The Defence Flight Safety Bureau (DFSB) has finalised the Aviation Safety Investigation Report into the accident on 28 July 2023, during Exercise Talisman Sabre 23, when an MRH-90 Taipan helicopter impacted waters in vicinity of the Whitsunday Islands.
Captain Danniel Lyon, Lieutenant Maxwell Nugent, Warrant Officer Class 2 Joseph 'Phillip' Laycock and Corporal Alexander Naggs tragically lost their lives in the accident.
This aviation safety investigation was one of the most complex conducted by Defence in recent history.
Aviation safety investigations do not seek to apportion blame or liability on individuals or organisations.
The investigation analysed causal and contributory factors spanning individual/crew actions, local conditions, risk controls and organisational influences in order to make recommendations for safety improvement and prevent re-occurrence of similar events.
The report identifies a number of findings and recommendations across the Defence Aviation Safety Program.
Families of the crew, crews involved in the mission and personnel within Army Aviation were briefed today on the findings of the report. DFSB is required to provide the report to the Inspector General of the Australian Defence Force, Comcare and Queensland Coroner upon request.
DFSB will provide a publicly releasable report upon completion of essential debriefings with Defence Aviation rotary-wing units, applicable Defence organisations and affected personnel. The report will be available in May.
This important debrief process is integral to ensure we protect the generative safety culture and the lives of the Defence aviation community.
Defence is providing the families, the crews involved in the mission and personnel within Army Aviation, and Defence Aviation Safety Authority, with the report findings to ensure a shared awareness of causal and contributory factors of the accident, and key recommendations to improve our safety systems for all.
The accident, and the report's findings and recommendations, serves as a catalyst for organisational reflection and to reaffirm our enduring aspiration for a generative safety culture. Defence is committed to a culture that maintains a persistent state of vigilance, is receptive to learning, is willing to respond to opportunities, and that maintains a collective commitment to protecting our people.
