KEMENTERIAN PERHUBUNGAN

DIREKTORAT JENDERAL PERHUBUNGAN UDARA

PERATURAN DIREKTUR JENDERAL PERHUBUNGAN UDARA

NOMOR: KP 325 TAHUN 2018

TENTANG

PETUNJUKTEKNIS PERATURAN KESELAMATAN PENERBANGAN SIPIL BAGIAN

19-06 {STAFINSTRUCTION PART 19-06)TENTANG PENERIMAAN {ACCEPTANCE}

SISTEM MANAJEMEN KESELAMATAN {SAFETY MANAGEMENT SYSTEM
PENYELENGGARA NAVIGASI PENERBANGAN

DENGAN RAHMAT TUHAN YANG MAHA ESA

DIREKTUR JENDERAL PERHUBUNGAN UDARA,

Menimbang bahwa dalam Peratxiran Menteri Perhubungan Nomor 62

Tahun 2017 tentang Peraturan Keselamatan Penerbangan
Sipil Bagian 19 {Civil Aviation Safety Regulation Part 19)
Tentang Sistem Manajemen Keselamatan pada sub bagian
19.17 mengatur Penerapan dan Penerimaan, Penyedia Jasa
Penerbangan memiliki Sistem Manajemen Keselamatan
yang diterima oleh Direktorat Jenderal Perhubungan Udara;

bahwa berdasarkan pertimbangan sebagaimana dimaksud

pada huruf a, dipandang perlu menetapkan Petunjuk
Teknis Peraturan Keselamatan Penerbangan Sipil Bagian
19-06 {Staf Instruction Part 19-06) tentang Penerimaan
(Acceptance) Sistem Manajemen Keselamatan {Safety
Manajemen System) Penyelenggara Navigasi Penerbangan,
dengan Peraturan Direktur Jenderal Perhubungan Udara;

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

(Lembaran Negara Tahun 2009 Nomor 1 Tambahan
Lembaran Negara Republik Indonesia Nomor 4956);
 -2-

2. Peraturan Pemerintah Nomor 77 Tahun 2012 tentang

Perusahaan Umum (Perum) Lembaga Penyelenggara
Pelayanan Navigasi Penerbangan Indonesia (Lembaran
Negara Republik Indonesia Tahun 2012 Nomor 176);
3. Peraturan Presiden Nomor 7 tahun 2015 tentang
Organisasi Kementerian Negara (Lembaran Negara
Republik Indonesia Tahun 2015 Nomor 5);
4. Peraturan Presiden Nomor 40 Tahun 2015 tentang
Kementerian Perhubungan (Lembaran Negara Republik
Indonesia Tahun 2015 Nomor 75);
5. Peraturan Menteri Perhubungan Nomor PM 49 Tahun
2011 tentang Peraturan Keselamatan Penerbangan Sipil
Bagian 172 Peraturan Lalu Lintas Udara [Civil Aviation
Safety Regulation Part 172) tentang Penyelenggara
Pelayanan Lalu Lintas Penerbangan [Air Traffic Service
Provide?);
6. Peraturan Menteri Perhubungan Nomor PM 57 Tahun
2011 tentang Peraturan Keselamatan Penerbangan Sipil
Bagian 171 (Civil Aviation Safety Regulation Part 171]
tentang Penyelenggara Pelayanan Telekomunikasi
Penerbangan (Aeronautical Telecommunication Service
Provider) sebagaimana telah diubah terakhir dengan
Peraturan Menteri Perhubungan Nomor PM 29 Tahun
2013; -

7. Peraturan Menteri Perhubungan Nomor PM 9 Tahun 2015

Tentang Peraturan Keselamatan Penerbangan Sipil Bagian
174 [Civil Aviation Safety Regulations Part 174) Tentang
Pelayanan Informasi Meteorologi Penerbangan
[Aeronautical Meteorological Information Services)
sebagaimana diubah terakhir dengan Peraturan Menteri
Perhubungan Nomor PM 138 Tahun 2015;
8. Peraturan Menteri Perhubungan Nomor PM 55 Tahun
2011 tentang Peraturan Keselamatan Penerbangan Sipil
Bagian 176 (Civil Aviation Safety Regulation Part 176)
tentang Pencarian dan Pertolongan (Search and Rescue);
 -3-

9. Peraturan Menteri Perhubungan Nomor PM 189 Tahun

2015 tentang Organisasi dan Tata Kerja Kementerian
Perhubungan (Berita Negara Republik Indonesia tahun
2015 Nomor 1844) sebagaimana telah beberapa kali
diubah, terakhir dengan Peraturan Menteri Perhubungan
Nomor 44 Tahun 2017 tentang Perubahan Kedua atas
Peraturan Menteri Perhubungan Nomor 189 Tahun 2015;
10. Peraturan Menteri Perhubungan Nomor PM 65 Tahun
2017 tentang Peraturan Keselamatan Penerbangan Sipil
Bagian 170 (Civil Aviation Safety Regulation Part 170)
tentang Peraturan Lalu Lintas Penerbangan (Air Traffic
Rules];
11. Peraturan Menteri Perhubungan Nomor PM 60 Tahun
2015 tentang Peraturan Keselamatan Penerbangan Sipil
Bagian 175 [Civil Aviation Safety Regulations Part 175)
Tentang Pelayanan Informasi Aeronautika (Aeronautical
Information Service);
12. Peraturan Menteri Perhubungan Nomor PM 115 Tahun
2015 tentang Peraturan Keselamatan Penerbangan Sipil
Bagian 176 [Civil Aviation Safety Regulation Part 176)
Tentang Pencarian Dan Pertolongan Pada Kecelakaan
Pesawat Udara (Search And Rescue);
13. Peraturan Menteri Perhubungan Nomor PM 62 Tahun
2017 tentang Peraturan Keselamatan Penerbangan Sipil
Bagian 19 (Civil Aviation Safety Regulation Part 19)
Tentang Sistem Manajemen Keselamatan (Safety
Manajemen System);

MEMUTUSKAN :

Menetapkan : PETUNJUK TEKNIS PERATURAN KESELAMATAN

PENERBANGAN SIPIL BAGIAN 19-06 (STAR INSTRUCTION
PART 19-06) TENTANG PENERIMAAN (ACCEPTANCE)
SISTEM MANAJEMEN KESELAMATAN (SAFETY
MANAGEMENT SYSTEM) PENYELENGGARA NAVIGASI
PENERBANGAN.
 -4-

Pasal 1

Dalam peraturan ini yang dimaksud dengan:

1. Direktur adalah Direktur Navigasi Penerbangan.
2. Direktur Jenderal adalah Direktur Jenderal Perhubungan
Udara.

3. Sistem manajemen keselamatan (safety management system),

yang untuk selanjutnya disebut SMS adalah pendekatan
sistematis untuk mengelola keselamatan, termasuk struktur
organisasi, akuntabilitas, kebijakan, dan prosedur yang
diperlukan.
4. Penerimaan (acceptance) SMS adalah penerimaan dan
pengakuan DGCA terhadap rencana implementasi sms
penyelenggara pelayanan dari fase inisial hingga mature
sesuai peraturan perundang-undangan.
5. Penilaian pelaksanaan SMS adalah mekanisme yang
dilaksanakan oleh Direktorat Jenderal Perhubungan Udara
untuk menilai rencana tahapan implementasi SMS pada
penyelenggara pelayanan Navigasi Penerbangan.

Pasal 2

Penyelenggara Pelayanan Navigasi Penerbangan wajib

melaksanakan SMS sesuai dengan peraturan perundang-
undangan.

Pasal 3

Pelaksanaan SMS sebagaimana dimaksud dalam Pasal 2 hams

dilakukan penilaian untuk mendapatkan pengakuan
penerimaan (acceptance)SMS dari Direktur Jenderal.

Pasal 4

(1) Penilaian pelaksanaan SMS Penyelenggara Pelayanan Navigasi

Penerbangan sebagaimana dimaksud dalam Pasal 3,
menggunakan tata cara sebagai berikut:
 -5-

a. pemeriksaan hasil GAP Analisis, rencana implementasi SMS

dengan mengacu pada ketentuan yang tercantum dalam
Lampiran Peraturan ini;
b. pemeriksaan pedoman SMS, dokumen data dukung lainya
dan bukti terkait dengan pelaksanaan SMS mengacu pada
ketentuan peraturan perundang-undangan.

(2) Setelah dilakukan penilaian sebagaimana dimaksud pada ayat

(1), dilanjutkan dengan pengawasan guna mengetahui
pelaksanaan SMS di lapangan.

Pasal 5

(1) Penilaian pelaksanaan SMS Penyelenggara Pelayanan Navigasi

Penerbangan dilakukan setelah Penyelenggara Pelayanan
Navigasi Penerbangan mengajukan. permohonan Penerimaan
(Acceptance) Pelaksanaan SMS secara tertulis kepada Direktur
Jenderal.

(2) Setelah dilakukan evaluasi terhadap permohonan sebagaimana

dimaksud pada ayat (1), Direktur menerbitkan Penerimaan
(Acceptance) Pelaksanaan SMS Penyelenggara Pelayanan
Navigasi Penerbangan.
(3) Direktur dapat menolak penerbitan Penerimaan (Acceptance)
SMS Penyelenggara Pelayanan Navigasi Penerbangan apabila
hasil penilaian tidak memenuhi persyaratan yang sesuai
ketentuan peraturan perundang-undangan.

Pasal 6

(1) Penilaian sebagaimana dimaksud dalam Pasal 5 dilakukan oleh

Tim Penilai yang ditetapkan oleh Direktur.
(2) Tim sebagaimana dimaksud pada ayat (1), beranggotakan
Inspektur Navigasi Penerbangan.
(3) Direktur menerbitkan Penerimaan (Acceptance) 14 (empat belas)
hari keija setelah penilaian pelaksanaan SMS dinyatakan dapat
diterima dan menerima rencana implementasi yang telah
disahkan oleh akuntabel eksekutif.
 -6-

Pasal 7

Direktur melakukan pengawasan terhadap pelaksanaan peraturan

ini.

Pasal 8

Peraturan ini mulai berlaku sejak tanggal ditetapkan.

Ditetapkan di Jakarta
Pada tanggal 31 OKTOBER 2018
DIREKTUR JENDERAL PERHUBUNGAN UDARA
Pelaksana Tugas,

ttd

Ir. M. PRAMINTOHADI SUKARNO, MSc.

SALINAN Peraturan ini disampaikan kepada :

1. Menteri Perhubungan;
2. Sekretaris Jenderal, Inspektur Jenderal, Para Kepala Badan di lingkungan
Kementerian Perhubungan;
3. Para Direktur di Lingkungan Ditjen Perhubungan Udara;
4. Para Kepala Otoritas Bandar Udara;
5. Para Kepala Bandar Udara di lingkungan Ditjen Perhubungan Udara;
6. Kepala Balai Besar Kalibrasi Penerbangan;
7. Kepala Balai Teknik Penerbangan;
8. Direktur Utama Perum LPPNPI.

Salinan sesuai dengan aslinya,

KEPALA BAGIAN HUKUM

,,p, K:
* I ri ;I,

-O
ENDAH PURNAMA SART
Pembina Tk. I (IV/b)
^^-.NIP. 19680704 199503 2 001
 Lampiran Peraturan Direktur Jenderal Perhubungan Udara
Nomor : KP 325 TAHUN 2018

Tanggal :31 OKTOBER 2018

SI 19 - 06
GUIDANCE MATERIAL AND PROCEDURES FOR AIR NAVIGATION SAFETY
MANAGEMENT SYSTEMS(SMS)ACCEPTANCE

Amendment :0
Tanggal :

REPUBLIK INDONESIA - KEMENTERIAN PERHUBUNGAN

DIREKTORAT JENDERAL PERHUBUNGAN UDARA
JAKARTA - INDONESIA
 -IJ-

AMENDMENT RECORD LIST

Amendment Issue Date Inserted by Page

Nomor
 -III-

FOREWORD

1. PURPOSE This Staff Instruction prescribes responsibilities

guidance to be used by the Air Navigation Inspector
for evaluating Service Provider's Safety
Management System Manual and Implementation.

2. REFERENCES This Staff Instruction should be used in

accordance with the applicable regulations.

3. CANCELATION This Staff Instruction do not replace any previous

publications.

4. AMENDMENT The amendment of this Staff Instruction shall be

approved by the Director General of Civil Aviation.

ACTING DIRECTOR GENERAL OF CIVIL AVIATION

ttd

Ir. M. PRAMINTOHADI SUKARNO, MSc.

Salinan sesuai dengan aslinya,

-KSPALA BAGIAN HUKUM

Ar

dirik: }
f t-H' ■

-o
ENDAH PURNAMA SARI
^ PembinaTk. I (IV/b)
^ '.-19680704 199503 2 001
 -IV-

ABBRBVIATIONS

DGCA : Directorate General of Civil Aviation

ERP : Emergency Response Plan

HIRM : Hazard Identification and Risk Management
ICAO : International Civil Aviation Organization
SMS : Safely Management System
SPIs : Safety Performance Indicators
SRB : Safety Review Board
SRC : Safety Review Committe
SRM : Safety Risk Management
 -V-

TABLE OF CONTENT

AMENDMENT RECORD LIST i

FOREWORD ii

ABBREVIATIONS iii

TABLE OF CONTENT iv

CHAPTER I

GENERAL 1
1. Applicability 1
2. Definitions 1

3. Regulatory References 3

CHAPTER II

SAFETY MANAGEMENT SYSTEM ACCEPTANCE 4

1. SMS Acceptance Procedure 4

2. SMS Implementation Plan Monitoring 7
3. Documentation 7

CHAPTER III

ROUTINE SMS ASSESMENT 8

1. Objective 8
2. Procedure 8
3. Documentation 8

APPENDIX A, SMS Acceptance Procedure 9

APPENDIX B. Four Phase of SMS Implementation 10
APPENDIX C. SMS Acceptance Checklist 11
APPENDIX D. Acceptance Report Format 29
APPENDIX E. SMS Acceptance Format 30
APPENDIX F. Routine SMS Assesment Checklist 32
APPENDIX G. Phase of SMS Implementaion Description 40
 -1-

CHAPTERI

GENERAL

1. Applicability

These staff instruction are intended for use by the Air Navigation Inspector
to :
a. acceptance of the air navigation Safety Management System;
b. surveillance of the Safety Management System implementation plan of
the air navigation service provider.

2. Definitions

Accident. An unplanned event or series of events that results in death,

injury, or damage to, or loss of, equipment or property.

Accountable executive. A single, identifiable person having responsibility

for the effective and efficient performance of the State's SSP or of the
service provider's SMS.

Audit. A systematic, independent and documented process for obtaining

records, statements of fact or other information and evaluating it
objectively to determine the extent to which policies, procedures, or
requirements are met.

Control, is one of the managerial functions like planning, organizing,

staffing and directing.

Corrective Action. Action to eliminate or mitigate the cause or reduce the

effects of a detected nonconformily or other undesirable situation.

Director. Director of Air Navigation

Director General. Director General of Civil Aviation

Errors. An action or inaction by an operational person that leads to

deviations from organizational or the operational person's intentions or
expectations.

Evaluation. Denotes the process whereby data is assembled, analyzed, and

compared to expected performance to aid in making systematic decisions.

High-consequence indicators. Safety performance indicators pertaining to

the monitoring and measurement of high-consequence occurrences, such
as accidents or serious incidents. High-consequence indicators are
sometimes
referred to as reactive indicators.
 -2-

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

accident.

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

the safety of operations.

Likelihood. The estimated probability or frequency, in quantitative or

qualitative terms, of a hazard's effect or outcome.

Lower-consequence indicators. Safety performance indicators pertaining

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

Management of Change. A formal process to manage changes within an

organization in a systematic manner, so that changes which may impact
identified hazards and risk mitigation strategies are accounted for, before
the
implementation of such changes.

Product/Service Provider. An organization engaged in the delivery of

aviation products or services.

Risk. See Safety Risk. The terms Risk and Safety Risk are used
S3Tionymously.

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

Safety Assurance. Processes within the SMS that function systematically

to ensure the performance and effectiveness of safety risk controls and that
the organization meets or exceeds its safety objectives through the
collection, analysis, and assessment of information.

Safety Management System (SMS). A systematic approach to managing

safety, including the necessary organizational structures, accountabilities,
policies and procedures.

Safety Objective. A measurable goal or desirable outcome related to

safety.

Safety Performance. A State's or service provider's safety achievement as

defined by its safety performance targets and safety performance
indicators.
 -3-

Safety Performance Indicator. A data-based safety parameter used for

monitoring and assessing safety performance.

Safety Policy. The documented commitment to safety of an organisation or

staff office, or an aviation service/product provider, organization, or
certificate holder, which defines its safety objectives and the
accountabilities and responsibilities of its employees with regard to safety.

Safety Promotion. A combination of training and communication of safety

information to support the implementation and operation of an SMS in an
organization.

Safety Risk. The composite of predicted severity and likelihood of the

pptential effect of a hazard.

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

hazards.

Safety Risk Management (SRM), A process within the SMS composed of

describing the system, identifying the hazards, and analyzing, assessing,
and controlling risk.

Severity. The consequence or impact of a hazard's effect or outcome in

terms of degree of loss or harm.

Violation. A deliberate act or omission to deviate from established

procedures, protocols, norms or practices.

3. Regulatory References

a. CASR 19
b. CASR 170
c. CASR 171
d. CASR 172
e. CASR 173
f. CASR 174
g. CASR 175
h. CASR 176
 -4-

CHAPTER II

SAFETY MANAGEMENT SYSTEM ACCEPTANCE

1. SMS Acceptance Procedure:

This chapter provides guidance on the assessment and acceptance of the

implementation of the Safety Management System for service provider,
such as:

a. Preparation of SMS acceptance

1) Director receives letter of application for SMS acceptance from Air

Navigation Service provider.
2) The Director sets the schedule for the SMS acceptance.
3) The Director deliver a notification letter to the service provider at
least 30 (thirty) days prior to the SMS acceptance assessment along
with the assessment protocol as contained in Appendix C. SMS
Acceptance Checklist
4) The Director specifies the number and composition of the SMS
acceptance team
5) Assessment team of SMS acceptance consists of:
a) Team Leader
b) Team Member
6) Assessment team of SMS acceptance prepares reference documents
related to SMS acceptance including:
a) SMS acceptance Checklist
b) CASR 19, CASR 170, CASR 172, CASR 171, CASR 173, CASR
174, CASR 175, CASR 176, AC 69-01, AC 69-03, AC 170-01, AC
170-02, AC 143-01 , AC 172 -01, MOS 170-01, MOS 171-01
MOS 172-02, MOS 175- 01, MOS 175-02, MOS 175-03, MOS
175-04, MOS 175-05, SI 69-01 , SI 143-01 and other
regulations relating to air navigation services.
c) Other relevant data
7) The team leader conducts the initial briefmg to the SMS acceptance
team at least 1 (one) day prior to the SMS acceptance at the
location.
8) The initial direction as referred to in paragraph (7) discusses the
following matters:
a) Introduction of team members
b) The scope of the SMS acceptance
c) On site work plan program
d) Distribution of tasks and responsibilities of the team
e) Preparation of opening and closing meetings with service
providers

b. On Site SMS Acceptance

1) The SMS acceptance team together with the service providers

conducts the opening meeting.
 -5-

2) The opening meeting as referred to in paragraph (1) intended to:

a) Introduction of members of the SMS assessment team
b) Submission of the scope of the SMS acceptance of the Service
Provider
c) Agreement of work plan program of SMS assessment on
location
d) Submission of documents required for the conduct of the
assessment
e) other related matters.
3) The team leader conducts daily briefing of the assessment team
before and / or after the daily assessment at the site.
4) The daily briefing referred to in particle (3) shall aim at:
a) Updating list fo checklist fulfilment
b) Identify the difficulties encountered in conducting the
assessment
c) Improve coordination and support of assessment teams
5) To ensure of valid, qualified, and accountable assessment. The
assessment team is guided by the checklist of SMS acceptance.
6) On site of SMS acceptance by:
a) Collecting data through interviews, review of related materials,
surveys, and testing of the implementation of the safety
management system of service providers. Fulfillment of each
checklist element is recorded with a clear information of how the
checklist elements are met.
b) If the service provider already has a SMS manual, then the
assesment of the content of SMS manual according to
legislation.
c) Evaluate the implementation of SMS GAP analysis for service
providers
d) Assess the SMS implementation phase of service providers
e) After on site SMS acceptance activity is completed, the
assessment team reviews all the input of the checklist elements
to ensure that the assessment is conducted objectively.
7) The evaluation of the SMS manual in particle 6 (b) that the SMS
manual should cover at least the follovdng sections: (referring to the
AC SMS Manual)
a) Document control;
b) SMS regulatory requirements;
c) Scope and integration of the safety management system
d) Safety policy;
e) Safely objectives;
f) Safety accountabilities and key personnel;
g) Safety reporting and remedial actions;
h) Hazard identification and risk assessment;
i) Safety performance monitoring and measurement;
j) Safety-related investigations and remedial actions;
k) Safety training and communication;
1) Continuous improvement and SMS audit;
m) SMS records management;
n) Management of change; an
o) Emergency/contingency response plan.
 -6-

8) The Review SMS GAP implementation conducted by the air

navigation services provider in particle 6 (c) by:
a) Check the SMS GAP element analysis in accordance with the
applicable provisions.
b) check implementation task made in accordance with the results
of SMS GAP analysis
c) check implementation schedule based on SMS GAP analysis
d) Making of the implementation schedule is based on the SMS
implementation phase as in appendix B. four phases of SMS
implementation phase.
e) The service provider shall update the SMS implementation plan
if there is a revision of the SMK implementation schedule.
9) Review phase of SMS implementation as referred to in particle 6 (d)
is intended to determine the extent to which service providers have
implemented SMS.
10)SMS implementation consists of 4 phases as stated in Appendix B.
11)The fuliiUment time of each phase is estimated as follows:
a) Phase I for 12 Months
b) Phase II for 12 months
c) Phase III for 18 Months
d) Phase IV for 18 Months
12)To determine the SMS service provider's phase, use the checklist in
appendix C part C. The phase determination depends on the extent
to which the service provider can meet each element phase.
13) Any elements of SMS implementation that have not fullfilled, will be
included in the SMS implementation schedule;
14)In the initial SMS service Provider, then only need to do assessment
in phase I only.
15)SMS Service provider declared to have reached phase mature if it
has fulfilled element to four phase.
16) Description of the fulfillment of the elements of the four phases of
SMS can be found in Appendix G. Phase of SMS Implementaion
Description
17)The assessment team made the acceptance report of the SMS
acceptance of the air navigation service provider. ( see Appendix D
Acceptance Report Format)
18)The assessment team and service providers conducts closing
meetings;
19) Closing meeting as referred to in particle (18) aims to:
a) Provide information to the head of the service provider related to
the SMS acceptance and the improvement of the SMS
implementation plan (if any).
b) Explain that service providers must submit revised SMS
implementation plans (if any) and have been authorized by the
accountable executive service provider to the Director.
c) Explain that the obligations of service providers in implementing
the implementation of SMK will be contained in the SMS
acceptance of service providers.
 -7-

c. Issuance of acceptance of SMS service providers

1) The service provider submits the document of the SMS

implementation plan which has been authorized by the accountable
executive of the service provider as the guideline for the SMS
implementation until the mature phase, to the Director.
2) The Director shall publish the acceptance of the SMS for the service
provider and require the service provider to implement the
Vocational Implementation Plan according to the agreed schedule,
(format in attachment E).

2. SMS Implementation Plan Monitoring

a. After DGCA perform acceptance on SMS service provider
implementation plan. Then DGCA will monitor the implementation of
the plan until mature phase.
b. Monitoring is conducted based on implementation plan schedule.
c. The purpose of monitoring to ensure service providers implement
implementation plans on schedule.
d. The Director shall deliver a notification letter to the service provider at
least 14 (fourteen) days prior to the monitoring of the SMS
implementation plan.
e. The Director determines team for the monitoring SMS implementation.
f. The monitoring team update the fulfillment of SMK implementation
elements.
g. After service providers SMS's reach the mature phase, the Director will
conduct a routine SMS assessment to monitoring operational of service
providers's SMS.

3. Documentation

DGCA performs documentation on SMS process of accepetance service

provider.
 -8-

CHAPTER III

ROUTINE SMS ASSESSMENT

1. Objective

After an organization's SMS has satisfied the regulator's initial assessment

and acceptance process, there will be many assessment questions from the
initial assessment checklist that will no longer be expedient or necessary
for routine assessment purposes. A routine SMS assessment checklist need
only focus on the operational aspects of an SMS and evidence of the
satisfactory implementation of its supporting processes.

2. Procedure

a. Routine SMS assessment only can be conducted if service provider's

SMS reach mature phase.
b. Routine SMS assessment may be conducted on a stand-alone basis or
incorporated as part of a routine organization/systems audit.
c. Routine SMS assessment do at the service providers headquarters and
branches with a focus on operational SMS.
d. The Director shall deliver a notification letter to the service provider at
least 14 (fourteen) days prior to the routine SMS assessment.
e. Routine SMS assessment checklist can be seen in Appendix F Checklist
routine SMS assessment
f. The normal Corrective Action Notice (CAN) protocol of the regulator can
also be applied to the routine SMS assessment.

3. Documentation

DGCA performs documentation on Routine SMS assessment service

provider.
 -9-

APPBNDIX A. SMS Acceptance Procedure

Start

I
SMS GAP Analisis report,
SMS Implementation Plan

Review SMS GAP

Analisis and SMS
Implementation plan

Yes

need
correction ?

NO

assess phase of SMS

Implementation

SMS Acceptance from

DGCA

End

APPENDK B. FOUR PHASES OF SMS IMPLEMENTATION
Phase 1(12 nionlhs'}
1. SMS Benienll.l (i}:
a) {dentify the SMS accountable
execulhite;
b) estat>nsh an SMS
implementation team;
c) derme the scope of the SMS;
d) perform an SMS gap
analysis.
2. SMS Bement 1.5(1);
a) develop an SMS
implementatton plan.
3. SMS Bement 1.3:
a] estat>n^ a key person/office
responsible for the
admlrristraQon ciid
maintenance of the SMS.
4. SMSBemenl4.1 (i);
a) establish an SMS training
programme for personnel,
with pn'orrty for the SMS
implementation team.
5. SMS Bement 4.2 (i);
a) initiate SMS/safety
coimnunicotion channels.
SMS Bement 1.5:SMS documentation (Phases 1 to •
SMS Elements 4.1 and 4.2: SMS training, education and communicallon (Phases 1 and IhereafteO »»»»»>»»»»»»»>»»»»»»»
'itPfemenfal/OT period indicated Is an appmximolion. The actual Implementation period Is dependent on the scope of actions
required for each elementa//ocafedand Ihe sIzeAxmplexity ofthe organizaOon.
element has t>een subdivided to fociSlate the phased implementation approach.
-10-
Phase 2(12 monlhs) Phase 3(16 months) Phase 4(18 months)
1. SMSBemenll.1 (n): 1. SMS Efement2.1 (0: 1. SMS Bement 1.1 (ill):
a) estabfish the safety policy and a) eslatrllsh a voluntary hazard a) enhance the existing
objectives, reporting procedure. disciplinary procedure/ policy
with due consideration of
2. SMS Bement 1.2; 2. SMS Element Z2: unintenUono]errors or
mistakes from deliberate or
a) define safety management a) establish safety risk gross vfolattons.
responsibilities and manogement procedures.
accountabilities across 2. SMSBemenl2.1 (Q):
relevant deportments of the 3. SMSEIemenl3.1 (f):
organization; a) Integrate hazards hfenGfied
a) establish occurrence from occurrerKe investigation
b) establish an SMS/safety reportlrrg and Investigalion reports vyilh the voluntary
coordination mechanism/ procedures; hazard reporting system;
committee;
b) establish o safety data b) Integrate hazard idenbfication
c) establish departmental/ collection and processing and risk management
divlslortal SAGs where system for high-consequence procedures with the
applicable. outcomes; »it>cantractor's or customer's
SMS Where applicable.
3. SMS Bement 1.4: c) develop high-consequence
SPis and assocfaled targets 3. SMS Element 3.1 (D):
a) establish an emergency and alert setllrtgs.
response plan. a) chance the safety data
4. SMS Element 3.2: collection and processing
4. SMS Bement 1.5 (li): system to Include lower-
a) establish a marrageraent of consequence events;
a) initiate progressive clangs procedure that
development of an SMS includes safety risk develop lower-consequertce
document/manual and other assessment. SPIs and associated
supportir>o documentation. (argets/aierl selfings.
5. SMS Element 3.3 (i):
4. SMSErement3.3 (ii):
a) establish an Internal quaCty
audit programme; a) estat>llsh SMS audit
programmes or integrate
b) establish an external qualty them into existing Internal and
audit programme. extern:^ audit programmes;
b) establish other operational
SMS review/survey
programmes where
appropriate.
5. SMS Element 4.1 (Q):
a) ensure that the SMS training
programme for an relevant
personnel has been
completed.
SMS Bement4.2(S):
a) promote safety tnfofmation
shailrtg and exchange
Internally arxf externally.
correspond to the tCAO SUS element numbers. SuflixBs such as e). b)and e)Indicate that the
 -11-

APPBNDIX C. SAFETY MANAGEMENT SYSTEM (SMS)ACCEPTANCE

CHECKLIST

Company Name
Address
Date of Assement

No Subject
Yes No Not Remark
/Applicable

PART A. SAFETY MANAGEMENT SYSTEM MANUAL

Does SMS Manual

include at least the
following sections:
1. Document control;
2. SMS regulatory
requirements;
3. Scope and integration
of the safety
management system
4. Safety policy;
5. Safety objectives;
6. Safety accountabilities
and key personnel;
7. Safety reporting and
remedial actions;
8. Hazard identification
and risk assessment;
9. Safety performance
monitoring and
measurement;
10. Safety-related
investigations and
remedial actions;
11. Safety training and
communication;
12. Continuous
improvement and SMS
audit;
13. SMS records
management;

14. Management of change;

an

15. Emergency/contingency
response plan.
 -12-

No Subject
PART B. SMS GAP ANALISYS IMPLEMENTATION
1 Has the ANSP make gap
analysis ?

2 Has the ANSP make

implementation task
identification plan
based on gap analysis?

3 Has the ANSP make

SMS implementation
schedule
based on
implementation task
identification plan?
 -13-

PART C. PHASE OF IMPLEMENTATION SMS

PHASE I(12 Month)
No Ref Aspect to be analysed GUIDANCE Status of Remark
Implementation
Yes 1 No 1 Partial
Cornponent I — SI^TETY policy AND OR.TFPTnJT?Q
lEle nagement^^^
1. CASR 19 / Identify the accountable Check organizational
■ -Li.

19.21 executive and the safety structure for identify

accountabilities of managers accountable executive
responsibility
2. CASR 19 / Establish an SMS Check organisation decree
19.23 implementation team. for SMS implementation
team

3. CASR 19 / Define the scope of the Check scope SMS in

19.23 organization's activities Implementation plan
(departments/divisions) to
which the SMS wiU be
applicable

4. CASR 19 / Conduct a gap analysis of Check Gap Analysis result

19.23 (g) the organization's current
systems and processes in
relation to the ICAO SMS
framework requirements (or
the relevant SMS regulatory
requirements)
h.lement 1.3 — /appointment of key safety pei'sonnel
 -14-

CASR 19 Has [Organization] appointed 1. Check organisational

19.21 (e) a qualified person to manage decree of Safety Manager
and oversee the day-to-day and responsibilities
operation of the SMS? 2. Check organisation
structure

CASR 19 Does the qualified person 1. Check organisation

19.21 (h) have direct access or structure
reporting to the 2. Check safety report to
accountable executive accountable executive
concerning the
implementation and
operation of the SMS?

Does the manager 1. Check organisation

responsible for administering structure
the SMS hold other 2. Check safety manager
responsibilities that may responsibilities
conflict or impair his role as
SMS
manager.

8. CASR 19 Has [Organization] establish 1. Check safety services

19.21 the safety services office? office
2. Check organisation
structure and

Erle^uent 1.5 — SMS dnmiTn«»nfafiAvi

9. CASR 19 Develop an SMS Check SMS implementation
19.23 (c) implementation plan on how plan
 -15-

the organization will

implement the SMS on the
basis of the identified system
and process gaps resulting
from the gap analysis
EUiment 4.1 — Trfining and education
10. CASR 19 Has training needs analysis Check training programme
19.45 been conducted ?

11. CASR 19 Is there a programme to Check personal training

19.45 provide SMS programme
19.47 training/familiarization to
personnel involved in the
implementation or operation
of the SMS?

12. CASR 19 Develop safety training Check training programme

19.45 considering:
a. initial (general safety)job-
specific training; and
b. recurrent training.

13. CASR 19 Has the organisation Check training records.

Appendix A - established a safety training
1.5 and 4.1 records system?

i#lement 4.2 — £iafety commuiiication

14. CASR 19 Has the organisation Check the safety
19.43 and initiated a mechanism or communication mechanism
19.47 medium for safety
communication?
 -16-

15. Has the organisation Check medium to convey

established a means to safety information
convey safety information
through any of;
1) safety newsletters, notices
and bulletins;
2) websites;
3) email.

Air Navigation Inspector and Team

SMS Manager and Team
signature
signature

Full Name
Full Name
NIP
NIK
 -17-

PHASB 11(12 Month)

No Ref Aspect to be analysed CHECKLIST Status of Remark
GUIDANCE Implementation
Yes No Partial
Component 1 SAFETY POLICY AND OBJECTIVES
Element 1.1 — Vlanagement commitment and responsibility
Has [Organization] establish Check Safety
/ 19.19 this safety policy and Policy
Appendix objectives
A 1.1
Element 1.2 — Safety accountabilities
2. CASR 19 / Has [Organization] define Check safety
19.27 (c) safety management (All accoutabilities in
aviation safety-related SMS Manual
positions) responsibilities
and accountabilities?
CASR 19 / Is there a safety review Check
19.21 committee (SRC) or review organisation
board for the purpose of decree for safety
reviewing SMS and safety commite
performance?

CASR 19 / Does Organisation establish Check

19.21 the safety action group organisational
(SAG)? decree for SAG

Has the organisation defined Check

clear functions for the SAG organisation
and the safety/SMS decree for safety
coordination committee? commite and SAG
 -18-

function
6. CASR 19 / Has the organisation
19.21 establish lines of Check lines of
communication between the communication for
safely services office, the coordination
accountable executive, the
SAG and the safety/SMS
coordination committee ?
/. CASR 19 Is the safety committee Check
Appendix chaired by the accountable organisation
A 1.2 executive or decree for safety
by an appropriately commite
assigned deputy, duly
substantiated in the
SMS manual?

8. CASR 19 Has the organisation Check SAG and

Appendix developed a schedule of SRC meeting
A 1.1 meetings for the safety schedule
services office to meet with
the safety/SMS
coordination committee and
SAG as needed?

Eleiment 1,4 — Coordination of emergency response planning

9. CASR 19 / Has the organisation Check ERP
19.25 reviewed the outline of the Manual
ERP related to the
delegation of authority and
assignment of emergency
responsibilities ?
 -19-

10. CASH 19 / Has the organisation Check ERP

19.25 established coordination Manual
procedures for action by key
personnel during the
emergency and the return to
normal operations ?
11. CASR 19 / Has the organisation Check ERP
19.25 identifed external entities Manual
that will interact with the
organization during
emergency situations ?

12. CASR 19 / Has the organisation assess Check ERP

19.25 the respective ERPs of the Manual
external entities ?

13. CASR 19 / Check ERP

Has the organisation
19.25 Manual
established coordination
between the different ERPs ?

14. CASR 19 / Has the organisation Check SMS

19.25 incorporated information Manual
about the coordination check ERP Manual
between the different ERPs
in the organization's SMS
documentation
Eleiment 1.5 —!
SMS documentation
15. CASR 19 / Does [Organization] Check sms manual
19.27 Establish manual document
sms stand alone or a unity
with the operation manual
 -20-

(minimum 5 years)?
16. CASR 19 / Does [Organization] Check doc recording
19.27 establishing an SMS filing
system to collect and
maintain current records
relating to the organization's
ongoing SMS processes?

17. CASR 19 / Does [Organization] Check doc

19.27 maintaining records to recording
provide a historical
reference as well as the
current status of all SMS
processes?

Air Navigation Inspector and Team

SMS Manager and Team
signature
signature

Full Name
Full Nflmp
NIP
NIK
 -21-

PHASE III(18 Months)

Aspect to be analysed CHECKLIST Status of Implementation Remark
GUIDANCE
Yes No
Component 2 SAFETY RISK MANAGEMENT
Element 2.1 - Hazard identification
CASH 19 Is there a process for Check voluntary
19.31 voluntary hazards/threats report procedure
19.59 reporting by all
employees?

CASR 19 Has the organisation 1. Check schedule

19.31 established a for HIRM process
19.59 programme/schedule for 2. Check HIRM
systematic review of all procedure
applicable aviation safety-
related processes/
equipment that are eligible
for the HIRM process?

CASR 19 Has the organisation Check HIRM

19.31 established a process for procedure
19.59 prioritization and
assignment of identified
hazards for risk mitigation?
 -22-

19.33 established a safety risk management

management procedure, procedure on
including its approval and manual sms
periodic review process?
5. CASR 19 Has the organisation Check manual
19.33 developed and adopt safety SMS;
risk matrices relevant to
the organization's
operational or production
processes?
6. CASR 19 Has the organisation Check SMS training
19.33 included adopted safety programme;
risk matrices and
associated instructions in
the organization's SMS or
risk
management training
material?
Component 3 — SAFETY ASSURANCE
Element 3.1 — S afetyperformance monitoring and measurement
7. CASR 19 Has the organisation 1. Check SMS
19.57 established an internal Manual
occurrence reporting and 2. Check
investigation procedure. mandatory or
This may include major defect
mandatory or major defect reports
reports(MDR) where
applicable?
8. CASR 19 Has the organisation 1. Check SDCPS
19.57 established safety data (Safety Data
collection, processing and CoUection and
analysis of high- Processing
 -23-

consequence outcomes? Systems)

2. Check SPI high
consequence

9. CASR 19 Has the organisation 1. Check SMS

19.57 established high Manual
Appendix consequence safety 2. Check SPI - high
A indicators (initial ALoSP) consequence
3.1.2 and their associated target
and alert
settings?

10. CASR 19 Has the organisation Check agreement of

19.35 reached an agreement with safety performance
the State oversight target
authority on safety
performance indicators and
safety
performance targets ?
Elenlent 3.2 — T he management of change
11, CAS R 19 Has the organisation 1. Check SMS
19.39 established a formal Manual
Appendix process for the 2. Check safety risk
A management of change that assesment
Butir 3.2 considers: procedure
a. the vulnerability of
systems and activities;
b. the stability of systems
and operational
environments;
c. past performance;
 -24-

d. regulatory, industry
and technological
changes.

12. CASR 19 Is the management of 1. Check SMS

19.39 change procedures address Manual
Appendix the impact on existing 2. Check safety risk
A safely performance and risk assesment
Butir 3.2 mitigation records before procedure
implementing new changes

13. CASR 19 Has the organisation 3. Check SMS

19.31 established procedures to Manual
19.33 ensure that safety 4, Check safety
assessment of new aviation assessment
safety-related operations, report
processes and equipment
are conducted (or
accounted for) as
applicable, before they are
commissioned ?

Elenlent 3.3 — C
14. CASR 19 Is there a procedure for Check internal
19.39 periodic internal quality audit procedure
Appendix audit programme ?
A
Point 3.3
15. CASR 19 Is there a procedure for Check external
19.39 periodic external quality audit procedure
 -25-

Appendix audit programme ?

A
Pomt 3.3
CASH 19 Is there a schedule for Check facilities/
19.39 evaluation of facilities, equipment
Appendix equipment, documentation evaluation
A and procedures to be schedule
Point 3.3 completed through audits
and surveys ?

Air Navigation Inspector and Team

SMS Manager and Team
signature
signature

Full Name
Full Name
NIP
NIK
 -26-

PHASE IV (18 Months)

No Ref Aspect to be analysed CHECKLIST Status of Implementation Remark
GUIDANCE
Yes No Partial
Component 1 — SAFETY POLICY AND OBJECTIVES
Element 1.1 — Management commitment and responsibility
1. CASR 19 Is the existing disciplinary 1. check SMS
Appendix procedure/policy enhanced Manual
A with due consideration of 2. Check Safety
Point 1.1 unintentional Policy
errors/mistakes from
deliberate/gross violations?
Component 2 — SAFETY RISK MANAGEMENT
Element 2.1 — Hazard identification
2. CASR 19 Are there procedures to 1. Check SMS
19.31 ensure that hazards/threats Manual
19.33 identified or uncovered 2. Check SOP
19.37 during incident/accident Accident/incide
investigation processes are nt
appropriately accounted for 3. Check
and integrated into the investigation
organisation's hazard report
collection and risk integration with
mitigation procedure? HIRM data
collection

3. CASR 19 Are there procedures to 1. Check SMS

19.31 review hazards/threats from Manual
 -27-

19.33 relevant industry reports for 2. Check reporting

19.37 follow-up actions or risk system from
evaluation where subcontractor
applicable? 3. Check corrective
action
^^omponent a — SAFETY ASSURANCE
Jalety performance monitoring and measurement
EXertient 3.1 — 6

4. CASR 19
Has the organisation Check SDCPS
19.57 (Safety Data
enhanced the safety data
collection and processing Collection and
system to include lower- Processing
consequence events ? Systems)
5. CASR 19 Has the organisation Check SPI - low
19.57 established lower- consequence
Appendix consequence safety/quality
A indicators with target/alert
3.1.2 level monitoring as
appropriate (mature ALoSP)
6. CASR 19 Has the organisation Check agreement
19.57 reached an agreement with of safety
Appendix the State oversight authority performance target
A on lower-consequence safety
3.1.2
performance indicators and
safety performance
target/alert levels ?

Com ponent 3 — SAFETY ASSURANCE

Elenlent 3.3 Con tinuous improvement of the SMS
7. CASR 19 Has the organisation Check SMS audit
19.41 established SMS audits or programme
 -28-

Appendix integrate them into existing

A -3.3 internal and external audit
programmes?
o. CASR 19 Has the organisation Check other survey
19.41 established other program if any
Appendix operational SMS
A - 3.3 review/survey programmes
where appropriate ?
Elennent 4.1—1 raining and education
9. CASR 19 Has the organisation Check training
19.45 ensured that the SMS programme
training
programme for all relevant
personnel has
beencompleted.
Elerlent 4.2 — Safetv communication
10. CASR 19 Does [Organization] 1. Check sms
19.47 participate in sharing safety- publication
information with 2. Check safety data
relevant external industry exchange
product and service
providers or organizations,
including the relevant
aviation regulatory
organizations?

Air Navigation Inspector and Team

SMS Manager and Team
signature
signature

Full Name
Pull Name
NIP
NIK
 -29-

Appendix D Acceptance Report Format

BERITA ACARA ASSESMENT PENERIMAAN (ACCEPTANCE] SISTEM

MANAJEMEN KESELAMATAN (nama service provider)

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

1. Dasar

Dasar Regulasi

2. Hasil Assesment

Berdasarkan asesmen Sistem Menejemen Keselamatan yang telah

dilakukan pada ... (nama service provider), tahapan implementasi SMK
berada pada Tahap (phase) 1 (satu)/Tahap (phase) 2 (dua)/Tahap (phase)
3 (tiga)/Tahap (phase) 4 (empat) {*sesuai ketentuan tahapan implementasi
SMK).

Pada dasarnya sistem manajemen keselamatan pada ... (nama service

provider) dapat diterima dengan menjalankan rencana implementasi Sistem
Menejemen Keselamatan secara berkelanjutan hingga Sistem Menejemen
Keselamatan mencapai phase mature.

3. Hasil assesment Sistem Manajemen Keselamatan terlampir

4. Demikian Berita Acara ini dibuat untuk digunakan sebagaimana mestinya

Inspektur Navigasi Penerbangan Pimpinan Service Provider

XXXXXXXXXX XXXXXXXXXXXX
 •30-

Appendix E SMS Acceptance Format

HEADER
Directorate General of Civil Aviation

SAFETY MANAGEMENT SYSTEM ACCEPTANCE

ON(NAME OF SERVICE PROVIDER)

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

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

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

The Air Navigation Service Provider must execute the implementation plan of
the Safety Management System continuously until the Safety Management
System reaches the mature phase.

The Air Navigation Service Provider shall maintain the implementation of the
Safety Management System in accordance with civil aviation safety regulations.

The implementation of Safety Management System on Air Navigation Service

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

Place, Date Month Year

On behalf Director General of Civil Aviation

Director ofAir Navigation

XXXXXXXXXX
Pangkat dan Gol XXXXX
NIP..XXXXXX
 -31-

KOP SURAT
Direktorat Jenderal Perhubungan Udara

PENERIMAAN (ACCEPTANCE) SISTEM MANAJEMEN KESELAMATAN (SAFETY

MANAGEMENT SYSTEM) PADA
(NAMA SERVICE PROVIDER)
Nomor ; SMS.DNP/nomor/b"ulan romawi/tahun

Sistem Manajemen Keselamatan ... (nama provider) .... mengacu pada Undang
- undang Republik Indonesia Nomor 1 Tahun 2009 tentang Penerbangan dan
CASR {Civil Aviation Safety Regulation^ 19 tentang Sistem Manajemen
Keselamatan {Safety Management System).
Direktur Navigasi Penerbangan menerima rencana implementasi sistem
manajemen keselamatan ... (nama provider) .... berdasarkan kebijakan
keselamatan, manajemen resiko, jaminan keselamatan, dan promosi
keselamatan pada penyelenggaraan pelayanan navigasi penerbangan.
Penyelenggara Navigasi Penerbangan harus menjalankan rencana
implementasi Sistem Menejemen Keselamatan secara berkelanjutan hingga
Sistem Menejemen Keselamatan mencapai phase mature.
Penyelenggara Navigasi Penerbangan harus menjaga pelaksanaan
implementasi Sistem Manajemen Keselamatan sesuai dengan peraturan
keselamatan penerbangan yang berlaku.
Pelaksanaan Sistem Manajemen Keselamatan penyelenggara Navigasi
Penerbangan yang telah diterima {accepted), diawasi oleh Direktur Navigasi
Penerbangan.

Tempat, Tanggal Bulan Tahun

a.n Direktur Jenderal Perhubungan Udara

Direktur Navigasi Penerbangan

xxxxxxxxxx
Pangkat dan Gol XXXXX
N1P..XXXXXX
 -32-

Appendix F Routine SMS assesment checklist

Company Name
Address
Date of Assement

Checklist Answer Recomend Remark

lidance ation
Yes No Partial
Management commitment and responsibilities [1.1]
CASR 19 Is the safety policy relevant to Check Safety
19.19 the scope and complexity of the Policy
Appendix A organization's
1.1 Operations?
CASR 19 Is there evidence that the safety Check SMS
19.19 policy is communicated to all communication
employees with channel
the intent. that they are made
aware of their individual safety
obligations?

3. CASR 19 Is there a periodic review of the Check safety

19.19 safety policy by senior commite schedule
management or the
safety committee?
CASR 19 Do the accountable manager's Check
19.19 terms of reference indicate his accountable
overall responsibility manager's
for all safety issues? responsibility
 -33-

Safety accountabilities [1.2] ■

0. CASR 19 / Is there a safety committee (or Check

19.21 equivalent mechanism) that organisational
reviews the SMS and decree for safety
ts safety performance? commitee
5. CASR 19 / Is the accountable manager's Check
19.21 final authority over all operations organizational
conducted under his structure for
organization's certiricate(s) identify
indicated in his terms of accountable
reference. executive
responsibility

Check example of
final authority by
accountable
manager
Appointment c:Key saiety personnel [1.3]

7. CASR 19 Does the manager performing Check

19.21 (e) the SMS role has relevant SMS organisational
functions included in his terms decree of Safety
of reference? Manager
8. CASR 19 Does the manager responsible Check
19.21 (h) for administering the SMS not organisation
hold other responsibilities that structure
may conflict or impair his role as
SMS manager? Check safety
manager
responsibilitis
 -34-

9. CASR 19 Does the SMS manager has Check

19.21 (h) direct access or reporting to the organisation
accountable executive structure
concerning the implementation check safety
and operation of the SMS? report to
accountable
executive
10. CASR 19 Is the SMS manager's position Check
19.21 (h) not lower than or subservient to organisation
other operational or production structure
positions?
Emergency resjponse planning [1.4J

11. CASR 19 / Does the ERP address possible Check ERP

19.25 or likely emergency/crisis Manual
scenarios relating to the
organization's aviation service
deliveries?
12. CASR 19 / Does the ERP include procedures Check ERP
19.25 for the continuing safe Manual
production, delivery or
support of its aviation products
or services during emergencies
or contingencies?
13. CASR 19 / Are ERP drills or exercises Check report and
19.25 carried out according to plan and documentation of
the result of driUs ERP excercises
carried out are documented?
14. CASR 19 / Does the ERP address relevant Check ERP
19.25 integration with external Manual
customer or subcontractor
organizations where applicable"?
 -35-

15. CASR 19 / Is there evidence of periodic Check review ERP

19.25 review of the ERP to ensure its Manual
continuing
relevance and effectiveness?
8MS documentation [1.5]

16. CASR 19 / Are the organization's SMS Check sms

19.27 components and elements document
adequately manifested in
the SMS document?
17. CASR 19 / Are the organization's Check SMS doc
19.27 documented SMS components recording
and elements in line with
the aviation authority's SMS
requirements?
18. CASR 19 / Is there evidence of relevant SMS Check doc
19.27 coordination or integration with recording
external
customer or subcontractor
organizations where applicable?
19. CASR 19 / Is there evidence of procedures Check doc
19.27 for periodic review of the SMS recording
document and
supporting documentation to Check review log
ensure their continuing
relevance?

20. CASR 19 / Are records pertaining to Check doc

19.27 periodic review of existing recording
safety/risk assessments
available?
 -36-

Hazard identification [2.1]

21. CASR 19 Is the number or rate of the Check amount of

19.31 organization's hazard report
19.59 registered/collected hazard based on
reports operation activity
commensurate with the size and
scope of the organization's
operations?
22. CASR 19 Is the hazard reporting system Check hazard
19.71 confidential and has provisions report protection
to protect the reporter's identity?
23. CASR 19 Is there evidence that Check
19.31 hazards/threats uncovered investigation
19.33 during the incident/accident report and HIRM
investigation process are database
registered with the HIRM
system?
24. CASR 19 Is there evidence that registered Check HIRM
19.31 hazards are systematically report
19.59 processed for risk
mitigation where applicable?
Safety risk assessment and mitigation [2.2]

25. CASR 19 Is there evidence that operations, Check periodic

19.33 processes, facilities and HIRM report
equipment with
aviation safety implications are
progressively subjected to the
organization's HIRM process.
26. CASR 19 Are completed risk assessment Check HIRM
19.33 reports approved by an report approval
 -37-

appropriate level of
Management?
27. CASR 19 Is there a procedure for periodic check safety risk
19.33 review of completed risk management
mitigation records? procedure on
manual sms
Safety performance monitoring and measurement [3.1]

28. CASR 19 Have the organization's SMS Check safety

19.57 safety performance indicators performance
Appendix A been agreed with the relevant indicators
3.1.2 national aviation authority?

29. CASR 19 Are there high-consequence Check SDCPS

19.57 data-based safety performance (Safely Data
Appendix A indicators (e.g. Collection and
3.1.2 accident and serious incident Processing
rates)? Systems)

30. CASR 19 Are there lower-consequence Check SDCPS

19.57 safety performance indicators (Safety Data ■
Appendix A (e.g. noncompliance, deviation Collection and
3.1.2 events)? Processing
Systems)

31. CASR 19 Are there alert arid/or target Check SPI target
19.57 level settings within the safety level and alert
Appendix A performance indicators where
3.1.2 appropriate?
32. CAS R 19 Does the organization's Check SMS
19.39 management of change manual
procedure include the
 -38-

requirement for a safety risk

assessment to be conducted
whenever applicable?
33. CASR 19 Is there evidence of corrective or Check analysis
19.57 follow-up action taken when root cause report
targets are not
achieved and/or alert levels are
breached?

The management of change [3.2]

34. CAS R 19 Is there evidence that relevant Check example of

19.39 aviation safety-related processes HIRM report
and operations
have been subjected to the
organization's HIRM process as
applicable?

35. CAS R 19 Does the organization's Check sms

19.39 management of change manual
procedure include the
requirement for a safety risk
assessment to be conducted
whenever applicable?

Continuous improvement of the SMS [3.3]

36. CASR 19 Is there evidence that an internal Check SMS audit

19.39 SMS audit/assessment has been schedule
Appendix A planned and Check SMS audit
Butir 3.3 carried out? report
 -39-

Training, education and communication [4.1, 4.2]

37. CASR 19 Is there evidence that all Check personal
19.45 personnel involved in SMS training record
opei-ations have undergone Check
appropriate SMS training or familiarization
familiarization? report
38. CASR 19 Are personnel involved in Check personal
19.45 conducting risk evaluation training record
provided with appropriate
risk management training or
familiarization?
39. CASR 19 Is there evidence of a safety Check sms
19.47 (SMS) publication, circular or publication
channel for
communicating safety and SMS Check safety data
matters to employees? exchange
implementation

Air Navigation Inspector and Team SMS Manager and Team

signature signature

Full Name Pull Name

NIP. NIK.
 -40-

Appendix G Phases of SMS Implementation Description

Phases of SMS Elemen What to do and description

Implementation
Phase 1 SMS a) Identify the See the Organizational Structure to identify the AE with the following
(12 month) Element SMS accountability and obligations:
i.i(i) accountable a. provision and allocation of human, technical, financial or other resources
executive; necessary for the effective and efficient performance of SMS;
b. direct responsibility for the conduct of the organization's affairs;
c. final authority over operations under the certificate/approval of the
organization;
d. establishment and promotion of the safety policy;
e. establishment of the organization's safety objectives and safety targets;
f. acting as the organization's safety champion;
g. having final responsibility for the resolution of all safety issues; and
h. establishing and maintaining the organization's competence to leam from
the analysis of data collected through its safety reporting system.
b) Establish an Check organisational decree for SMS Implementation team and responsibility
SMS The team should be comprised of representatives from the relevant
implementation departments. The team's role is to drive the SMS implementation from the
team; planning stage to its final implementation. Other functions of the
implementation team will include but not be limited to
a. developing the SMS implementation plan;
b. ensuring the adequate SMS training and technical expertise of the team in
order to effectively implement the SMS elements and related processes;
and
c. monitoring of and reporting on the progress of the SMS implementation,
providing regular updates and coordinating with the SMS accountable
executive.
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c) Define t±ie Check scope of sms in implementation plan fair navigation provider)
scope of the Define the scope of the organization's activities (departments/divisions) to
SMS; which the SMS will be applicable. The scope of the organization's SMS
applicability vdll subsequently need to be described in the SMS document as
appropriate.
d) Perform an
SMS gap Check Gap Analysis result
analysis. Conduct a gap analysis of the organization's current systems and processes
in relation to the ICAO SMS framework requirements (or the relevant SMS
regulatory requirements)
GAP analisys dilakukan berdasarkan panduan SMM appendix 7 chapter 5
SMS a) Develop an Evidence : Dokumen SMS implementation plan
Element SMS Develop an SMS implementation plan on how the organization will implement
1.5(1) implementation the SMS on the basis of the identified system
and process gaps resulting from
plan. the gap analysis.
SMS a) Establish a Check organisational decree of Safety manager and responsibilities
Element key person/ Identify the key SMS person (safety/quality function) within the organization
1.3 office who will be responsible for administering the SMS on behalf of the
responsible for accountable executive.
the a. managing the SMS implementation plan on behalf of the accountable
administration executive;
an
performing/facilitating hazard identification and safety risk analysis;
maintenance of monitoring corrective actions and evaluating their results;
the SMS. providing periodic reports on the organization's safety performance;
maintaining records and safety documentation;
planning and facilitating staff safety training;
providing independent advice on s^ety matters;
monitoring safety concerns in the aviation industry and their perceived
impact on the organization's operations aimed at service delivery;
coordinating and communicating (on behalf of the accountable executive)
with the State's oversight authority and other State agencies as necessary
 -42-

on issues relating to safety; and

j. coordinating and communicating (on behalf of the accountable executive)
with international organizations on issues relating to safety.

The selection criteria for a safety manager should include, but not be limited
to, the following:
a. safety/quality management experience;
b. operational experience;
c. technical background to understand the systems that support operations;
d. people skills;
e. analytical and problem-solving skills;
f. project management skills; and
g. oral and written communications skills.
b) Establish the Safety services office is a place where safety manager and team work for :
safety services a. collection and analysis of safety data
office. b. distribution of safety information
c. other activity related to sms implementation
4 SMS a) Establish an Check SMS training program
Element SMS training
4.1 (i) programme for
personnal, with
priority for the
SMS
Implementation
 -43-

team. a) Conduct a training needs analysis.

b) Organize and set up schedules for appropriate training of all staff
ncror'.hng to md:vi.duol ?-''rpon.sibilities and involvement in ih^ SMS.
c) Develop safet}'" training considering:
" initial (general safety)job-specific training; and
■ recurrent training.
d) Identify the costs associated with training.
e) Develop a validation process that measures the effectiveness of training.
f) Establish a safety training records system.
SMS a) Initiate check mechanism or medium for safety comrmi^cation
Element SMS/safety a) Initiate a mechanism or medium for safety communication.
4.2 (i) communication b) Establish a means to convey safety information through any of:
channels. 1) safety newsletters, notices and bulletins;
2) websites;
3) email.
Phase 2 SMS a) establish a) Establish this safety policy and objectives
(12 month) Element this safety b) Accountable executive signed the Organization's safety poUcv
1.1 (U) policy and c) Establish Communicate the safety policy throughout the organization
objectives d) EstabUsh a review schedule for the safety poUcy to ensure it remains
relevant and appropriate to the organization.
e) Establish safety objectives for the SMS by developing safety performance
standards in terms of
i) Safety performance indicators
ii) Safety performance targets and alert levels
iii) Action plans
f) Establish the SMS requirements for subcontractors :
i) EstabUsh a procedure to write SMS requirements into the contracting
process
ii) EstabUsh the SMS requirements in the bidding documentation
 -44-

SMS a) define safety a) Defme safety management(All aviation safety-related positions)

Element management responsibilities and accountabilities accross relevan departemens of the
1.2 responsibilities organi7:ation ( example operations, manufarti.iring, maintenance,
and engineering, training and dispatch than for support functions(human
accountabilities resources, administration, legal and financial 1
b) Establish an SMS/Safety coordination mecanism/committe
Establish departmental/ divisional SAGs were applicable
d) Ensure clear functions for the SAG and the safety/SMS coordination
committee
e) Establish lines of communication between the safety services office, the
accountable executive, the SAG and the safety/SMS coordination
committee
f) Appoint the accountable executive as the chairperson of the safety/SMS
coordination committee
g) Develop a schedule of meetings for the safety services office to meet with
the safety/SMS coordination committee and SAG as needed
SMS a) Emergency a) Review the outline of the ERP (contingency plan, crisis management plan
Element response plan and continuing airworthiness support plan.) related to the delegation of
1.4 authority and assignment of emergency responsibilities.
b) Establish coordination procedures for action by key personnel during the
emergency and the return to normal operations.
c) Identify external entities that will interact with the organization during
emergency situations.
d) Assess the respective ERPs of the external entities.
e) Establish coordination between the different ERPs.
f) Incorporate information about the coordination between the different
ERPs in the organization's SMSdocumentation.
SMS Create an SMS a) Establish manual document sms stand alone or a unity with the
Element documentation operation manual
1.5 (ii) system to b) establishing an SMS filing system to collect and maintain current records
describe, store. relating to the organization's ongoing SMS processes
 -45-

retrieve and c) maintaining records to provide a historical reference as well as the

archive all current status of all SMS processes such as: a hazard register; an index
vSMS-related of completed safetj'-assessments; SMS/safety''training records; current
inlbrmation SPIs and associated safety objectives; internal SMS audit reports;
and records by SMS/safety committee meeting minutes and the SMS implementation
plan;
d) maint^ing records that will serve as evidence of the SMS operation and
activities during internal or external assessment or audit of the SMS
Phase 3 SMS a) Hazard
(18 month)
a establish a voluntary hazard reporting procedur:
Element Identification. i) The objective of the reporting system;
2.1 (i)
ii) The scope of the aviation sectors/areas covered by the system;
iii) Who can make a voluntary report;
iv) When to make such a report;
v) How the reports are processed;
vi) Contacting the [Name of system] manager;
^^ 4__ /

b) Establish a programme/schedule for systematic review of all applicable

aviation safety-related processes/equipment that are eligible for the HIRM
process.
process.
c) Estabfish a process for prioritization and assignment of identified hazards
for risk mitigation.
SMS Safety risk a) establish safety risk management procedures.
Element assessment i) Hazard identification;
2.2 and mitigation ii) The scope of the aviation sectors/areas covered by the system;
iii) Risk analysis (probability);
iv) Risk analysis (severity);
v) Risk assessment and tolerabilit;
vi) Risk control / mitigation;
Develop and adopt safety risk matrices relevant to the organization's
operational or production processes.
 -46-

SMS Safety a j^stablish occnrrence reporting and investigation procedures:

Element performance ■Occurence reporting may range from thc' highest-consequence occurrences
>11 AA ^ ^ ^ _

3.1 (i) monitoring and (accidents, serious incidents) to lower-consequencc events such as
measurenicnt operational incidents, sysiiem/equipment failures or defects
b) Establish a safety data collection and processing system for high-
txi: _ _i . ■ 11 ..

consequence outcomes;
i) Accident investigation data;
ii) Mandatory incident investigation data;
iii) Voluntaiy reporting data;
iv) Continuing airworthiness reporting data;
v) Operational performance monitoring data;
vi) Safety risk assessment data;
vii) Data from audit findings/reports;
vih) Data from safety studies/reviews; and
/TPQ/^ Safety
(RSOOs) data from
or regional otherand
accident States, regional
incident safety oversight
investigation organizations
organizations
(RAIOs), etc
—Develop high-consequence SPIs and associated targets and alert settinffs.
i) Accident ratej
ii) Serious incident rate;
iii) Monitoring of high risk, regulatory, non compliance outcome fe g
ICAO audit finding): ^ ^
d) Reach an agreenient with the State oversight authority on safety
performance indicators and safety performance targets.
SMS The a) Establish a management of change procedure that includes safety risk
Element management of assessment.
3.2 change
 -47-

b) Ensure that management of change procedures address the impact on

existing safety performance and risk mitigation records before
ncv/ cb'T^no-pfj
c) Establish piocedures to ensure tiiai safety assessment of new aviation
safet^^-related operations, processes and equipment are conducted (or
SMS
3-Ccounted for) as applicable, before they are commissioned.
Continuous a) Develop forms for internal evaluations.
Element improvement of
3.3 (i) the SMS b) Establish an internal quality audit programme
c) Establish an external quality audit programme
d) Define a schedule for evaluation of facilities, equipment, documentation
and procedures to be completed through audits and surveys.
e) Develop documentation relevant to operational safety assurance.
Phase 4 Management
(18 month) SMS
commitment
a) Enh^ce the existing disciplinary procedure / policy with due
Element
and consideration of unintentional errors or mistakes from deliberate or gross
1.1 (iii) violations.
responsibility
SMS Hazard b] Integrate hazards identified from occurence investigation reports with the
Element identification voluntaiy hazard reporting systems.
2.1 fii)
c) Integrate hazard identification and risk management procedures with the
subcontractors or customers SMS where applicable.
SMS Safety- d) Enhance the safety data collection and processing system to include
Element performance lower-consequence events;
3.1 (u) monitoring and
measurement e) Develop lower-consequence SPIs and associated targets/alert settings.
 -48-

4 SMS Continuous f) EstebUsh SMS audit programmes or integrate them into existing internal
Element improvement of and external audit programmes.
3.3 (ii) the SMS
g) Establish other operational SMS review/survey programmes where
appropriate.
5 SMS
Element Training and h) Ensure that the SMS training programme for all relevant personnel has
4.1 (ii) education been completed.
0 SMS Safety i) Promote safety information sharing and exchange internally and
Element communication externally.
4.2 (ii)

ACTING DIRECTOR GENERAL OF CIVIL AVIATION

ttd

Ir. M. PRAMINTOHADI SUKARNO, MSc.

Salinan sesuai dengan asUnya,

, . KEPALA BAGIAN HUKUM
//
'v'/

f, ■
r. i ,

ENDAH PURNAMA RAPT

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