snook agreed. He was then asked how he could have thought that his CoA covered the installation of a turbine engine in aircraft TVU. He said:

[107]

2A Approved maintenance data

(1) Subject to subregulation (3), the approved maintenance data for an aircraft, aircraft component or aircraft material consists of the requirements, specifications and instructions that are:

(a) contained in the maintenance data set out in subregulation (2); and

(b) applicable to the maintenance of the aircraft, aircraft component or aircraft material, as the case requires.

(2) For the purposes of paragraph (1) (a), the maintenance data are:

(a) requirements in:

(i) regulations 42U, 42W, 42X, 42Y, 42Z and 42ZA or in instruments made under those regulations; and

(ii) directions (however described) made under an airworthiness directive or under regulation 25, 38 or 44;

being requirements that specify how maintenance on aircraft, aircraft components or aircraft materials is to be carried out; and

(b) specifications in documents or designs approved under regulations 22 or 35 by CASA or by authorised persons as to how maintenance on aircraft, aircraft components or aircraft materials is to be carried out; and

(c) instructions, issued by the manufacturers of aircraft, aircraft components or aircraft materials, that specify how maintenance on the aircraft, components or materials is to be carried out; and

(d) instructions, issued by the designers of modifications of aircraft or aircraft components, that specify how maintenance on the aircraft or components is to be carried out; and

(e) any other instructions, approved by CASA under subregulation (4) for the purposes of this paragraph, relating to how maintenance on aircraft, aircraft components or aircraft materials is to be carried out.

(3) CASA may, for the purpose of ensuring the safety of air navigation, declare in writing that an instruction mentioned in paragraph (2) (c) or (d) that CASA thinks is deficient is not included in the approved maintenance data for an aircraft, aircraft component or aircraft material.

(4) CASA may, for the purposes of paragraph (2) (e), approve instructions relating to how maintenance on aircraft, aircraft components or aircraft material is to be carried out.

[130]

The third item Mr McDonnell referred to was a requirement to conduct a 12-monthly inspection of the air heater and exhaust. In fact, the requirement set out in the old maintenance manual is to check the carburettor heater and exhaust manifold. That manual states the frequency of the inspection should be once per year. There is only one signature against that item in the maintenance manual used by Mr Snook. There is no indication that he conducted the inspection annually. The updated maintenance manual requires a check of the air heater and exhaust manifold once a year.
In his evidence-in-chief, Mr Snook said that the expression air heater is ambiguous because it could be a reference to the cabin heater. In any event, Mr Snook agreed that it was an inspection which should be completed on the 100-hourly periodic inspection, which occurs at either 100 hours or 12 months, whichever arrives first.
Under cross-examination Mr Snook maintained that the requirement was rather ambiguous because none of the Dromaders which he serviced had air heaters. We understood that to be a reference to cabin air heaters. He maintained that the expression used in the new maintenance schedule was ambiguous because one could not determine whether it was a reference to a cabin heater or a carburettor heater. Again, with respect to Mr Snook, the outdated maintenance manual which he was using referred to carburettor heater and exhaust manifold. The updated manual, in the power plant section, only referred to air heater and exhaust manifold but how that could be construed as a reference to a cabin heater when the Dromader aircraft did not have cabin heaters is beyond our comprehension. Mr Snook also maintained that, in any event, the exhaust system is inspected on the periodic 100-hourly inspection and it includes the heat shield. Therefore, he understood it to include an inspection of the carburettor heater.
Mr Snook was asked why he didn't record that and he said: Well, yes, it's sign off as an inspection. However, quite plainly, the maintenance schedule used by Mr Snook merely has a notation (not his initials, PS, but something which he referred to as indicating okay), not in any of the columns but prior to where the first column commences. When asked why he did not record what he had done, Mr Snook said: I don't know what an air heater is. That was followed by a verbal exchange which can only be described as bizarre. Although he agreed there was a carburettor air heater fitted to the aircraft, he also said that there was no air heater fitted to it. In any event, when asked whether one would know when that heater had last been inspected, Mr Snook responded that it was done on every 100-hourly inspection. However, a person inspecting the maintenance record could not determine that from the annotation made by Mr Snook indicating it was okay.
The fourth item Mr McDonnell referred to is a requirement under the updated maintenance schedule to: Check the nuts of engine - mount ring attach bolts for security. Nuts tightening torque: 7-8 kGm (607-694 in.lbs). The outdated maintenance manual simply required a: check of engine mount ring attach bolts for security. There was no requirement to check the nuts attached to those bolts in order to check their torque.
Mr Snook's response to that requirement in his evidence-in-chief was that the inspection requirement mentioned in both schedules is identical. He said this was the case because the requirement to check the bolts for security requires the maintenance engineer to refer to the maintenance manual in order to obtain the torque pressures required to ensure those bolts were secure. He said it was pointless to tighten something without knowing to what extent it should be tightened. While that is undoubtedly correct, as Ms Macdonnell pointed out, there was no requirement under the outdated schedule to ensure the correct torque of the nuts on the engine bolts which secured the engine to the aircraft. In the outdated schedule, Mr Snook again put his initials under the 100 and 500-hour columns and said that complied with the item as it was set out in the current schedule.
In fact, Mr Snook insisted under cross-examination that when maintaining this aircraft, he worked from the latest maintenance manual. The problem is that we had no evidence before us indicating that the required periodic maintenance was carried out in accordance with the updated maintenance manual. What is perhaps even more serious is that a person examining the maintenance conducted on this aircraft by reference to the outdated maintenance manual would have no idea as to the actual status of that aircraft's periodic maintenance.
The same issues were raised with the fifth item to which Mr McDonnell referred. This is a requirement to check the shock absorber frame (the engine mounting frame) to fuselage attachment nut torque, every 500 hours or 12 months, whichever comes first. After re-tensioning the nuts, they are required to be lock-wired. The outdated manual required a check of the engine mount attachment fittings for condition. That item appears to have been initialled as okay by Mr Snook at 50 hours, 100 hours and 500 hours.
The final item identified by Mr McDonnell was the requirement to test the stall warning system once a year. Mr Snook's response was that the Dromaders he serviced had no stall warning system. Nevertheless, Mr Snook was criticised for not making an entry to that effect. The stall warning system is not mentioned in the outdated maintenance manual.
Mr McDonnell said in evidence that at the audit exit interview, Mr Snook was not aware that the maintenance manual had changed. This was despite what Mr Snook said about the way in which he conducted maintenance on NIN, and that he said he was aware of the current maintenance schedule and worked from that version but did not make a record of the work he conducted in the schedule attached to the logbook. Given the nature of the responses by Mr Snook as recorded above, we find that Mr Snook was unaware of the changes made to the Dromader aircraft maintenance manual. Alternatively, if he was aware of the changes, because he considered they were small or technical, he formed the view that he did not need to alter the way in which he conducted maintenance on those aircraft.

[131]

Mr McDonnell identified a number of items that had significantly changed the maintenance requirements set out in the outdated maintenance manual. He also identified a component service lives list, which was introduced by PZL Service Bulletin E/02. 142/91.
Mr Snook agreed that the maintenance schedule for the PZL18 aircraft stated that all work included in the schedules should be executed according to the mandatory instructions, M18 servicing manuals, ASz-62IRm18 engine logbook, as well as the bulletins edited by the aeroplane and engine manufacturers. Mr Snook said that he had numerous discussions with CASA officers about what was and what was not required regarding service instructions, service letters and service bulletins. According to Mr Snook, these discussions concluded with his understanding that not every service bulletin was mandatory. It was only so if it was guided by an airworthiness directive.
Mr Snook also said that if the registered operator of the aircraft told him to carry out maintenance in accordance with any particular service bulletin, he would do so, but that he was not legally bound to follow those maintenance requirements simply because they were set out in a service bulletin. There was no dispute about the fact that the Part 1 logbook statement for NIN provides that the aircraft was to be maintained in accordance with the PZL18 flight manual and service manuals as well as the relevant airworthiness directives.
The service bulletin in question, E/02. 142/91 states, on its cover, that it is a MANDATORY SERVICE MANUAL. The subject of the bulletin is said to be the Extension of aircraft service life up to 6000 flying hours. At clause 1 under the heading PURPOSE, it states the bulletin is aimed at notifying Operators of an extension of the preliminary service life from 5,000 fl. hours to 6,000 fl. hours for PZL M18, M18A and M18AS DROMADER aircraft. At clause 2, the bulletin then sets out the basis upon which the extension of service life may be granted. It also states that the service lives of accessories, parts and rubber elements are described under Item 4, Section III of the bulletin. The bulletin cancelled all previously issued bulletins regarding service. The previously issued bulletins were identified.
The service bulletin noted that aircraft with serial numbers 1Z001-01 to 1Z0022-26 could have their flying hours extended to 6,000.
Mr Snook focused on clause 3 of the bulletin under the heading APPLICABILITY. That paragraph provided that the service life of an aircraft which had flown fewer than 3,000 hours since new would be extended to 3,000 flying hours, having regard to the extension of the airworthiness certificate, without performing additional procedures. According to Mr Snook, because NIN had not flown 3,000 hours, the service bulletin only became applicable at 3,000 plus 300 hours. When it was put to Mr Snook that clause 3 referred to the aircraft and not its components, Mr Snook disagreed. He was certain that the bulletin only comes into play at 3,000 plus 300 hours. The reason for the bulletin, according to Mr Snook, was that it enabled an extension to 6,000 flying hours on the basis of compliance with the service bulletin.
To put it at its lowest, Mr Snook's understanding of service bulletin E/02. 142/91 is seriously flawed. As is clearly stated under the heading PURPOSE, there were four reasons for issuing the bulletin. The first was the extension of the aircraft's service life from 5,000 to 6,000 flying hours. That extension of service life was based on three factors, which we need not set out. The bulletin also established the service life of accessories, parts and rubber elements. These were set out in Table 4.1 of the service bulletin. Clause 3, under the heading APPLICABILITY, states that, for aircraft which have flown fewer than 3,000 hours at the time of the issue of the bulletin, the service life of those airframes is extended to 3,000 flying hours without the need to perform additional procedures. Clearly, the reference to additional procedures is a reference to the factors upon which the extension of service life of the aircraft is based. In other words, it relates to clause 2 (under the heading PURPOSE) of that service bulletin.
In order to extend the service life from 5,000 hours to 6,000 hours, the aircraft needed to satisfy an airframe structure fatigue test; an examination and theoretical analysis conducted in accordance with FAR 23.572; and an analysis of the technical condition of aeroplanes under operation with the highest number of hours since new. It is those additional procedures which extend the airframe life. Clause 3 simply states that those additional procedures need not be performed, undoubtedly because the manufacturer is satisfied that an airframe life of 3,000 hours does not require those procedures to be completed in order to verify the integrity of the airframe. It is not a reference to periodic maintenance. If that was intended, it would have said so. As Ms Macdonnell pointed out in her submissions, many aircraft components have service lives of less than 3,000 hours TTIS. It could not possibly be intended that those limits be dispensed with by one sentence in the service bulletin. Clearly, they are not.
Regardless, Mr Snook said under cross-examination that he was not required to inspect components which had less than 3,000 hours TTIS. He categorically stated that he had not inspected those components. In fact, in his evidence-in-chief, Mr Snook went so far as to say that_:_

[133]

As for all maintenance which was due prior to 3,000 hours flight time, Mr Snook said that what he did was an inspection, in situ, of the components that were due in the period between zero and 3,000 hours.
The subsequent service bulletin issued by the aircraft manufacturer was E/02. 172/2001. It extended the service life of the aircraft to 10,000 flying hours. That service bulletin made it plain that the provisions set out in it were not applicable to equipment, rubber components installed in the aircraft or the engine and its accessories, or a particular propeller. It stated that those items should be operated subject to the requirements established and still effective for those particular components.
Plainly, the component service lives set out in Table 4.1 of service bulletin E/02. 142/91, remained applicable to all of the Dromader aircraft serviced by Mr Snook. Therefore, Mr Snook failed to carry out the maintenance required by the service bulletin on all of those aircraft. As Mr McDonnell said, none of those components had a component history card; nor were they included in the recurring maintenance control sheet.
Where the compliance period for maintenance was less than the aircraft TTIS, as Mr McDonnell said, it should be assumed that those items should have been serviced in accordance with the component service lives schedule. Where they were not, the aircraft's airworthiness status is unknown.
In our opinion, Mr Snook's lack of understanding of the requirements set out in the service bulletin resulted in the Dromader aircraft being in an uncertain airworthiness condition. In fact, some 19 of the accessories set out in Table 4.1 of the E/02. 142/91 service bulletin had reached the end of their service life without having been inspected. In clause 4.1.1, beneath the table setting out the service life of accessories, parts and rubber components, is a statement requiring accessories which have reached a service life limit to be dismantled and subjected to a laboratory test to prove their compliance with technical specifications, or be replaced with new items. Clearly, Mr Snook did not follow that procedure.
Furthermore, to make it clear that the list of items in Table 4.1 required periodic maintenance in accordance with that table, irrespective of the airframe time of the aircraft, clause 4.1.3 provides that those accessories admitted to further operation after overhaul or on the basis of good technical condition and measurement results can have their service lives extended successively up to the airframe service life value. Clause 4.1.4 deals with the lives of accessories not mentioned in Table 4.1. Clause 4.2 deals with the storage and operation period of rubber hoses installed in the aircraft. These clauses should have indicated to Mr Snook that the limits on the service lives of certain components described as accessories in the service bulletin required mandatory inspection in the period stated.
We find that Mr Snook failed to comply with mandatory service bulletin E/02.142/91.

[136]

If an election is made to satisfy requirement 1, the altimeter must be tested at intervals not exceeding 24 months. If an operator elects requirement 2, the integrity of all aircraft instruments and instrument systems must be checked at intervals not to exceed three years or at the intervals approved in accordance with a system of maintenance for the aircraft under CAR 42M. The AD came into effect on 16 July 2003.
The AD also states that the requirements and intervals of AD/INST/8 Amdt 3 have been retained for those operators who wish to continue to maintain their aircraft instruments in accordance with the requirement of Amdt 3 and at intervals in the interim period, until the CASR Part 43 and Part 91 come into effect.
Mr Snook agreed that the certificate of registration holder of NIN had elected to maintain the aircraft's instruments in accordance with Requirement 1. There are two issues which arise out of the alleged non-compliance with the AD. The first is in respect of the magnetic compass of the aircraft and the second in respect of the altimeter.
In the recurring airworthiness directive control sheet for the NIN, Mr Snook had entered the AD and had written immediately above it, REQ1a. Mr Snook agreed that the registered owner of the aircraft had elected Requirement 1 following the issue of the AD. It is not clear when that election was made. Mr Snook said his recollection was that the altimeter had always been maintained in accordance with the AD.
Mr McDonnell, in determining whether there had been proper compliance with the AD, assumed that the election was made when the previous AD, AD/INST/8 Amdt 3 was next due, which was in October 2005. Of course, if the election had been made earlier, that would have brought forward the times for testing the pressure altimeters. Assuming that the election was made in October 2005, compliance with the AD should have taken place at that time. According to Mr McDonnell, there was no evidence of the AD being carried out until 4 December 2007. In fact, it is quite likely that the election to adopt Requirement 1 of the AD was made at an earlier point in time because Aeronautique's worksheet dated 22 March 2005 has an entry regarding the AD. It simply indicates that the AD was carried out on 20 October 2002; which is what is recorded in the recurring airworthiness directive control sheet. Directly under that entry is the annotation: Due 20.10.05.
There is also another entry beside that date, 2_/3yr._ Mr Snook said he did not recall why he made that notation. He suggested it might have been Requirement 2 or Requirement 3. However, that cannot be correct. There are only two requirements. Requirement 1, if elected, must occur at intervals not exceeding two years; and Requirement 2, if elected, must not exceed three years. There was no evidence of the AD being carried out at any time between 2002 and 2007.
Therefore, according to Mr McDonnell, the aircraft was released to service from three maintenance release inspections, one 50 hourly periodic inspection and after 10 maintenance events without complying with the AD. The requirement to comply with the AD was not listed in the two expired maintenance releases included in the logbook. Therefore, the aircraft operated for a period of 49 months in excess of the 24 month compliance requirement. Mr McDonnell also noted that the AD was not entered into Part 1 of the maintenance releases for that aircraft. That, according to Mr McDonnell, directly contributed to the failure to conduct the maintenance.
Under cross-examination, Mr Snook insisted that he had signed the worksheet for the work carried out on 22 March 2005 and therefore, irrespective of what he wrote under the compliance details section for the AD, maintenance in compliance with that AD was in fact carried out on that day. Ms Macdonnell directed Mr Snook's attention to the worksheet attached to the logbook dated 6 February 2007. There, in respect of the AD, under the column Compliance Details, Mr Snook set out the fact that the altimeter was repaired and refitted. Despite that, Mr Snook insisted that having made the entry on the worksheet, and signed off that entry, he had conducted the maintenance required by the AD.
However, as Ms Macdonnell pointed out in the respondent's submissions, when Mr Snook was asked what was indicated by the stroke he placed in various boxes on the recurring airworthiness directive control sheet in the logbook, he said:

[138]

Against the AD for 22 March 2005, Mr Snook had placed a stroke against that entry. Although Mr Snook maintained that his having signed the worksheet on 22 March 2005 against the AD entry indicated that it had been carried out, the objective evidence indicates that it had not. We therefore find that Mr Snook failed to comply with the AD in respect of the altimeter.
The maintenance manual for the PZL M18 Dromader aircraft requires an in-flight check of the K1-13AK magnetic compass for correct indications at four basic headings, at least every 18 months.
AD/INST/8 Amdt 4 plainly states that it is applicable to compasses installed in aircraft which are not approved for IFR operations. According to Mr McDonnell, given that an election had been made to adopt Requirement 1 of the AD, instruments other than the pressure altimeter were required to be maintained in accordance with the aircraft manual. The magnetic compass was serviced in accordance with AD/INST/8 Amdt 3 on 20 October 2002, with corrections recorded in the logbook. On 8 January 2005 calibrations were conducted and corrections recorded in the logbook. Therefore, having adopted Requirement 1 of AD/INST/8 Amdt 4, the magnetic compass was due for an in-flight check in July 2006. That was the requirement in the current maintenance manual at the time of his audit in August 2008.
When it was put to Mr Snook in cross-examination that following an election by an operator to follow Requirement 1, the maintenance of other flight instruments in the aircraft needed to be maintained in accordance with the manufacturer's requirements, Mr Snook emphatically said that was incorrect. According to Mr Snook, when the airworthiness directive was introduced, it omitted the requirement to carry out or to have a maintenance program in place to carry out an inspection of the other instruments (other than the altimeter) and that defect was later followed up by an airworthiness bulletin which clarified that aspect.
Mr Snook also said, under cross-examination, that when the aircraft came to Australia it had a different compass to that stated in the manufacturer's maintenance manual and that an election was made to maintain the compass in accordance with AD/INST/8 Amdt 2. Mr Snook said that there was absolutely no requirement to maintain any other instruments and that no maintenance had been done on them. Mr Snook referred to the fact that if there was any requirement for maintenance on the instruments, it was set out in the repair manual.
Therefore, according to Mr Snook, the other instruments were maintained on condition until such time as those instruments needed repair. They did not require any particular inspection or testing. He agreed that those instruments would be maintained on condition until they ceased to function.
That cannot possibly be correct. Even in the outdated service manual which Mr Snook used to record periodic maintenance, there was a requirement to remove the airspeed indicator, altimeter, pressure inputs system (pitot - static system), rate of climb indicator, compass and fuel gauge at least every 18 months. As Ms Macdonnell submitted, Mr Snook's evidence about maintaining those instruments on condition explains why there is only one entry made on the maintenance schedule.
In our opinion, Mr Snook is plainly incorrect. AD/INST/8 Amdt 4 clearly states it is also applicable to instruments other than pressure altimeters. It is applicable to airspeed indicators, altimeters, pitot-static systems, fuel quantity gauges and compasses in VFR aircraft. The election to maintain pressure altimeters in accordance with Requirement 1 of the AD does mean that all of the other instruments should be maintained on condition. As Ms Macdonnell submitted, that would result in no maintenance at all being done on instruments until they failed. That could not possibly be the correct interpretation. In fact, because the second alternative (Requirement 2) is to check the integrity of all aircraft instruments and systems in accordance with the former AD, it is tolerably clear that the choice is to continue checking all aircraft instruments and instrument systems in accordance with that former AD or, alternatively, test the pressure altimeters every two years and then continue to maintain any other instruments in accordance with the manufacturer's requirements.
No doubt, the complexity of the instruments in any particular aircraft might influence which choice is made. To suggest that by electing Requirement 1, the other instruments can be ignored, is dangerous. Yet that is what Mr Snook understands the requirement to be. In our opinion, Mr Snook's capacity to understand maintenance requirements from documents is seriously deficient and it causes us grave concerns.

[139]

Although this incident could not be described as serious, it is indicative of the way in which Mr Snook seems to approach maintenance work.
Mr Snook explained that the aircraft, which was part of a water-bombing operation in Western Australia, was on standby. He had conducted a 100- hourly inspection and the aircraft apparently was not flown for about six months. Because the fire season was returning, he was asked to go and look at the aeroplane to make sure it was still in good order. When Mr Snook turned the master switch on in the aircraft, he noted that the interrogating light on the transponder began flashing. It caught his attention because he was aware that the light does not ordinarily flash when the aircraft is powered up.
As it turned out, the reason the light was flashing was that the transponder had been left on when the aircraft was previously shut down and the interrogating light came on because the transponder was functioning. Mr Snook said that after he had completed his checks and returned the aircraft to the hanger to work on it, he wrote into the worksheet the fact that the transponder appeared to be malfunctioning.
While working on the aircraft, a radio-qualified LAME was also in the hangar and he asked that person if he would check the transponder. The LAME turned the transponder on, checked it and said it was functioning normally. Therefore, having written the problem down on the worksheet, Mr Snook, signed off the worksheet in order to clear it. Mr Snook was aware that his AME licence did not cover radios. He said that what he was doing, in effect, was crossing out an entry which should not have been made in the first place.
Under cross-examination Mr Snook was asked whether he agreed that the work done on the transponder fell within the radio category. His response was: Well it is and it isn't, I suppose. He agreed that he had told Mr McDonnell, when first asked about this matter, that he had carried out an operational check after identifying the problem and found the transponder operating correctly. However, as Ms Macdonnell said, he now seemed to have changed his evidence about that.
In his evidence-in-chief, Mr Snook referred to a radio qualified aircraft maintenance engineer checking the transponder and confirming it was serviceable. Ms Macdonnell then asked him why he did not get that engineer to certify the completion of that maintenance. Mr Snook said there was no work there, nothing was carried out and he was just signing off the worksheets because he knew it was serviceable.
Ms Macdonnell asked Mr Snook whether he was aware that he could not just put a line through that entry, particularly as the worksheets were subsequently attached to the logbook. Mr Snook said that if he put a defect on the worksheet, and he found it was not applicable, he would put a line through it. He then suggested he could put whiteout (correction fluid) over it because it was not applicable. The worksheet had not been put in the logbook at that time and in his view, it only formed part of the logbook when that was done.
Ms Macdonnell pointed out to Mr Snook the general instructions for making entries in the logbook and particularly the requirement that no entry is to be obliterated or erased by any means; and that the use of correction fluid is not permitted. He agreed with that. Mr Snook nevertheless maintained that he could make a change to the logbook if he initialled it and certified the change. When Ms Macdonnell said that he needed to identify why the entry was incorrect, he agreed. When Mr Snook was asked to agree that he should not have signed off that entry in the maintenance sheet, he made the following extraordinary statement:

[141]

The issue with this item is not whether Mr Snook conducted maintenance on a radio component of the aircraft. Rather, it goes to the very heart of his understanding the certification of completion of maintenance process. Despite not being qualified to certify for the completion of maintenance in the radio category, Mr Snook could see nothing wrong with making such a certification. The problem with this type of attitude and approach to the certification of completion of maintenance is that no operator of the aircraft can be certain that when a maintenance release is issued for a particular aircraft, its state of airworthiness is accurately described on that document.
As the Tribunal has previously noted in aviation maintenance matters, the breakdown of the system of certification of completion of maintenance is a very serious matter indeed. There is no other means by which it is possible to determine whether all maintenance required to be performed on an aircraft has been performed. Furthermore, Mr Snook's view that he could cross out the entry and initial it is nothing short of remarkable. It would not tell the operator of the aircraft anything about the serviceability or otherwise of the transponder. Clearly, Mr Snook should have had a radio-qualified aircraft maintenance engineer certify completion of that entry by stating the that the flashing ident light simply indicated normal operation.
When it was put to Mr Snook that even a functional test had to be performed within a particular category of maintenance, Mr Snook replied that he could do it as a pilot. He said: I'm licensed to carry out that particular action as a pilot. He said that if he put in his pilot licence number against his signature that might have met the requirements. Then, shortly after Ms Macdonnell pointed out he had previously said that as a pilot he could not certify it was serviceable, he agreed that he was confused.
Again, this highlights Mr Snook's lack of understanding of the CARs dealing with maintenance of aircraft. Schedule 8 of the CAR sets out maintenance that may be carried out on Class B aircraft by a pilot entitled to do so under CAR 42ZC(4). Of course if a pilot does not hold an AME licence endorsed for the radio category, the only basis upon which he could do maintenance under CAR 42ZC(4) is under the supervision of an engineer who holds that endorsement. He could not certify completion of that maintenance. In any event, not one of the items listed in Schedule 8 refers to checking the serviceability of radio equipment.

[146]

Mr McDonnell was so concerned with the deficiencies he noted following the audit of the maintenance records of NIN that he caused a Direction to be served on the registered operator of the aircraft under CAR 38(1). Mr McDonnell said that his Direction required a comprehensive compliance audit of the other PZLM-18 aircraft operated by the registered operator to check compliance with the manufacturer's maintenance requirements and all ADs. He set out his findings in relation to aircraft NIN and said that those findings led him to believe that the maintenance requirement for the other PZLM-18 aircraft belonging to the registered operator may be in a similar state.
Mr Robert Poynton carried out the compliance order. Mr McDonnell said that in the course of carrying out that order, Mr Poynton told him that the logbooks were a shambles and that he was having difficulty in determining what maintenance had been done and what was required. According to Mr McDonnell, Mr Poynton said he could not determine the service life of some components and that to eliminate confusion he had recommended that those components be tested in accordance with the manufacturer's requirements. Mr McDonnell issued a further Direction under CAR 38 to the registered operator requiring the components referred to in PZL service bulletin E/02. 142/91 to be serviced.
Mr McDonnell found a number of other deficiencies when conducting his audit of aircraft NIN. We have not referred to every item but that is not to say that those discrepancies are not relevant. They support the picture already developed by Mr McDonnell regarding the servicing of this aircraft. It was, in our view, seriously unsatisfactory. In fact, CASA was so concerned with Mr Snook's non-compliance with the CAR that it decided to do further audits of aircraft maintained by him. It audited the records of aircraft VH-EHK, VH-ZRR, VH-KZE and VH-FJU.
According Mr McDonnell, those audits confirmed the endemic nature of Mr Snook's non compliance with the CAR. The results of those audits are discussed below.

[147]

After Mr McDonnell had reviewed the maintenance documents of the Dromader aircraft, he contacted Mr Snook on 2 September 2008. He asked if he could attend Mr Snook's maintenance hangar to discuss his findings and to collect further maintenance documents. According to Mr McDonnell, Mr Snook became very defensive and asked if there were problems. When Mr McDonnell told him there were, Mr Snook indicated that he shouldn't say anything until he had spoken to his lawyers but he nevertheless indicated he believed CASA was harassing him and wanted more logbooks simply to find more problems.
According to Mr McDonnell, Mr Snook told him he believed CASA intended to destroy his business and if that was the case, Mr Snook did not want Mr McDonnell to attend his premises. He also told Mr McDonnell he planned to call the police because he would not allow CASA to destroy his business. A police officer from the Murdoch Police Station subsequently contacted Mr McDonnell, indicating they had received a telephone call from Mr Snook.
On 4 September 2008 when Mr McDonnell attended Aeronautique's maintenance facility at Jandakot, he did so with two police officers from the Murdoch Police Station. They believed they needed to be present in order to keep the peace. On arrival at Aeronautique's hanger, Mr McDonnell found the hangar door locked and Mr Snook did not appear to be present. Mr McDonnell called Mr Snook by telephone and told him that he was at the hangar. He had advised Mr Snook of his intention to examine further documents in a faxed letter the previous day. Mr Snook told Mr McDonnell he had not received his fax and he refused to attend the hangar to open it up. This resulted in CASA issuing a notice in writing to Mr Snook under CAR 301, to surrender his job register and the aircraft maintenance release book to CASA. On 10 September 2008, Mr Snook delivered the documents requested to CASA's Perth office.
On 20 November 2008 Mr McDonnell concluded a review of the maintenance records of aircraft EHK. He found a number of problems with those maintenance records, namely, failure to:
- (a) carry out a test flight following replacement of the diaphragm in the gear backup extender actuator;
- (b) enter details of a check flight in the aircraft maintenance release, following adjustments made to engine a maximum rpm;
- (c) comply with the logbook instructions regarding the AD compliance list;
- (d) maintain the aircraft in accordance with approved data for the aircraft arising from failure to comply with the manufacturer's service bulletins and failure to record those bulletins in the logbook;
- (e) maintain engine flexible fuel lines, the vacuum pump and auxiliary vacuum pump in accordance with the maintenance manual;
- (f) comply with CAR 42ZE and Schedule 6 of the CAR regarding certification for the co-ordination of maintenance; and
- (g) comply with CAR Schedule 6 requirements by not including aircraft TTIS or the name of the CoA holder on the certifications.
In his oral evidence, Mr Snook agreed that he did not carry out a test flight following the replacement of the diaphragm gear backup extender actuator. According to Mr McDonnell, paragraph 6.14a of the maintenance manual for that aircraft mandates a test flight and it sets out the specific tests and parameters that the system must meet to be serviceable. In the worksheet for job number 2392, which was attached to the aircraft logbook, the item was listed at number 2. The rectification details read:

[152]

When further asked about this maintenance, Mr Snook said that he used his experience and a variety of means to achieve the result. He said he made an educated guess as to the most practical means to an end. He then said: I don't follow the maintenance data religiously, no. He said that he chose a method to reach the same end, based on his 40 years experience as an aircraft maintenance engineer.
The above exchange during his cross-examination was, in our opinion, indicative of the way Mr Snook deals with maintenance problems in the course of conducting his business as a CoA holder and as a LAME. It is, in our opinion, a seriously unsafe method of conducting aircraft maintenance. There is a world of difference between testing a component on the ground and testing it in flight, especially with respect to the landing gear. While the parties did not provide us with the details of the test parameters set out in the maintenance manual, it is reasonable to infer that those parameters are likely to have included particular airspeeds and possibly various altitudes. It is also likely that there were other flight parameters under which the landing gear needed to be tested. Mr Snook did not consider any of this to be relevant. Accordingly, we find that, as in many other areas where Mr Snook has conducted maintenance, his performance of maintenance was not only unsatisfactory, it was also unsafe.
The second issue identified by Mr McDonnell was an entry made in worksheet number 2332, indicating a test flight was required after adjusting the constant speed unit. The rectification details included adjustment of the constant speed unit to 2,700 rpm. However, there was no evidence that the aircraft was flown. Mr Snook issued a maintenance release, number 88499, following that work. The first entry on the maintenance release is by a Mr Millar, dated 1 August 2008, and it states No FLT.
Mr Snook did not respond directly to this claim by CASA, although in his final submissions, Mr Ribbands put it down to clerical error or a certification error. With respect to Mr Ribbands, when viewed in the context of the way in which Mr Snook has conducted other maintenance, it is far more significant than that. It is a clear failure to comply with the manufacture's maintenance requirements. Furthermore, Mr Snook nevertheless issued a maintenance release following that purported maintenance work. By doing so, he has clearly misstated the airworthiness of that aircraft.
Mr McDonnell also identified no fewer than 33 ADs which were relevant to the Piper PA-28 series aircraft (which includes EHK), that were not included in the AD compliance statement in the aircraft logbook. Although Mr McDonnell conceded that some of those ADs might not be applicable to this particular aircraft, there is no record in the logbook to indicate that to be the case.
Mr Snook said that he continued the previous maintenance organisation's practice of maintaining a list of ADs in the logbook issued in respect of PA-28 aircraft, when he took over the maintenance of EHK. However, when questioned further, it was clear that he had not maintained that list. In fact, he referred to it as about 40 pages of non-applicable information. This is despite the fact that the instructions for the completion of the logbook indicate that the reason for non-applicability of airworthiness directives, which are applicable to the aircraft/engine but not applicable to the aircraft/engine to which the logbook applies (emphasis added), must be stated and certified. This is clearly what the previous maintenance organisation had done. Mr Snook's reason for not doing so was that he thought it was non-applicable data and that it would involve research; which it appeared he was not prepared to undertake.
As the instructions for the completion of loose-leaf logbooks provide, non- recurring ADs must be entered in that part of the logbook. The general instructions are made under the CARs and accordingly, should be treated as subordinate legislation. If the AD does not apply to the particular aircraft, then, as the instructions state, the reason for non-applicability must be entered as per general instruction (k). It appears to us that Mr Snook was not aware of this requirement at all.
Mr McDonnell noted that Mr Snook was not maintaining the aircraft in accordance with approved maintenance data because there were at least three service bulletins which applied to the aircraft, and there was no indication in the logbooks that the maintenance referred to in those bulletins had been carried out. Mr McDonnell identified the following bulletins:
- (a) number 1178 - nose gear forging inspection/replacement - issued 24 September 2007;
- (b) number 1187 - voltage suppressor replacement - issued 8 February 2008; and
- (c) number 1191 - Precision Airmotive service bulletin PRS-107 Rev 1 - issued 7 March 2008.
When questioned about this requirement, Mr Snook gave a most extraordinary explanation. In his view, unless CASA issued an AD mandating the application of a particular service bulletin, service instruction or service letter, then that document did not form part of the approved maintenance data for the aircraft. He said that was the view he has held since he came to Australia in 1981. He said that Aeronautique did not subscribe to service bulletins, service letters or service instructions. He did say that aircraft owners sometimes produced service bulletins and asked for the maintenance in those bulletins to be carried out. In that case, he would comply. Otherwise, he would not carry out the service bulletin unless CASA had issued an AD in respect of that work. He also agreed that he had probably issued maintenance releases without having carried out the relevant work which had been promulgated in service bulletins, service instructions or service letters.
There was no dispute that the logbook statement at Part 1 clearly states that the certificate of registration holder had elected to service time-lifed components in accordance with the Airframe Maintenance Manual Latest Revision. That also applies to the engine.
The expression maintenance instruction is defined in CAR 2:

[163]

Mr McDonnell noted that in the recurring maintenance control for EHK, flexible hoses were said to require replacement after either three years or 1000 hours. Although Mr Snook carried out maintenance on EHK in September 2007 and June 2008, he simply put a stroke in the box under flexible hoses, indicating that that he had not carried out the maintenance. It appears from the first entry on the recurring maintenance control sheet that inspection for those items was due after 6097 hours. The last inspection conducted by Mr Snook was at 6100.3 hours TTIS. Therefore, that maintenance was overdue. Mr McDonnell also noted that maintenance of the auxiliary vacuum pump was not mentioned in the recurring maintenance control sheet and therefore he was unable to locate certification for the replacement of that item, assuming of course that it was time-lifed.
Despite what is recorded in the recurring maintenance control sheet regarding flexible hoses, Mr Snook said he had investigated the problem of flexible hoses and that research led him to believe that no matter what kind of flexible hose was fitted to an aircraft, the best thing to do is to stick to 5 years, and that's what we've adopted. When asked whether there was anything in the CAR which supported this view, Mr Snook said there was not. He did agree that his worksheet for job number 2392 had an entry relating to flexible oil lines and fuel lines (1000 hours) but that task had not been completed because it was not applicable. That was because the hoses referred to in the recurring maintenance control manual were no longer fitted to the aircraft. It is not clear how Mr Snook established that. He reasoned that because the aircraft had done 6000 hours it would have had the hoses changed on many occasions.
Mr Snook then proceeded to mention that CASA had issued ADs in respect of flexible hoses but that those had since been cancelled and this put the entire decision-making process into disarray. We did not understand what Mr Snook was saying. He agreed eventually that he assumed the hoses were not the manufacturer's original hoses. While that might be evident given the hours flown by the aircraft, it does not mean that the manufacturer's approved flexible hoses were not being used on the aircraft. Mr Snook was asked whether he may have overlooked the entries on the recurring maintenance control page and he responded that he would have noticed and disregarded them.
Mr Snook was also referred to his worksheet for job 2392, where the flexible oil lines and fuel lines are entered in the defects/rectification column with 1000 hours in brackets beside those entries. When asked why he wrote the figure 1000 there, Mr Snook said he was simply recording information. When asked what it meant, and when the 1000 hours would run from, he responded I have no idea. Mr Snook said that the information on the control page should have been deleted long ago because the requirement for replacement of the flexible oil lines and fuel lines after 1000 hours had gone.
Mr Snook was then referred to the alternative vacuum pump and he said that component was not fitted to the aircraft. Furthermore, the vacuum pump that was fitted to the aircraft was not governed by the requirements of the aircraft manufacturer's manual because it was not one either prescribed or made by the aircraft manufacturer. He said that those items should have been scratched out or removed from the logbooks.
As we understood Mr Snook, he was of the view that where original aircraft components have been replaced with components from different manufacturers, the manufacturer of those components might stipulate a different service life for their components. Where that is the case, Mr Snook seemed to be suggesting that those components should be maintained in accordance with the component manufacturer's stated service life. However, when he was asked whether there was anything in this aircraft logbook which indicated that a replacement part had been fitted with a different service life, he was unable to point to anything.
The problem with Mr Snook's understanding is that it overlooks the logbook statement in Part 1, which clearly states that component service lives are to be in accordance with the Airframe Maintenance Manual Latest Revision. While it is true that where a component manufacturer issues a maintenance instruction which applies to a component fitted to the aircraft, that instruction is taken to form part of the manufacturer's maintenance schedule, it would need to be recorded in the logbook.
If CASA had issued ADs regarding flexible hoses, whether they are for fuel, hydraulic fluid, oil or some other liquid, compliance with the ADs would be mandatory. Where an AD is subsequently cancelled, the maintainer of the aircraft is bound by what is set out in the logbook statement Part 1, which might include instructions issued by an aircraft component manufacturer.
On examining Aeronautique's worksheets for the 100 hourly inspection of EHK conducted on 25 June 2008, Mr McDonnell noted that persons other than Mr Snook conducted categories of that maintenance. This work involved the instruments category, which is not covered by Mr Snook's AME licence. According to Mr McDonnell, the categories of maintenance performed in the course of conducting the 100 hourly periodic inspection needed to be co-ordinated in accordance with CAR 42ZE and Schedule 6 of the CAR.
CAR 42ZE(1) provides that:

[176]

It was apparent to us from the evidence that Mr Snook was not comparing the maximum allowable oil consumption of this aircraft with the oil consumption figures he obtained from the operator. He was simply recording what the operator told him. Despite that, Mr Snook was certifying for the completion of maintenance in accordance with the AD and issuing MRs without knowing the true condition of the engine. Records of oil consumption or oil added were kept between March 2007 and November 2007. In that period, the aircraft flew 100 hours. It appears that 8 litres of oil was added over that period. That corresponds to a usage rate of .08 litres per hour.
In his evidence, Mr McDonnell expressed concern that if engine consumption in August 2008 had increased to .5 litres per hour, the increased usage would warrant investigation. In our opinion, that seems to be a reasonable conclusion to draw, particularly where there appears to have been no measure made against the maximum allowable oil consumption for this engine.
AD/LYC/78 Amdt 5 deals with the thermostatic oil cooler bypass valve. This AD is recorded in the recurring airworthiness directive control sheet and it dictates an inspection interval of 600 hours. Mr McDonnell said that the AD requires an inspection at 300-hour intervals for engines fitted with dual magnetos and 600-hour intervals for non-dual magneto engines. The control sheet does not indicate that any inspections have been made of this item since installation in November 1999.
When conducting maintenance on this aircraft on 22 November 2007, Mr Snook entered the AD on the worksheet under job number 2346. In the compliance details, he noted NA (not applicable) and he added 300 hours and the word noted. He also added the words ref dual mags. In other words, Mr Snook indicated that the inspection was at a 300 hourly interval because the aircraft was fitted with dual magnetos. However, as Mr McDonnell pointed out, according to the engine logbook, the engine is fitted with two single magnetos and therefore the 600-hour interval applies.
The recurring airworthiness directive control sheet indicates that between 26 September 2000 and 19 September 2007 the aircraft had flown some 1,150 hours. Mr Snook conducted the 100 hourly inspection on 22 November 2007 and although he entered AD/LYC/78 Amdt 5 on the worksheet, he noted it was not applicable. That was clearly incorrect. Nevertheless, on the same day, Mr Snook issued maintenance release number 69246, indicating that the aircraft was airworthy; when that was not in fact the case.
Mr McDonnell also claimed that Mr Snook had failed to complete the aircraft's records in accordance with the logbook instructions, which provide for the recording of components fitted, airworthiness directives and special inspections or modifications carried out. Mr McDonnell listed numerous airworthiness directives issued by Cessna, relating to the 188 Series aircraft and issued by Lycoming, relating to the engine. A number of those ADs are not listed in the logbook. Mr McDonnell has also listed all the service-lifed components set out in the Cessna 188 Maintenance Manual. There was no record in the logbook of those components being serviced in accordance with the maintenance manual. Mr Snook agreed that the company previously maintaining the aircraft did not include any details of work carried out during inspections between August 2004 and March 2007.
It is clear from the logbook that on 20 September 2007, the TTIS of the aircraft was 7,199.4 hours. When Mr Snook first conducted a 100 hourly inspection on the aircraft on 22 November 2007, the TTIS was 7,295 hours. When Mr Snook was asked whether he should have checked the components listed by Mr McDonnell for maintenance in accordance with the service manual, he agreed that there was no record of any information being recorded prior to him conducting maintenance. He agreed that the inspections referred to by Mr McDonnell should have been carried out. He agreed that where there was no evidence of something having been done, he would go to the next time interval and conduct the servicing at that time. Mr Snook said there was no other way to do it. According to Mr Snook:

[179]

In his audit of the maintenance documents dealing with this aircraft, Mr McDonnell identified four items which he said failed to comply with the CAR. Mr McDonnell found that Mr Snook had not:
- (a) complied with Schedule 6 of the CAR by failing to certify the co-ordination of stages of maintenance where more than one person had certified for the stages;
- (b) complied with the CAR Schedule 6 requirement indicating that he had complied with airworthiness directives applicable to the aircraft;
- (c) ensured that the records he was making were accurate; and
- (d) completed the aircraft's records in accordance with the logbook instructions regarding the recording of components fitted, airworthiness directives, special inspections or modifications carried out.
As for the requirement to certify the co-ordination of maintenance, this arose because of the requirement to replace all aileron cables. In the 100 hourly inspection conducted by Mr Snook on 26 April 2007, his worksheets record that he replaced all aileron control cables. Mr Brad Thompson conducted the second inspection of that work. However, Mr Snook did not certify the co-ordination of those stages of maintenance, as he was required to do under Schedule 6 of the CAR.
Ms Macdonnell took Mr Snook to the page in the logbook which was used for recording component changes. She asked Mr Snook why, there being a component change record, he did not enter details of the aileron cable change in the control record. Mr Snook then embarked upon an explanation as to why an aileron cable was not a component of an aircraft.
Putting that explanation to one side for a moment, it may be that Mr Snook was confused by Ms Macdonnell's suggestion that an aileron cable change warranted an entry in the component change record. Instructions for the use of s 3 of the logbook dealing with the component change record make it clear that s 3 is used to record installation and removal details of components attached to the engine. It then gives some examples of those components. Obviously, an aileron cable is not a component attached to the engine. That is certainly not the place to record that component change.
However, the aileron cables are clearly time-lifed components. They are subject to 100 hourly and 500 hourly inspections but they must be retired from service after 800 hours. The expression time-lifed aircraft component is defined at CAR 2 and it means:

[186]

An aircraft component does not include any part, equipment or apparatus for an aircraft in respect of which a direction is in force under CAR 2(2). CAR 2(2) provides that CASA may direct that any part, equipment or apparatus for an aircraft shall, for the purposes of the CAR, be deemed not to be an aircraft component. That has not been the case in respect of aileron cables.
In worksheet number 2413, Mr Snook had listed AD/Cessna 188/20 Amdt 1 requirement 2(a). He simply noted Aileron Control Cables. When asked about this in cross-examination, and in particular how somebody reading the logbook entry could understand what the outcome of the examination was, Mr Snook said he had signed it off and therefore the cables must have been found to be serviceable. He said if that was not the case, he would have identified the defect. Although that might be an assumption which Mr Snook would make, the entry he made certainly does not comply with Schedule 6 of the CAR and a different maintenance organisation may well wish to know what was done, if anything.
In the compliance details for that work, Mr Snook had only entered the time in service, ie. 297.5 hours. As Mr McDonnell said in his evidence, this certification does not comply with Schedule 6, paragraph 4.4(l). What Mr Snook was required to include under that detail was a statement setting out any defects found when complying with the AD.
Mr McDonnell also noted that there was a discrepancy between the last entry on maintenance release number A69241 and the hours stated in the logbook. The maintenance release understated the hours by 6.3. This is not the first occasion on which Mr Snook had made an error in transcribing total time in service of the aircraft from the logbook to the next maintenance release.
Mr McDonnell was critical of the fact that Mr Snook was not completing any of the control pages for components fitted, airworthiness directives, special inspections or modifications. Under cross-examination, Mr Snook agreed that he had not continued to make entries in those control pages. He agreed that the aircraft had flown 298 hours while being maintained by him since 26 April 2007. He was asked why the air-filter and the hydraulic dispersal system were not replaced after 200 hours, in accordance with the Cessna 188 maintenance manual. Mr Snook suggested that the only reason it was not recorded in the logbook was because the pilot most probably changed it. When it was put to Mr Snook that the pilot appeared to have endorsed an oil change, he agreed there was nothing else recorded in the logbook.
Despite the fact that he had no evidence that the air-filter and the hydraulic dispersal system had been replaced, Mr Snook signed the maintenance release for the aircraft on 26 August 2008. When it was put to Mr Snook that his failure to make the entries did not satisfy his legislated responsibilities, Mr Snook agreed that he had not complied in that particular case. As to the incorrect time entered in the maintenance release from the logbook, Mr Snook explained that it was a clerical error.
Again, although some of Mr Snook's failures to comply with the CARs seem to be relatively minor, these are all matters which indicate Mr Snook's lack of awareness of his responsibilities and duties under the legislation, when conducting maintenance on aircraft.

[189]

Mr McDonnell said that the maintenance manual applicable to this aircraft set out a number of special inspections but there were no entries in the logbook indicating that those inspections had been carried out. They included 400 hourly checks relating to the engine valves and components associated with them and 500 hourly inspections of the oil cooler and landing gear mounts.
When it was put to Mr Snook that those inspections should have been carried out on the first occasion he conducted a periodic inspection of the aircraft, Mr Snook said that would only be the case for the engine valves and components if the engine had done 400 hours. When it was pointed out to him that the logbook contained no entries that those inspections had been carried out, Mr Snook suggested that possibly the engine had not done 400 hours.
However, an inspection of the logbook revealed that the engine had done substantially more than 400 hours since the last inspection**.** The operational record of the engine disclosed that it was removed and overhauled when the TTIS of the aircraft was 1,984 hours. The engine was overhauled and returned to the aircraft on 19 June 1975. The 100 hourly inspections carried out by prior maintainers indicate that by 17 October 1992, the aircraft's TTIS was 3,325 hours. The logbook then contains further periodic inspections (prior to Mr Snook commencing the maintenance of this aircraft) in December 1993, June 2003 and December 2004.
There is no record that, in the course of any of those periodic inspections, special inspections were carried out although the aircraft had flown some 1,429 hours following the overhaul of the engine. It was therefore not open to Mr Snook to suggest that he did not have the means available to determine whether those special inspections had been carried out.
Mr Snook also suggested that those items might be covered under Schedule 5 of the CAR. While the action required to be taken under Section 2 of Schedule 5, dealing with the engine, is to drain the oil cooler and to refit and secure the hose, there is no requirement to clean and check the oil cooler.
Mr Snook also suggested that the special inspection requiring a check of the landing gear mounts would be covered under Schedule 5. Mr Snook may be correct in that Schedule 5 requires an inspection of the undercarriage attachment to the airframe. Nevertheless, as Mr McDonnell said, those special inspections needed to be recorded in the logbook, certifying that maintenance in accordance with the special instructions had been completed.
Mr McDonnell also referred to a number of components for which there were no logbook entries indicating that they had been serviced in accordance with the maintenance manual. These items required service every 1000 hours. Mr Snook agreed he had not carried out that maintenance in accordance with the maintenance manual. When Mr Snook was asked whether he referred to the maintenance manual before signing maintenance releases for the aircraft, he said that he did. However, he then attempted to explain, as far as we could understand, that the maintenance manual was out of date because the manufacturer of the aircraft had provided only minimal support.
Mr Snook said that he tried to find out whether the manual was current and he had spoken to Bunbury Flying School, where the aircraft was apparently based. However, he was unable to obtain any more current documents. Mr Snook said that, from the manual that he used, he was unable to identify the inspections Mr McDonnell said had been overlooked. He then said that Schedule 5 of the CAR guided him.
Despite the logbook statement at Part 1 indicating that all special inspections and lifed component changes listed in a schedule of airworthiness limitations and contained in the maintenance manual applicable to the aircraft, had to be complied with, Mr Snook gave the following confusing response:

[191]

When Mr Snook was asked about his questioning the validity of the logbook, he said that it was an old logbook and as far as the CASA requirements were concerned, it was not valid. He said that he was in the process of updating all the logbook statements. When he was asked if the registered owner of the aircraft had made a fresh election, he said that was correct and that the fresh election was in force at the time he commenced maintaining the aircraft. However, under cross-examination, Mr Snook agreed that in his response to CASA's show cause notice, he said: CASA are now requesting that special inspections and lifed components contained in the maintenance manual be carried out. In any event, there was no evidence before us, other than Mr Snook's statement, that the owner of the aircraft had changed the election set out in the logbook statement Part 1.
Mr McDonnell also noted that Mr Snook carried out the requirements under AD/Inst/8 Amdt 4 requirement 1 (altimeter only) on 21 December 2005 and that it was next due on 21 December 2007. Mr Snook subsequently carried out a further periodic inspection on 12 January 2007 and issued maintenance release number A58649, which expired on 12 January 2008. Because the AD/Inst/8 Amdt 4 requirement 1 was required to be completed at two year intervals, that inspection again became due within the period of validity of that maintenance release. However, Mr Snook failed to enter the AD onto the maintenance release when he issued it, as is required under Civil Aviation Orders (CAO) 100.5 paragraph 7.5. The CAO requires it to be recorded in the Maintenance Required section of the maintenance release. That did not happen.
Between 21 December 2007, when the AD was due, and 12 January 2008 when that maintenance release expired, the aircraft flew on four occasions; undoubtedly because the requirement to perform the inspection set out in the AD was not noted on the maintenance release. Because maintenance was outstanding at the time the aircraft was flown, the aircraft was not airworthy and in fact the maintenance release had ceased to be in force by virtue of CAR 47(1). Mr Snook agreed that he should have entered the pending maintenance under the AD that was due on 21 December 2007, in the maintenance-required section of the maintenance release.
The Fuji aircraft is an aerobatic trainer. It has an aerobatic fatigue life limitation, which is set out in AD/FA-200/17 Amdt 1. That AD requires the aircraft to be retired from service before achieving 1,700 aerobatic flying hours. Those hours are the hours actually spent in aerobatic flight and do not include positioning time. Prior to Amdt 1 coming into effect, the original issue of the directive referred to fatigue equivalent flying hours. The AD states that those hours may still be used but they should be divided by 1.5 to be compatible with the retirement life in the amended AD. That results in one fatigue equivalent flying hour being equal to .66 of an aerobatic flying hour.
The parties agreed that no aerobatic flight time or fatigue equivalent flight time had been recorded in the logbook between 1975 and 2005. In the course of conducting the 100 hourly inspection on 21 December 2005, Mr Snook entered the AD dealing with aerobatic fatigue life limitation on his worksheet and, in compliance, he noted total aerobatic hrs 250.
When asked how he arrived at the total of 250 hours of aerobatic flight, Mr Snook said that the first 100 hourly inspection in 2005 was done at Bunbury. When he discovered there was no record of any aerobatic hours in the logbook, he brought that to the attention of the Chief Flying Instructor at Bunbury Flying School. He told the Chief Flying Instructor that he had searched the logbook but could not find the hours recorded. He said, somehow or another, he could not remember how, between the two of them they worked out that the conservative number of aerobatic hours, based on the total flight time of the aircraft, would be in the region of 250 hours. He then said:

[199]

When pressed to explain how he had arrived at the 250-hour figure, the answers Mr Snook gave were essentially non-responsive or simply unintelligible.
As a consequence of its discovery of the Canberra Aero Club letter, CASA was concerned that the aircraft was likely to exceed its mandatory retirement life of 1,700 aerobatic hours unless further enquiries were made and an accurate fatigue life of the aircraft calculated.
Mr McDonnell directed the certificate of registration holder to determine the fatigue life of the aircraft and he grounded it until the issue was resolved. CASA subsequently made a determination based on the information provided by the owner and set the aerobatic hours at 400.
However, we should make one comment about Mr McDonnell's calculations of aerobatic hours. In his written statement of 17 August 2009, Mr McDonnell said that the Canberra Aero Club letter recorded the aircraft's fatigue life as 298 aerobatic hours. That statement is incorrect. The 298 figure relates to fatigue hours calculated by taking one tenth of the total hours less any aerobatic flight recorded, and then adding the recorded aerobatic flight. The result is the fatigue hours said to be flown by the aircraft. That calculation, in our opinion, corresponds with what is stated in AD/FA-200/17 Amdt 1, where it refers to fatigue equivalent flying hours previously calculated. If we were then to divide the fatigue hours by 1.5 as stated in the AD, that results in a figure of 198.6 aerobatic flying hours.
Regardless, we are not suggesting that Mr Snook's figure of 250 hours was sufficiently conservative to ensure that the aircraft did not exceed its limit of 1,700 aerobatic flying hours. That is because the figure calculated according to the Canberra Aero Club letter was the position in September 1975 and not the position in 2005 when Mr Snook commenced servicing the aircraft. In our opinion, he should have made further enquiries of the registered owner and, if necessary, referred the matter to CASA to seek its assistance.
Mr McDonnell also pointed out that there was a discrepancy in the aerobatic hours Mr Snook recorded when he conducted the periodic inspection on 12 January 2007. He recorded a figure of 257 aerobatic hours, when the maintenance release indicated a further 8.7 aerobatic hours flown since the previous periodic inspection in December 2005 when he recorded 250 hours. Though the discrepancy was only 1.7 hours, as Mr McDonnell pointed out, it discloses a lack of attention to detail by Mr Snook.
Mr McDonnell was also critical of some entries Mr Snook had made in the logbook in 2005, 2007 and January 2008. In a loose-leaf entry dated 21 December 2005, Mr Snook stated that he had removed and replaced the left hand and right hand magnetos. The rectification details simply state retimed LH and RH magneto. Mr McDonnell said that it was not clear whether Mr Snook replaced the magnetos or re-fitted the same magnetos.
When this was put to Mr Snook, he agreed that the word should have been refitted. The same was said of an entry on 18 January 2008 when he recorded replace LH cowl support bracket and he noted the rectification details as c/o. Again, it was not clear whether the replacement part was new, whether it was a MITCOM (manufacture of aircraft components in the course of maintenance) part, or whether it was a new part. Mr Snook recorded no details.
While this seems to be a small matter, it does lead to confusion. The word replacement indicates to the ordinary reader that another part had been substituted for the part originally attached to the aircraft. Mr McDonnell also pointed out that, in an entry made on 12 January 2007, Mr Snook referred to lower cowl repairs carried out in two places. The rectification details state repaired cowl as required. Mr McDonnell said the entry did not comply with Schedule 6 of the CAR because no approved data to carry out the maintenance was stated, as required by paragraph 4.4(f) of Schedule 6. That is correct.
In her cross-examination, Ms Macdonnell referred to Mr Snook's response to CASA's claims about his entries in the logbook and his response to the show cause notice, where he said:

[204]

These responses are typical of Mr Snook's attitude towards CASA and what he sees as minor errors. What Mr Snook does not seem to appreciate is that certification of the completion of maintenance is much more than merely a clerical task. The person maintaining an aircraft is responsible for issuing a maintenance release which is a statement to the operators of the aircraft and its crew that the aircraft has been properly maintained in accordance with the statements set out in Part 1 of the aircraft's logbook; and that every stage of maintenance has been properly completed. Without full and proper entries in the maintenance documents and in the logbook of an aircraft, there is no way that the operator or crew of an aircraft can be satisfied that it is airworthy, irrespective of the fact that a maintenance release has been issued.
In fact, the crew may be misled by the fact that a maintenance release has been issued indicating that all maintenance due on that aircraft has been properly performed. The problem is that incomplete or incorrect entries of maintenance data may indicate lax maintenance work or a lax attitude to recording that maintenance work. Whichever it is, it is unacceptable, as it compromises the safety of air navigation. The fact that Mr Snook appears not to recognise that causes us grave concern.
The final matter Mr McDonnell referred to, in relation to this aircraft, was repair of the windscreen. Photographs of that repair work were attached to Mr McDonnell's statement of 17 August 2009. Those photographs disclosed a large crack in the windscreen, on the co-pilot's side, which had been repaired by a larger patch. The patch appeared to be an oblong shaped piece of perspex, which had been fused to the outside of the windscreen. It plainly obstructs the co-pilot's view significantly.
When Mr Snook was asked whom he considered responsible for ensuring that the windscreen repair complied with statutory requirements, he said it was the person who carried out the repair. Ms Macdonnell identified the repairer as Corsair Pty Ltd, trading as Aviation Composites (Corsair). Mr Snook said that he believed Corsair conducted the repair work under its CoA. When Ms Macdonnell put to Mr Snook that the work was in fact carried out under his CoA and Corsair was a subcontractor engaged by Mr Snook, he agreed that was correct. At first blush, this may appear to be a misunderstanding of the questions which were put to Mr Snook. However, as should become apparent, it is far more than that. When asked to clarify which of his statements was correct, Mr Snook said:

[209]

Mr McDonnell said he had ascertained that the engineer who performed the work on the windscreen did not hold a licence which authorised him to perform this type of maintenance. According to Mr McDonnell, that engineer could only do the work under Mr Snook's supervision and, on the basis that Mr Snook certified the completion of that maintenance task. Mr McDonnell said when he asked Mr Snook more detailed questions about the repair, Mr Snook said he should address his questions to Corsair. Mr Snook did not appear to understand that because the 100 hourly inspection was being carried out under the authority of his CoA, and because he personally signed for the work which was performed under his supervision, he was responsible for the repairs.
Ms Macdonnell tendered copies of a search conducted on CASA's website dealing with maintenance organisations. The activity type listed for Corsair is Components Airframes. The search page of CASA's website lists the type of operations to which CoAs apply. The operation described as Components Airframes is distinct from maintenance class B. In other words, Corsair's CoA applies solely to the maintenance of aircraft components, and in particular, airframe components. It is not authorised to conduct maintenance of aircraft.
Ms Macdonnell also tendered in evidence Corsair's CoA, issue 02. Issue 02 amended the original CoA in respect of the locations at which Corsair may conduct airframe component maintenance. Those locations, which are listed in Schedule 1, simply indicate Temporary. Schedule 2 to the CoA explains that the approved activities set out in Schedule 1 are subject to the conditions set out in Schedule 2. That schedule provides that all maintenance carried out at temporary locations must be carried out in accordance with the provisions of s 5 of the Corsair Pty Ltd Quality Procedures Manual. Schedule 2 also provides that the maintenance of components is permitted only to the extent that approved data is held and for which the required tools, test equipment, skilled personnel and environmental control facilities are available. The approved activities are:

[211]

Mr McDonnell testified that Corsair's CoA was limited to the maintenance of aircraft airframe components, rather than the maintenance of aircraft. If the windscreen had been removed from the aircraft, Corsair would have been authorised to work on that as an aircraft airframe component. However, while the windscreen remained attached to the aircraft, its CoA did not cover any work on an aircraft component.
Mr Snook rejected this interpretation. However, in our opinion, it is correct. If it were not, it would permit persons with CoAs, which cover the maintenance of airframe or engine components, to work directly on those components while they remain attached to an aircraft. In order to do that work, it is likely that connections and fittings may need to be removed and replaced to allow access to the component in need of repair. The problem is that the CoA holder is unlikely to be aware of the maintenance requirements for any fittings, attachments or other components which have been dislodged or removed in order to conduct the repairs on the component in question. As a result, the airworthiness of the aircraft could easily be compromised.
Therefore, although it appears that the repair of a windscreen can be conducted without interfering with any other components of the airframe, that would not be good reason to make an exception to the rule. Accordingly, we agree with CASA that it was not permissible for Corsair to conduct repairs on the windscreen of the aircraft while it remained attached to the airframe.
Mr McDonnell agreed that the repairs could have been conducted while the windscreen remained attached to the airframe if they were conducted under Mr Snook's CoA. If that was the case, the work would need to be conducted at Mr Snook's maintenance facility and the Corsair engineer who in fact conducted the maintenance would need to certify for completion of that stage of maintenance. Because Mr Snook would be co-ordinating the maintenance, he would be responsible for certifying the co-ordination of that maintenance in the course of the 100 hourly inspection. In our opinion, Mr McDonnell is correct and his opinion accords with CAR 42ZC(4)(c).
Mr McDonnell, in a file note he made on 19 March 2009 when he interviewed Mr Snook about this repair work, said that Mr Snook did not appear to fully comprehend his comments. This was borne out in the course of Mr Snook's cross-examination. When asked whether Corsair was permitted under its CoA to work on the windscreen while fitted to the aircraft, Mr Snook responded that the CoA did not indicate whether a component could be repaired while it was fitted. In fact, Mr Snook said his impression was that Corsair was going to carry out the task while the windscreen remained fitted and that it was capable of doing that under its CoA. However, after discussion with the engineer who intended to do the work, he was told by that engineer that he (the engineer) could not sign for the repair if working under Mr Snook's CoA.
In fact, there was probably another reason why the engineer could not sign for the work. Mr McDonnell, after making enquiries of Corsair about the engineer who performed the work on the windscreen, discovered that the engineer did not hold a licence which authorised him to perform that kind of maintenance. In other words, the work could only be carried out under Mr Snook's CoA and he was required to be personally responsible for the repair work.
Mr McDonnell testified that Mr Snook told him the repair work had been carried out in accordance with FAA Airworthiness Advisory Circular 43.13 (AC 43.13). Mr McDonnell said that he compared the repair against AC 43.13 and noted that it did not comply with the approved repair schemes. He also said that it was obvious to him that the repair compromised vision through the co-pilot's side of the windscreen. In his opinion, it should have been obvious to an experienced and competent LAME that the location and size of the repair on an aircraft used for pilot training was unsafe, given its potential to obscure the vision of the student/co-pilot and the pilot.
A copy of AC 43.13 was in evidence. Mr McDonnell concluded that the repair did not comply with s 4 of A C43.13 because:
- (a) it was not minor and it was in the pilot's line of vision as described in subsection 3-40;
- (b) the repair had not been stitched as described in subsection 3-40a;
- (c) the repair had not been made using screws and washers as described in subsection 3-40b; and
- (d) subsection 3-40c does not include repairs using a doubler or patch.

[215]

Airfast Pty Ltd (Airfast) is owned by Mr Frank Fry, who is not qualified as an AME. On about 29 August 2007 Airfast applied to CASA for a CoA and provided a proposed Maintenance Organisation Manual (MOM). Mr Neal Martin was nominated as the engineering manager and Mr Snook as the senior LAME. Their names appear at Appendix 1 of the MOM under the heading Register of Appointed Persons.
According to Mr Green's written statement dated 21 July 2009, because of Mr Snook's previous history regarding the maintenance of aircraft, CASA had concerns about whether he would carry out the duties of the position in a satisfactory manner if the engineering manager was not present. Mr Green sent Mr Snook a letter dated 1 November 2007 and arranged for a meeting at CASA's Perth regional office. The purpose of the meeting was to determine whether CASA considered him suitable to hold the positions for which he had been nominated at Airfast. Mr Green said that Mr Snook was initially reluctant to attend this meeting at CASA's offices. Mr Green made a file note of that meeting. The CASA officers who attended the meeting were satisfied that Mr Snook was suitable for the positions nominated. He was also nominated as the MITCOM appointed person.
CASA issued Airfast with a CoA on 16 November 2007. Mr Martin became the engineering manager and carried out that role. Although Mr Snook denied ever having accepted the nomination for the position of senior LAME under Mr Martin's supervision, when Mr Martin unexpectedly left Airfast in May 2008, the worksheets for the 50 hourly and 100 hourly inspections disclosed that Mr Snook signed off on those inspections as the LAME. Another AME carried out the actual maintenance work.
This situation continued until a new engineering manager was appointed on 6 October 2008. Whether, as CASA contended, Mr Snook filled the role of the engineering manager or that of the senior LAME from the date of Mr Martin's departure, remains an open question. Mr Snook maintained that during that period, he was only hired as a subcontractor to assist in the maintenance operations. He also agreed in cross-examination that he did perform work for Airfast while Mr Martin was the chief engineer of that organisation. However, he continued to maintain that he did not perform that work in the capacity of the senior LAME but as a subcontracted LAME.
Mr Snook nevertheless agreed that he did sign logbook entries and maintenance releases on behalf of Airfast when Mr Martin left the organisation. Mr Snook was taken to a number of final certifications in the logbook of the aircraft VH-XAT (XAT) and he agreed that he had made the entries on behalf of Airfast. He indicated that one entry was a clerical error. The CoA number inserted in those entries belongs to Airfast. Although Mr Snook continued to deny that he acted as senior LAME in place of Mr Martin, CASA submitted that we should find he assumed the responsibilities of the engineering manager until the appointment of the replacement for Mr Martin. According to CASA, any other finding would be inconsistent with Mr Snook signing the maintenance releases for and on behalf of Airfast.
The problem with Mr Snook's responses to the questions put to him regarding his role in the maintenance structure of Airfast is that when Airfast applied for the issue of a CoA, Mr Snook agreed to be nominated as the senior LAME**.** Mr Martin was nominated as the engineering manager. In the MOM, the responsibilities of the senior LAME include the following:

[217]

Quite clearly, the position of senior LAME was established when Airfast sought a CoA because of the requirements set out in CAR 30. In particular, CAR 30(2C)(c) provides that if the certificate covers the maintenance of aircraft, approval of the CoA is subject to a condition that each of the activities covered by the certificate must be carried out under the control of a person appointed by the applicant to control the activities.
Furthermore, CAR 30(2D)(c) provides that, in relation to each activity covered by the certificate that is required by paragraph (2C)(c) to be carried out under the control of a person, the position occupied by that person must be stated. Obviously, the establishment of the senior LAME position and the nomination of Mr Snook to that position was to satisfy CASA that CAR 30 had been met. Although Mr Snook maintained that any work he did for Airfast was as a subcontracted LAME, that flies in the face of the conditions which apply to Airfast's CoA. Despite being interviewed by CASA to assess his suitability for the position, thereby holding himself out to CASA to be prepared to take on the role of senior LAME in the event that the CoA was granted, Mr Snook nevertheless maintained that he had not accepted the nomination. His reasons for adopting that position are unclear.
Mr Snook agreed to have his name put forward to CASA as the senior LAME. By doing so, he accepted that when undertaking that role, he could certify on behalf of Airfast, the maintenance performed under its CoA. He did certify on behalf of Airfast the maintenance performed after Mr Martin left the organisation. Logically, therefore, Mr Snook accepted the role of senior LAME by his conduct. His denial that he accepted the role of senior LAME appears to be because he never formally advised Airfast that he had accepted the position. That, in our view, is irrelevant. Having held himself out as being prepared to take on the senior LAME role, and subsequently having certified the completion of maintenance on behalf of Airfast, Mr Snook must be held to have accepted, by his conduct, the role of senior LAME for that CoA holder.
Mr Green, who was part of the audit team which conducted an audit of Airfast, provided a detailed account of the problems he discovered in the worksheets and logbooks of the aircraft XAT. That was the only aircraft maintained by Airfast. Mr Green said that a number of work packages were analysed including 50 hourly inspections, defect rectification, 100 hourly periodic inspections and component overhaul worksheets. The audit team also reviewed the maintenance records for XAT.
Mr Green reported that he found most jobs in the audit sample were poorly recorded and executed. Specifically:
- (a) job packages were not completed using the worksheets nominated for that purpose in the Airfast procedures manual;
- (b) Mr Snook was not certifying the completion of maintenance in accordance with Schedule 6 of the CAR. Specifically:
  - (i) he did not certify the co-ordination of maintenance where multiple engineers had completed different stages of maintenance and within different categories of maintenance;
  - (ii) in some instances, Mr Snook did certify the co-ordination of maintenance but, because he had not been involved in any one of the stages of maintenance involved in a particular task, he was not permitted to do so;
  - (iii) he did not make final certification of completion of maintenance;
  - (iv) he failed to record required information for the replacement of time-lifed components;
  - (v) there was no evidence of an independent inspection having been conducted of the aircraft flight control system as required by CAR 42G;
  - (vi) he failed to record details of replacement parts/components as required by CAR 42W(4) and Schedule 6;
- (c) Mr Snook had a practice of making entries against maintenance items to the effect that they were noted or noted NR with no certification, making it unclear as to whether the items of maintenance were in fact performed and if not why not;
- (d) there was poor tracking of maintenance requirements leading to the aircraft being released into service with new maintenance releases issued on five occasions while maintenance requirements remained outstanding;
- (e) there was a failure to carry out the work mandated by airworthiness directives;
- (f) there was non-compliance with approved maintenance data; and
- (g) there were contraventions of logbook instructions.
Many of the problems referred to above are also evident in the audits CASA conducted of the other aircraft we have referred to above. We do not intend to detail those concerns. We merely say that having examined the maintenance records referred to by Mr Green, we find his statements, regarding certification of the completion of maintenance and certifying the co-ordination of maintenance, to be correct. Furthermore, in our opinion, these failures are not mere oversights by Mr Snook but rather evidence a deeply rooted and fundamental problem with Mr Snook's approach to aircraft maintenance record keeping and his compliance with the CARs.
As a further example of this deeply rooted and fundamental problem, we refer to the worksheets for job number 1009002, which was carried out on 10 September 2008. That was a 50 hourly inspection involving multiple LAMEs in multiple categories. Mr Snook certainly performed some of those stages of maintenance because he supervised an AME who conducted some of the maintenance. As such, he was responsible for the work he supervised (Schedule 6, para 1.3). As the senior LAME at Airfast, Mr Snook was responsible for co-ordinating that maintenance.
The responsibilities of a person who co-ordinates maintenance are set out at paragraph 3.3 and 3.4 of Schedule 6. The person who co-ordinates the carrying out of maintenance must ensure that:
- each stage of maintenance is performed by a person who is permitted by CAR 42ZC to carry out the maintenance;
- certification for completion of each stage of maintenance is made by the person who performed that stage of maintenance;
- the carrying out of each stage of maintenance does not adversely affect another stage of maintenance; and
- the carrying out of the category of maintenance is completed.

[219]

There are other examples where Mr Snook signed the co-ordination of maintenance (where work had been performed in multiple categories) when he was not permitted to do so because he did not co-ordinate any of the maintenance categories nor was he the sole LAME performing maintenance in one of the categories involved on the job. For job number 080808, the certification sheet shows certification for the various categories involved in that maintenance having been signed off. Mr Snook certified none of those categories. Nevertheless, the co-ordinating certification dated 11 August 2008 bears his name and licence number. He has also purported to certify that he co-ordinated the categories of maintenance on behalf of Airfast.
Exactly the same problem arises with job number 290808, where Mr Snook signed the co-ordinating certification on 1 September 2008 although he did not certify the completion of any category of maintenance involved. Schedule 6, paragraph 3.6(a) provides that where different categories of maintenance are required to be co-ordinated, the maintenance must be co-ordinated where, (a) if maintenance is conducted within a category of maintenance by more than one person, a person co-ordinating the carrying out of the maintenance within that category or, (b) if maintenance within a category of maintenance is performed by one person, that person must be the person who certifies for the co-ordination of maintenance across the categories.
With job number 290808, there are entries in the AD and special inspection compliance sheet but no certification of the completion of a number of stages of maintenance. There was also no final certification for the completion of the maintenance involved in that job. The same can be said for job number 1009002. In fact, as Mr Green said, that job does not appear to have even been entered in the logbooks.
If, in the course of carrying out maintenance, a time-lifed aircraft component is fitted or replaced, a number of details about that component must be included in a certification of completion of a stage of maintenance. Paragraph 2.5(l) of Schedule 6 lists those requirements. Paragraph 4.4(n) repeats these requirements in respect of final certifications. Mr Snook was required to set out the number of the document that covered the supply of the component in accordance with CAR 42W(4) and, if components have been overhauled, the time in service since the most recent overhaul or the number of cycles completed by the component.
In job number 290808 the work required to be done included replacing the left hand starter and the left hand electric fuel pump (boost pump). Other than recording the serial number of the item removed and the item fitted, there is no further entry, as required under paragraph 2.5(l) of Schedule 6. The same problem arises in job number 0807006, in respect of the right hand boost pump. In job number 080808, Mr Snook replaced the left hand magneto of the right hand engine without including the proper details in the certification or completion of that stage of maintenance.
Under cross-examination, Mr Snook was referred to AD/Beech 65/62, dealing with rudder pedal arms. Under the section dealing with requirements, the AD mandates inspection of the upper portion of each rudder pedal arm for cracks, using the fluorescent dye penetrant method, in accordance with CAO 108.10. Mr Snook was then taken to the worksheets where that item was dealt with, under job number 290808. The worksheet item does not refer to the AD but states remove replace pilot LH + RH rudder pedal arms. In the rectification details, Mr Snook simply stated pilot's LH + RH rudder pedal arm assy's replaced with serviceable items. When it was put to Mr Snook that there was no reference to the number of the document that covered the supply of those new components in accordance with the requirements in Schedule 6, Mr Snook said:

[221]

Despite having said that, Mr Snook agreed that the maintenance work in accordance with the AD was part of the 100 hourly inspection. When he was asked who did the 100 hourly inspection, he agreed it was he. He also agreed that any task done in the course of the 100 hourly inspection was his responsibility. However, when it was put to him that under the 100 hourly inspection, for which he was responsible, components with an unknown history had been fitted to the aircraft, his response was: Well, that is not my problem. That is Airfast's problem. Airfast is controlling their own destiny; not me. That was despite the fact that Mr Snook agreed that he was the person who certified the completion and coordination of the entire 100 hourly inspection. Putting aside the fact that Mr Snook could not certify the coordination of maintenance and hence could not make the final certification in any event, by putting his signature on the certification sheet, as he did, he indicated a complete lack of awareness of his responsibilities and duties and the authorities granted under the CAR.
Mr Green was also critical of Mr Snook for failing to properly track the maintenance requirements for aircraft XAT, which led to the aircraft being released into service and new maintenance releases being issued on five occasions while maintenance requirements remained outstanding. Mr Green referred to the following:
- (a) AD/Beech/65/61 Amdt 4 - which required a 200 hourly inspection of the landing gear fork assembly for cracks;
- (b) AD/Beech/65/62 Amdt 3 - which required a 12 monthly inspection of each rudder pedal arm for cracks;
- (c) AD/Aircon/9 - Amdt 7 - which required an inspection of the aircraft cabin heater;
- (d) heater fuel pressure regulator due for overhaul - overrun by more than 1,000 hours; and
- (e) failure to perform a duplicate inspection of the aileron system.
Mr Snook was taken to the recurring airworthiness directive control pages of the aircraft logbook, where AD/Beech/65/61 Amdt 4 appears at item 10. The last occasion on which maintenance in accordance with the AD was carried out was 12 March 2008, when the aircraft TTIS was 4483.2 hours. As this was a 200 hourly inspection, the next occasion on which this inspection was due was when the TTIS reached 4683.2 hours. However, Mr Snook crossed out that item, stating that it was not applicable due to the serial number of the aircraft.
Mr Snook was taken to the AD, albeit Amdt 5 rather than Amdt 4. It was not suggested that the applicability was in any way altered by the updated amendment. The AD indicates that it is applicable to A65 and A65-8200 models with serial numbers LC-240 to LC-335. The serial number of XAT is recorded on the recurring airworthiness directive control as LC-327. Quite clearly, it is a model to which the AD applies. When Mr Snook was again asked why he had crossed out that item, he said:

[224]

AD/Beech/65/62 Amdt 3 is item 11 on the recurring airworthiness directive control sheets. It indicates that the inspection is due on a 12 monthly basis. The control sheet indicates that the inspection was last carried out on 9 July 2007. Mr Snook carried out maintenance on 21 July 2008 and he simply put a stroke in the box against item 11. He gave no explanation for disregarding this item.
AD/Aircon/9 Amdt 7 requires an inspection, functional test and overhaul of the cabin combustion heater. Compliance with the inspection and functional test are required at intervals not exceeding 100 hours or 24 months time in service, whichever occurs first. The overhaul requirement must be complied with at intervals not exceeding 500 heater hours since the last overhaul or eight years since the last overhaul, which ever occurs first. Mr Green explained the importance of conducting maintenance on the cabin heater. He said that a latent defect could result in excessive carbon monoxide entering the cabin incapacitating the crew. The heater is a combustion-type and is fuelled from the aircraft's fuel system.
Mr Snook made a logbook entry on what appears to be 23 September 2008, certifying that the 100 hourly inspection had been completed. Again, Mr Snook signed for and on behalf of Airfast. The logbook entry refers to job number 190908. The worksheets for that job (at item 1) refer to the 100 hourly inspection. Mr Snook signed off that entry and, although the original date appears to have been 25 September 2008, the 5 has been overwritten to make it a 3. Mr Snook also signed off item 17 of the additional worksheets by inserting: REF A.C.S. RE WORKSHEETS. The date of that entry also seems to have been overwritten to indicate that the work was completed on 23 September 2008. Another LAME certified items 2 to 9 on the additional worksheet for that job on 20 September 2008 and 21 September 2008.
The next four worksheets are headed AIRWORTHINESS DIRECTIVE AND SPECIAL INSPECTION COMPLIANCE SHEET. There are 18 entries on these sheets. All of them appear to have been completed by Mr Snook. He had certified compliance in respect of items 1 to 4 and dated those entries 25 September 2008. Again, the 5 has been overwritten by the 3. Entry number 5 simply states NOTED. RF. NR.
Item number 6 refers to AD/Aircon/9 Amdt 7. The compliance details are listed under compliance 1 to compliance 3. The compliance 1 and 2 details refer to the 100 hourly or two-year maintenance requirements under that AD. The licence number column has had correction fluid applied and Mr Snook has overwritten the word noted and written REFER A.C.S. C/O. In addition, after compliance 2, Mr Snook has added REF WORKSHEETS. C/O. Those entries are dated 23 September 2008, the 3 having been written over what appears to have been a 5. The compliance 3 requirement simply has the word NOTED written in the licence column .
The 100 hourly inspection was done in accordance with Schedule 5 of the CAR. As Mr Green said in his statement dated 21 July 2009, compliance with Schedule 5 is not a substitute for the maintenance specified in AD/Aircon/9. On the recurring airworthiness directive control for 23 September 2008, under items 26 and 27, which refer to the part 1 and part 2 compliance sections of the AD, Mr Snook has entered the initials: ACS. On the recurring maintenance control sheet, at item 16, which refers to cabin heater test, being a test at 500 hours time in service, Mr Snook has initialled it as having been completed on 23 September 2008 when the TTIS was 5292.6 hours.
Having noticed those entries in the logbook and the worksheets, Mr Green said he contacted Mr Noel Carvell, a LAME from Aviation Calibration Services (ACS), and asked him what he knew about those entries in relation to the AD. According to Mr Green, Mr Carvell said that ACS only carried out the work that was requested by Airfast; that is, the Schedule 5 inspection. Airfast did not request that ACS perform the work required for compliance with AD/Aircon/9 Part 1 & 2 and therefore it was not performed. Mr Carvell said he had not seen the text which was added to the worksheet by Mr Snook at the time he certified the completion of maintenance in the electrical and instrument categories. He said that he had run the heater as part of the CAR Schedule 5 inspection requirements. Mr Carvell noted that the hour-meter for recording heater operational hours was not reliable.
On the certification sheet, Mr Snook had certified the completion of maintenance in the airframe category and he dated that certification 23 September 2008. All of the other certifications, except for the radio category, were made on the same date. The radio category was certified on 19 September 2008. Mr Snook certified coordinating the maintenance and that entry appears to have originally been dated 25 September 2008 but was altered to 23 September 2008.
Mr Snook could not shed light on why the dates had been changed from 25 September 2008 to 23 September 2008. In our opinion, the explanation lies in the date that Mr Carvell certified the electrical and instrument categories. That was 23 September 2008. When Mr Snook was first interviewed about this matter, he told Mr Green that he heard the heater running in the hangar and assumed that Mr Carvell had carried out the AD in respect of that equipment. If that was true, then the date Mr Snook made entries against item 6 of the Airworthiness Directive and Special Inspection Compliance Sheet could not possibly have been 25 September 2008. That is because Mr Carvell certified completion on 23 September 2008. In other words, it appears as though Mr Snook has attempted to support his explanation that he believed ACS had completed the AD, by altering the date of the entries he signed off, from 25 September 2008 to 23 September 2008.
When it was put to Mr Snook in cross-examination that he had changed the entries he made at item 6 on the worksheet for job number 190908, Mr Snook categorically denied having altered those entries. Mr Snook was not shown the original worksheets in the course of his cross-examination. However, counsel provided us with the originals subsequent to his cross-examination and they were admitted into evidence. Mr Snook said this:

[228]

We find that Mr Snook has altered entries on the worksheet and his subsequent denial of the alteration is a very serious matter indeed. As Ms Macdonnell submitted, there was no basis upon which Mr Snook could assume that AD/Aircon/9 had been carried out. Nevertheless, in order to avoid criticism, Mr Snook subsequently altered the entries on the worksheet directing responsibility for compliance with the AD to ACS. This is despite the fact that he must have known that the services of ACS had been engaged solely to conduct the 100 hour periodic inspection in the electrical, instrument and radio categories. Those inspections were carried out in accordance with Schedule 5 of the CAR. We find that ACS was not engaged to complete the AD.
Clearly, the work required by the AD had not been performed. That resulted in a serious overrun of that time-lifed component. It is also significant that despite knowing that, Mr Snook issued a new maintenance release (number 73564) on 25 September 2008. In our opinion, there was no excuse for this dangerous approach to the maintenance requirements of an aircraft.
Because the hour-meter registering time in service for the heater was unreliable, Mr Green applied Note 2 of the AD and deemed the heater hours to be 50% of the time in service of the aircraft. That resulted in an overrun of that time-lifed component by more than 100%. On 6 October 2008 CASA issued an A Class Aircraft Survey Report under CAR 38, effectively grounding the aircraft until the outstanding requirements relating to the AD had been met.
Under cross-examination Mr Snook continued to maintain that ACS was responsible for performing the tasks required to satisfy the AD. He did not accept responsibility for the fact that the maintenance had not been performed. This is despite the fact that Mr Snook certified that he coordinated the maintenance involved in that 100 hourly inspection. Quite clearly, Mr Snook does not understand his responsibility for certifying the coordination of maintenance as set out in Schedule 6 of the CAR. This was borne out rather graphically by Mr Snook's response to a question from Ms Macdonnell. Her question was, if the Tribunal accepted the work required under the AD had not been carried out, whether he accepted responsibility for the aircraft being released to service. His response was:

[236]

CAR 33(1) provides that CASA may require the holder of an aircraft maintenance engineer licence to undergo an examination designed to test his or her competency as the holder that licence. CAR 33(2) provides that an authorised person (defined in CAR 2) may, at any time, inspect an aircraft or aircraft component to ascertain the competence and diligence of the holder of an aircraft maintenance engineer licence, an airworthiness authority or an aircraft welding authority. As Ms Macdonnell submitted, those regulations imply a LAME has a duty to carry out work within the scope of his or her licence in a competent and diligent manner. It requires a LAME to have adequate skill and be properly qualified to carry out the work. It also requires the LAME to be effective and it logically follows that he or she must comply with the regulations made to give effect to the statutory objective of ensuring the safety of air navigation. A LAME's duty is also to be attentive, heedful and careful in the conduct of aircraft maintenance. This necessarily means compliance with the CARs.
A CoA is issued subject to the conditions set out in CAR 30(2C). Among those conditions is the requirement that the activity which the certificate covers, must only be carried out at a place or places where the facilities and equipment necessary for the proper carrying out of the activity are available. Those places are listed in the schedule to the CoA. The activities must also be carried out in accordance with a system of quality control, which must include procedures for the control of work carried out under the certificate; the maintenance, control and calibration of equipment; and control of stores. It is also a condition that activities involving the maintenance of aircraft are carried out under the control of the person who is appointed by the applicant for a CoA to control the activities. A person must not contravene a condition to which its CoA is subject.
As CASA submitted, Mr Snook's responsibilities, as the holder of a CoA, included:
- (a) meeting the conditions set out in CAR 30 and complying with the requirements of Schedule 6 as the person who carries out the maintenance, as that expression is defined in the schedule;
- (b) carrying out maintenance in accordance with Part IVA Division 4 of the CAR; and
- (c) complying with Part IVA Division 9 of the CAR, in respect of maintenance releases and the recording of defects and major damage.
The maintenance issues on aircraft YOG, which arose because of the tailpipe becoming separated from the muffler, have been set out in detail above. It seems this incident set in train a number of investigations by CASA, regarding the conduct of aircraft maintenance by Mr Snook.
Mr Ribbands submitted that as far as his AME licence was concerned, although Mr Snook had made a number of errors, at no time did he demonstrate a wilful disregard for his obligations and compliance with the regulations. In his final submissions, Mr Ribbands accepted that the many examples and allegations of incorrect maintenance or incorrect methodology when conducting maintenance, involved recurring themes. While we agree with that submission, to be fair to Mr Snook, and because we have canvassed in some detail the evidence regarding all of the allegations, we will explain the consequences of our findings in some detail.
The incident that occurred on the flight from the paddock, where aircraft YOG made a forced landing, to Bunbury arose because the tailpipe separated from the muffler after 3.2 hours flight time, having previously been fitted to the aircraft by Mr Snook. Mr Snook was well aware of a cracking problem where the tailpipe was joined to the muffler. Mr Trotter, who welded the tailpipe back to the muffler, also made him aware that the cracking was the result of engine vibration. Despite becoming aware of the problem, Mr Snook considered that he had satisfied his duty as a LAME by replacing the muffler with its re-welded tailpipe in exactly the same way in which it had been previously fitted.
In our opinion, a competent and diligent LAME would have concluded that either there was excessive engine vibration which caused the cracking problem, or that the fitting of the muffler system was incorrect. That should have prompted Mr Snook to look for the cause of the cracking, in order to ensure that it did not recur. To illustrate the point, if a piston on the engine completely failed, it would seem that Mr Snook would understand that he had complied diligently with his duty as maintenance engineer if he replaced the piston without conducting a thorough examination to determine why the piston failed. Conducting maintenance in that way would, almost inevitably**,** lead to the failure of the replacement component.
Had Mr Snook obtained an illustrated parts catalogue for the aircraft muffler system, it would have been immediately apparent that the cracking was caused by an incorrectly supported exhaust and muffler system. Merely welding the tailpipe back to the muffler system and refitting it in the same way as it was previously fitted discloses Mr Snook's incompetence and failure to comply with his duty as a LAME. Alternatively, possibly for commercial considerations, he decided not to spend more time in determining the cause of the problem. Whichever it was, we find that Mr Snook did not satisfy his duty as an LAME to ensure the safe navigation or operation of this aircraft.
Mr Snook's examination of the aircraft when it was in the paddock, after having successfully made a forced landing, also attracts serious criticism. We find it inconceivable that a competent LAME would not have recognised that the loss of the tailpipe, the obvious discolouration of the metal firewall, and the explanation by the pilot, Mr Coxall, that he had experienced smoke in the cockpit, was sufficient reason to immediately ground the aircraft until the cause of the smoke was identified. In fact, identifying the cause of the smoke in the cockpit was a simple task. In our opinion, it defies common sense to suggest, as Mr Ribbands did in his final submissions, that there was no way that Mr Snook would have been able to determine, from the discolouration on the firewall and the missing tailpipe, that there was any significant airworthiness issue which had arisen as a consequence of the missing tailpipe.
The suggestion that the incorrect foam fitted to the underside of the carpet was the culprit and that Mr Snook could not have been expected to detect that is, with respect, an absurd diversion. The aircraft had made an emergency landing in the paddock due to smoke in the cockpit. Therefore, Mr Snook necessarily knew that there was something very seriously amiss with this aircraft. Until the cause of the problem was positively identified and proper maintenance conducted to rectify the problem, the aircraft was clearly not airworthy and that fact should have been recorded in the maintenance release by Mr Snook or by Mr Coxall.
Mr Snook is not absolved from making an entry in the maintenance release simply because Mr Coxall took that document with him to Kalgoorlie. Upon completing his inspection, Mr Snook should have contacted Mr Coxall immediately and asked him to endorse the maintenance release with a statement indicating that the tailpipe had parted from the muffler and that he had experienced smoke in the cockpit. Had that been done, no issue would have arisen for Mr Snook regarding whether the aircraft could be flown back to Bunbury.
We were not satisfied with the reasons Mr Snook gave for coming to the conclusion that the aircraft was safe to fly. In our opinion, a LAME diligently performing his duties would have concluded that the aircraft was not airworthy. That would have been the end of the matter. Accordingly, we find that Mr Snook's inspection of the aircraft and subsequent decision that the aircraft was fit to fly discloses a dangerous lack of understanding of his fundamental duties to ensure the safety of air navigation.
Mr Snook later compounded his failure by his determination not to report the incident or to record that the aircraft had suffered a defect or major damage. An aircraft suffers major damage if the damage may affect the safety of the aircraft or cause the aircraft to become a danger to a person or property. The same definition applies to a major defect. Again, it is incomprehensible to us that a competent LAME would have come to the same conclusion as Mr Snook. In his final submissions, Mr Ribbands submitted that this aspect of the incident was at best peripheral. We do not agree. The incident itself, if properly reported, would have served as a very clear warning to other aircraft operators and maintainers about the possibility of a cockpit fire following malfunction of an exhaust system that caused extremely hot exhaust gasses to impact on metal components.
The opinions expressed by Mr Snook and Mr Cain, that there was no fire in the aircraft, but rather some melting of a substandard material, are plainly incorrect**.** In fact, it is something of a diversion from the cause of the problem, which was the missing tailpipe and the decision to fly the aircraft in that condition. Mr Ribbands, in his final submissions, agreed that the material inside the cockpit was smouldering. He nevertheless submitted that was not sufficient to trigger the major defect reporting provisions in CAR 51 and 51A.
With the greatest respect to Mr Ribbands, material that is smouldering is on fire. For a matter to be reported under CAR 51A(1)(d), there need not have been a fire but merely a situation which could have caused a fire in the aircraft. The conditions experienced by Mr Coxall on that flight had already gone beyond the minimum requirements to invoke CAR 51A.
Mr Ribbands also submitted that if a chief engineer had the overall responsibility for Mr Snook's CoA, then it would be reasonable to assume that any errors of judgement which Mr Snook may have made in respect of that incident would not have been made. We cannot accept that submission. It is speculative and, having regard to the way in which Mr Snook appears to conduct his maintenance generally, probably incorrect.
All of the concerns we have expressed above regarding this incident lead us to find that Mr Snook failed in his duty with respect to a matter affecting the safe navigation and operation of this aircraft. In fact, his conduct fell so far below a reasonable standard that one would expect of a LAME that it was extremely fortunate that no lives were lost.
As for aircraft TVU, we have found that Mr Snook was not authorised to conduct the maintenance work which he conducted on that aircraft's turbine engine. Nor was Mr Snook authorised to carry out the periodic inspection under his CoA. Once again, Mr Snook's reasons for installing the engine in aircraft TVU while it was in his hangar, and his subsequent explanation about performing the work under another CoA holder's certificate, stretches credulity. His explanation, that the aircraft was originally certificated with a piston engine and that led him to believe that his AME licence and CoA authorised him to do the work, is bizarre. Furthermore, the evidence of Mr Montauban and the fact that the job was booked in for a 100 hourly inspection on 21 August 2007, some 11 months before the aircraft was brought in for maintenance, discloses the disingenuousness of Mr Snook's explanation.
In our opinion, the evidence clearly discloses that Mr Snook undertook work which exceeded the limits of the work specified in the endorsement on his AME licence. Furthermore, the conduct of maintenance on a turbine-engined aircraft at Mr Snook's facility at Jandakot was outside the conditions stated on his CoA. We do not accept that Mr Snook commenced work on aircraft TVU inadvertently. Mr Snook has been an aircraft maintenance engineer for 40 years. He knew his licence and CoA did not cover work on a turbine-engined aircraft. Accordingly, we find that Mr Snook's attempt to conduct the 100 hourly periodic inspection and the fitting of a new turbine engine in the aircraft disclosed a complete disregard for the regulations. Therefore, in conducting this maintenance, Mr Snook failed in his duty in respect of a matter affecting the safe navigation or operation of this aircraft.
The maintenance records of aircraft NIN and the other PZL M-18 Dromader aircraft are indicative of the way in which Mr Snook has conducted aircraft maintenance. In particular, they disclose his attitude towards maintenance record keeping. It was clear to us that Mr Snook regarded the recording of maintenance carried out, including certification of the completion of categories and stages of maintenance, to be merely clerical work. That is not the case.
In fact, as the Tribunal noted in Re Brazier and Civil Aviation Safety Authority [2004] AATA 313, the system of certification of completion of maintenance is a central plank in the regulations dealing with maintenance and repair of aircraft. It is essential to the safe operation of aircraft because it is the only means by which pilots or operators of an aircraft can be satisfied that all maintenance required to be performed on an aircraft has been performed in accordance with the system of maintenance which the holder of the certificate of registration has elected to use. Any breakdown in the proper recording of aircraft maintenance is a failure by the LAME to comply with his or her duty in respect of a matter affecting the safe navigation or operation of an aircraft. It is not a minor clerical matter.
CASA listed no less than eight failures on Mr Snook's part, as a LAME and a CoA holder, to comply with the CARs dealing with the maintenance of aircraft. Mr Snook's explanation for those failures, in many instances, is difficult to comprehend. He appears to read into a maintenance requirement whatever he thinks is appropriate. He certainly does not follow a maintenance schedule as it is written.
For example, where the updated maintenance schedule set out different requirements for maintenance than those set out in the old maintenance schedule, Mr Snook maintained, on a number of occasions, the schedules were identical. We do not know why Mr Snook seems unable to follow maintenance documents but whatever the reason; it is of serious concern to us.
Mr Snook's misunderstanding of the applicability of Service Bulletin E/02. 142/91 was also of major concern to us. Mr Snook focused on one paragraph under the heading Applicability and concluded that because the service life of aircraft which have flown fewer than 3000 hours since new could be extended to 3000 (plus 10%) flying hours without performing additional procedures, that meant the Service Bulletin only came into effect at 3000 plus 300 hours. Therefore, as far as Mr Snook was concerned, the service life limits of accessories, parts and rubber elements did not come into effect until that time. The Service Bulletin referred to additional procedures but it seems Mr Snook did not understand that was a reference to the procedures for extending airframe life. For reasons which remain unclear to us, Mr Snook believed that was a reference to periodic maintenance.
In his final submissions, Mr Ribbands disputed CASA's contention that compliance with service bulletins issued by an aircraft manufacturer was mandatory. He said that the evidence of Mr Snook and Mr Cain was to the effect that service bulletins are not mandatory. He submitted that in the past, CASA had a practice of issuing an airworthiness directive when it required mandatory compliance with the manufacturer's service bulletins. Therefore, in the absence of an AD, the service bulletin was not mandatory. He suggested that this position had changed in recent times so that compliance with service bulletins emanating from the country of manufacture of the aircraft was mandatory.
Ms Macdonnell rejected Mr Ribbands' submissions and indicated that they were a misstatement of the law and the evidence given in this matter. She submitted that the requirement to comply with the manufacturers' service bulletins was not a recent change and that there was no evidence to support his submissions to that effect. Ms Macdonnell pointed out that even Mr Cain conceded that the current position has existed since the CAR was first made in 1988. In our opinion, Ms Macdonnell's submissions are clearly correct.
CAR 42V requires a person carrying out maintenance on an Australian aircraft to ensure that the maintenance is carried out in accordance with the applicable provisions of the aircraft's approved maintenance data. The expression approved maintenance data is defined in CAR 2A. It means, amongst other things, any other instructions approved by CASA under subregulation (4). CAR 2A(4) provides that for the purposes of CAR 2A(2)(e), CASA may approve instructions relating to how maintenance on aircraft, aircraft components or aircraft material is to be carried out.
According to Mr Ribbands, the reference to applicable provisions in CAR 42V(1) connotes the existence of inapplicable provisions of the aircraft's approved maintenance data. In other words, provisions that might seemingly exist would form a part of the approved maintenance data but which are not applicable for the purposes of carrying out the maintenance. In order to determine which parts of an aircraft's approved maintenance data are applicable, according to Mr Ribbands, one reverts to the definition contained in CAR 2A.
Therefore, according to Mr Ribbands, referring to CAR 2A(2)(c), service bulletins which specify how maintenance on aircraft or components is to be carried out would fall within the definition of approved maintenance data. However, CAR 2A does not include or otherwise make mandatory a service bulletin promulgated by a manufacturer of an aircraft that stipulates that maintenance ought to be done.
With all due respect to Mr Ribbands, that is not quite correct. CAR 2 defines maintenance instruction to mean an instruction issued by the manufacturer of an aircraft, aircraft component or aircraft material but it does not include an instruction issued by a manufacturer or designer if it is clear from the terms of the instruction that the manufacturer or designer regards compliance with the instruction as optional. Therefore, where a service bulletin clearly states that compliance is optional, then that service bulletin would not form part of the manufacturer's approved maintenance data for the purposes of CAR 2A.
Otherwise, a service bulletin setting out instructions about how maintenance on the aircraft, components or material is to be carried out, does form part of the approved maintenance data and a person carrying out maintenance on an Australian aircraft, where the registered owner of the aircraft has elected to use a manufacturer's maintenance schedule for the aircraft's maintenance, must comply with that instruction if the instruction applies to the aircraft in question. Service bulletins will usually set out, by some form of identification such as serial numbers of aircraft, to which aircraft the bulletin applies. For example, service bulletin E/02 142/91 expressly states that it is for PZL M18, M18A and M18AS Dromader aircraft. That service bulletin also refers to particular aircraft serial numbers to which the bulletin applies.
Therefore, where CAR 2A refers to the applicability of maintenance of the aircraft, that is a reference to the specific aircraft in question. The bulletin of course may not cover that particular aircraft because of its serial number or particular model number. Whether the bulletin should be regarded as approved maintenance data depends on whether the manufacturer regards compliance with the instruction as optional. If the manufacturer does not regard compliance as optional, compliance is not optional; it is mandatory.
We cannot accept Mr Ribbands' submission that, in the absence of an AD, compliance with a service bulletin is not mandatory. Mr Ribbands submitted that CASA issued an AD in circumstances where it required compliance with a service bulletin and that this action was taken pursuant to CAR 2A(4). There was no evidence before us that that was the case. In fact, all of the ADs to which we were referred and of which we have obtained copies, are ADs made under the CASR 39.001. Those ADs expressly state that they are made under the CASR 39.001. They are not instructions approved by CASA under CAR 2A(4).
In fact, CAR 2A(4) provides that CASA may, for the purposes of CAR 2A(2)(e), approve instructions relating to how the maintenance of aircraft, aircraft components or aircraft materials is to be carried out. CAR 2A(2)(e) refers to any other instructions approved by CASA under CAR 2A(4) relating to how maintenance on aircraft, aircraft components and aircraft materials is to be carried out. That appears to be a reference to a maintenance instruction issued by CASA. Under CAR 2, a maintenance instruction is defined, inter alia, as an instruction issued by CASA or an authorised person in writing under CAR 38. The maintenance instructions commonly issued under CAR 38 (called directions) are A Class aircraft survey reports, as Mr Green issued in respect of XAT. As is set out in CAR 38(2), maintenance directions issued by CASA are not binding on a person unless they are served on the person. There is no reference in CAR 38 to an AD. That is undoubtedly because, at least since 1998, ADs have been issued under the CASR 39.001.
Prior to the introduction of the CASRs, ADs were found in CAR 37A. The provisions of the old CAR 37A are not dissimilar to the new directive in Part 39 of the CASR. It was only where CASA considered that an unsafe condition existed, is likely to exist, or is likely to develop, that it could issue an AD in writing. Although not necessarily so, ADs may require a person to comply with an instruction, direction or requirement issued by the manufacturer of an aircraft or aircraft component or aircraft equipment. That would of course apply to an aircraft regardless of whether the registered owner of the aircraft had elected to comply with the manufacturer's maintenance manual for the purpose of periodic maintenance.
To suggest, as does Mr Snook, that it is only ADs which require a person to comply with an instruction, direction or requirement issued by the manufacturer, because a service bulletin then becomes mandatory, is to totally misunderstand the function of ADs. While ADs must be in writing (CASR 39.001(2)(a)), they are not served on any person. It should therefore be clear that the directions referred to under CAR 38, which appear to be maintenance instructions issued by CASA under CAR 2A(2)(e) and which form part of the approved maintenance data, do not include ADs. ADs are dealt with discretely under Part 39 of the CASR.
The upshot of this is that service bulletins issued by a manufacturer, unless the manufacturer clearly indicates that the instructions contained in the bulletin are optional, form part of the approved maintenance data for the purposes of maintaining aircraft, aircraft components or aircraft material. CAR 42V(1) makes it mandatory when performing maintenance to carry that maintenance out in accordance with the applicable provisions of the approved maintenance data. In any event, the Part 1 logbook statement clearly discloses an election to maintain the aircraft in accordance with its flight manual and service manuals. The current service manual for the PZL M18 series of Dromader aircraft provides, at paragraph five:

[241]

The maintenance Mr Snook conducted on the Dromader aircraft graphically illustrates his inability to comprehend the statutory requirements for the maintenance of aircraft. While the statutory requirements are undoubtedly complex and there is room for misunderstanding, that does not excuse a LAME from compliance, particularly after receiving CASA's opinion about compliance requirements. If Mr Snook had any doubt about any aspect of maintenance, he should have been conferring with CASA's airworthiness inspectors on a regular basis. We find that in conducting the maintenance on the Dromader aircraft Mr Snook seriously failed in his duty with respect to a matter affecting the safe navigation or operation of those aircraft.
We only need to make brief mention of the audits conducted of the records of aircraft EHK, ZRR and KZE. One of the very serious concerns, which arose from the questioning of Mr Snook regarding the maintenance of these aircraft, was the fact that he agreed that he did not follow maintenance data religiously. It appears that Mr Snook conducted maintenance on aircraft based on the way in which he thought things should be done. As long as the result in his mind was the same, the method he employed to achieve that result was irrelevant. This, in our opinion, is a highly dangerous attitude towards the maintenance of aircraft. It certainly does not satisfy the requirement that he conduct maintenance in accordance with his duties and with due diligence.
The audit of the maintenance records of these aircraft also highlighted Mr Snook's inability or unwillingness to comply with the Schedule 6 requirements regarding the certification of the completion of maintenance.
Ms Macdonnell pointed out to us that aircraft ZRR was involved in a fatal accident on 17 November 2009. Although the Australian Transport Safety Bureau (ATSB) had issued a preliminary report, the investigation is ongoing. The report indicates that the investigation will include a review of the aircraft's maintenance history. This contradicts Mr Snook's statement, made in the course of his cross-examination, that maintenance had been entirely excluded as a possible cause of the accident. However, because the ATSB has not fully investigated this matter, we wish to make it very clear that any conclusions we have drawn about the maintenance of aircraft ZRR have totally disregarded the fact that this aircraft was subsequently involved in an accident. It would be improper and unfair to Mr Snook to draw any inferences from this accident.
We were deeply disturbed by Mr Snook's response to what he described as clerical errors. In his opinion, a clerical error has never caused an aircraft accident or incident. The problem with this response is obvious. While the simple act of making an incorrect entry in the aircraft logbook or maintenance sheets cannot directly cause an accident or incident, it could easily lead to time-lifed components being used beyond their limits or proper inspections not being carried out. Those situations quite clearly have the potential to cause an accident. Furthermore, where maintenance releases are issued in situations where maintenance remains outstanding, and the aircraft is in fact not airworthy, the operator or pilot of the aircraft will be oblivious to a potential hazard because maintenance which should have been carried out, has not. Correct and proper recording of maintenance is essential for the safe navigation and operation of aircraft.
The maintenance work conducted on the windscreen of aircraft FJU clearly demonstrates Mr Snook's lack of understanding of the limits and conditions placed on his CoA. It also demonstrates his inability or unwillingness to understand that it is his responsibility as a CoA holder to ensure that maintenance conducted under his CoA is properly conducted, by persons authorised to conduct that maintenance on the particular aircraft. His failure to comprehend these requirements and his permitting unauthorised maintenance on an aircraft under his CoA resulted in Mr Snook failing in his duty with respect to a matter affecting the safe navigation or operation of that aircraft.
The final issue we considered was Mr Snook's involvement in maintenance carried out for Airfast. We were very concerned by Mr Snook's attempts to distance himself from responsibility for maintenance conducted under Airfast's CoA and his role as the senior LAME. Mr Snook's conduct in performing maintenance under Airfast's CoA and certifying the completion of maintenance on behalf of Airfast is evidence of his acceptance of the role of senior LAME.
Mr Green, who audited a sample of the maintenance records of aircraft XAT, found numerous examples of poorly executed and poorly recorded maintenance. Many of the matters to which Mr Green directed his criticism are matters which have also arisen in the audits conducted by Mr McDonnell in respect of the other aircraft. We need not repeat them. However, there is one further matter which arose in the maintenance of XAT which was extremely serious. This was Mr Snook's attempt to transfer to ACS responsibility for failing to comply with the AD relating to the cabin heater.
As we have found, Mr Snook altered the worksheet records to give the appearance that another maintenance organisation, ACS, had certified the completion of maintenance on the cabin heater when it was never contracted to do that work. Mr Snook altered the dates of those entries, and a number of other entries, because, in our opinion, the initial date inserted in the worksheet was two days after ACS had certified completion of maintenance in its categories. Unable to alter the date of certification of those categories of maintenance, Mr Snook then altered the date in the worksheet referring to compliance with the AD regarding the cabin heater. This was dangerous and inexcusable. This is particularly so because Mr Snook must have known or ought to have known that ACS had not been asked to carry out compliance with the AD for the cabin heater.
Quite plainly, Mr Snook's certification that maintenance required by the AD to be conducted had been completed was, within his knowledge, false. He nevertheless issued a maintenance release following that periodic inspection. It necessarily follows that he failed in his duty as a LAME regarding the maintenance of that aircraft. It clearly affected the safe navigation or operation of the aircraft because the aircraft was not airworthy when released from maintenance.
Having considered all of the evidentiary material dealing with Mr Snook's AME licence and his CoA, we find that CAR 269(1)(c) is enlivened. The only remaining question is whether Mr Snook's conduct was such that it warrants cancellation of his AME licence and CoA. We are of the opinion that it does. Mr Snook's conduct of maintenance and his understanding of the regulatory requirements are seriously substandard.
Furthermore, having observed Mr Snook give evidence for several days, it is clear to us that he is unlikely to accept the errors and failings we have described above. His dismissive attitude and the arrogance disclosed by his apparent belief that 40 years experience as an aircraft maintenance engineer entitles him to disregard the proper means by which maintenance should be conducted is deeply disturbing. While we fully appreciate what the consequences of this decision will be on Mr Snook, we cannot elevate our concern above the concern we have for the safety of air navigation. Mr Snook's conduct as an LAME and holder of a CoA clearly has the potential to put lives at risk. It is our duty to ensure that does not happen.
Although our finding in respect of CAR 269(1)(c) disposes of the licence and CoA matters, for the sake of completeness, we believe we should also express our views about Mr Snook's fitness and propriety to have the responsibilities and to exercise and perform the functions and duties of the holder of an AME licence and a CoA.

[243]

We have already referred to the meaning of the expression fit and proper person as explained by the High Court in the Bond case. There is no requirement for an applicant for an AME licence to demonstrate that he or she is a fit and proper person. Therefore, the considerations regarding this criterion are wider than those which can be taken into account when considering a pilot's licence.
CAR 269(1)(d) provides that an AME licence or a CoA may be suspended or cancelled if CASA is satisfied that the holder of the licence, certificate or authority is not a fit and proper person to have the responsibilities and exercise and perform the function and duties of a holder of such a licence or certificate or an authority.
Ms Macdonnell submitted that as a CoA holder, Mr Snook has the responsibility to comply with the conditions set out in CAR 30(2C). Quite plainly, an AME licence holder and CoA holder should demonstrate a willingness and ability to comply with all statutory requirements relating to the maintenance of aircraft. It is not sufficient, in our opinion, to indicate a willingness to comply, while demonstrating an inability to comply due to incompetence or any other reasons.
Although Mr Ribbands submitted that Mr Snook, in conducting aircraft maintenance, at no time demonstrated a wilful disregard for his obligations or the regulations, the evidence before us and the findings we have made in respect of the audits of the various aircraft upon which Mr Snook conducted maintenance do not support that submission. In fact, there was evidence of Mr Snook deliberately altering dates on worksheets to make it appear that a category of maintenance certified as having been completed was covered by the worksheet entry in question. In any event, even if it could be said that many of the errors Mr Snook made were simply honest mistakes, that does not provide an answer to the fit and proper question. As Perram J said in Civil Aviation Safety Authority v Central Aviation Pty Ltd [2009] FCA 49 at [42]:

[245]

Mr Ribbands submitted that the passage by Perram J we have quoted above was in the context of considering the combined issues of honesty and financial hardship. Mr Ribbands also submitted that Perram J determined that honesty and financial hardship were matters that may be taken into account in deciding how to exercise a discretionary power to suspend or cancel a licence or certificate. We cannot accept those submissions.
As to the first aspect, it is true that Perram J was examining the Tribunal's conclusion that the applicant in that case was an honest man who would suffer financial hardship if his CoA was cancelled. Perram J then said it was difficult to see that honesty and financial hardship had anything to do with the Tribunal's conclusions that the applicants had failed in their duty under CAR 269(1)(c) with respect to a matter affecting the safe operation of the aircraft. His Honour referred to the applicant's failure to notice a steel cap was missing from an engine port (which we understood was the basis for seeking the cancellation of his CoA) and that it was difficult to incorporate notions of honesty or financial hardship into the particular field of discourse.
His Honour also said it was difficult to see how financial hardship to the applicant had any relevance to the issue of whether he was a fit and proper person. He then made the statement which we have quoted above. In other words, his Honour was saying that honesty might go to the fitness and propriety issue but that financial hardship did not. Even if honesty was a relevant consideration, he said that without more, he found it difficult to understand that honesty might be an answer to a lack of fitness if it was due to incompetence.
In this case, there are many examples of incompetence, which we have referred to in the course of our reasons. That is why, in our view, honesty does not become a significant factor in determining Mr Snook's fitness and propriety. As to the second part of the submission, with due respect to Mr Ribbands, that is a misstatement of paragraph 43 of his Honour's decision. He did not say they are matters which may be taken into account but rather, they were factors which the Tribunal took into account in that case when considering CAR 269(1)(c). However, his Honour said there was nothing to indicate that this is what in fact occurred because the Tribunal failed to give an adequate explanation.
In its statement of facts and contentions, CASA set out in considerable detail Mr Snook's compliance history regarding the maintenance of aircraft since 1993. Mr Snook did not take issue with any of the matters set out in that document. In summary, the history is as follows.
- (a) In 1993 CASA suspended Mr Snook's AME licence for 60 days and required him to undergo an airworthiness administration examination following identification of the following actions:
  - (i) failing to certify the completion of maintenance in logbooks;
  - (ii) certifying completion of maintenance when components had obviously exceeded their time-life;
  - (iii) issuing a maintenance release when the aircraft was not serviceable;
  - (iv) making an unapproved modification to an aircraft component;
  - (v) allowing maintenance to be performed by an apprentice unsupervised;
  - (vi) failing to comply with maintenance requirements on two aircraft which resulted in both of those aircraft being forced to make unscheduled landings; and
  - (vii) installing cylinders in an engine which failed after 11 hours flight time.
- (b) CASA suspended Mr Snook's AME licence in 1995 for:
  - (i) failing to rectify corrosion;
  - (ii) failing to replace severely warn components;
  - (iii) failing to conduct ADs as required;
  - (iv) failing to rectify unserviceable equipment even though the defects were endorsed on the aircraft's maintenance release; and
  - (v) issuing a maintenance release when the aircraft was inspected in accordance with an incorrect maintenance schedule.
- (c) The Tribunal found in respect of his 1993 and 1995 suspensions that circumstances involved in those matters were serious lapses of professional engineering performance on the part of Mr Snook, which warranted suspension of his licence.
- (d) CASA cancelled Mr Snook's CoA in 2002 for contravention of CAR 42U. However, the Tribunal subsequently set that decision aside because:
  - (i) although Mr Snook was unable to explain an alteration of a logbook entry, the Tribunal suggested its own explanation ;
  - (ii) the Tribunal found Mr Snook had contravened CAR 42W but that the contravention was not wilful, reckless or even a negligent disregard of the regulations which might endanger the safety of aviation and that Mr Snook had an honest and reasonable belief for the contravention; and
  - (iii) the Tribunal described Mr Snook's record of compliance with regulations as less than exemplary and agreed that CASA conduct a regular six monthly audit of Mr Snook's business operations.
- (e) CASA conducted an aviation safety audit in November and December 2003, which resulted in the issue of three requests for corrective action (RCA).
- (f) CASA conducted a special audit of Mr Snook's operations in November 2004 and this resulted in six RCAs and there remained three unsatisfactory answers to questions.
While Mr Snook may consider all of the above audits and safety trend indicator assessments as oppressive, the disturbing (though not surprising) aspect of this history is that the findings we have made in the course of this matter are not dissimilar to the issues which have been raised about Mr Snook's maintenance since 1993.
It is not surprising because, given Mr Snook's evidence, particularly under cross-examination, he has obviously continued to have the same problems with CASA regarding the way in which he conducts maintenance as a LAME, and his operations under his CoA. Mr Snook's contumacious attitude towards CASA's officers is unacceptable. This was clearly illustrated by Mr Green in his statement made on 19 January 2010.
Mr Green said that on 5 January 2010, in the company of his acting team leader, Mr Graham Hall, he attended the premises of Aeronautique at Jandakot airport. The purpose of their visit was to review the job register and maintenance release book and compare those documents against the weekly activity report provided to CASA by Mr Snook. This followed the Orders made by the Tribunal on 26 February 2009 when it extended a Stay in both matters until they were concluded. The Stay Orders were subject to two conditions, namely:
- (a) that Mr Snook provide to the regional manager of CASA's Perth Office, at the commencement of each week, a schedule of planned maintenance for that week; and
- (b) that Mr Snook permit CASA's officers to attend Aeronautique's premises at Jandakot airport on reasonable notice to inspect maintenance conducted by Mr Snook and any relevant maintenance records.
According to Mr Green, upon entering Aeronautique's hanger, he and Mr Hall were met by Mr Snook who told them that they must read the notice which he had attached on the entry door to his hangar. That notice, a copy of which was attached to Mr Green's statement, was some three pages in length setting out conditions of entry into Aeronautique's maintenance facility by CASA. Mr Snook insisted that unless the CASA officers accepted the conditions of entry by signing the document, he refused to answer any of CASA's questions or to allow access to any documents. He also said that he would not accept any advice from CASA, unless Mr Green and Mr Hall signed the conditions of entry form.
In the course of the hearing, we asked Mr Snook whether he was aware of the conditions attached to the Order that the Tribunal made on 26 February 2009. He said that he was, although he maintained that he was fearful of what CASA would do to his business if its officers where permitted unrestricted access to his premises.
In our opinion, Mr Snook does not seem to have any insight into his actions and their likely consequences. His history indicates that, irrespective of anything which is said to him about the maintenance of aircraft, if he holds a contrary view, he will not be persuaded. The fact that his views are frequently demonstrated to be erroneous appears to make no difference at all. In our opinion, these traits are unacceptable in a person who bears the responsibility for the safety of others. Accordingly, we find that Mr Snook is not a fit and proper person to hold and AME licence or a CoA.

Snook and Civil Aviation Safety Authority [2010] AATA 582 (6 August 2010)

At a glance

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Judgment (250 paragraphs)

Snook and Civil Aviation Safety Authority [2010] AATA 582 (6 August 2010)

Legislation Cited (4)

Cases Cited (1)