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Defence Publications

Sea King Board of Inquiry

Board of Inquiry Chapters

PREFACE [PDF 249 KB]

EXECUTIVE SUMMARY [PDF 5.11 MB]

TABLE OF CONTENTS [PDF 518 KB]

CHAPTER 1: [PDF 4.30 MB] Conduct of the Board of Inquiry

CHAPTER 2: [PDF 448 KB] Biographies of the deceased members and the survivors

CHAPTER 3: [PDF 2.76 MB] Background to the accident

CHAPTER 4: [PDF 723 KB] A Discussion on responsibility and accountability

CHAPTER 5: [PDF 7.78 MB] The final flight of Shark 02 and the rescue of the survivors

CHAPTER 6: [PDF 6.45 MB] The primary cause of the accident and associated issues

CHAPTER 7: [PDF 6.81 MB] Immediate contributory causes of the accident

CHAPTER 8: [PDF 2.18 MB] Analysis of the maintenance activities

CHAPTER 9: [PDF 2.90 MB] Non-compliant maintenance practices within the 817 Squadron

CHAPTER 10: [PDF 2.80 MB] Management of noncompliant practices by CO 817 Squadron

CHAPTER 11: [PDF 5.31 MB] Naval Aviation FEG HQ Support of 817 Squadron

CHAPTER 12: [PDF 2.54 MB] Maritime Headquarters Support to 817 Squadron

CHAPTER 13: [PDF 1.77 MB] The Defence and Navy safety system

CHAPTER 14: [PDF 4.95 MB] ADF Airworthiness management system structure

CHAPTER 15: [PDF 1.09 MB] Naval Aviation maintenance training continuum

CHAPTER 16: [PDF 2.54 MB] Logistics support system analysis

CHAPTER 17: [PDF 1.61 MB] Previous Australian Defence Force Boards of Inquiry and investigation recommendations

CHAPTER 18: [PDF 2.16 MB] The manner and cause of death

CHAPTER 19: [PDF 3.30 MB] Non causal issues

CHAPTER 20: [PDF 1.04 MB] Compensation and remediation

CHAPTER 21: [PDF 5.08 MB] Conclusion

Abbreviations [PDF 478 KB]