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Terry Wilcutt
Chief, Safety and Mission Assurance
Welcome to the OSMA safety message archive. This page contains my OSMA ViTS safety presentation along with a case study and other related media. These stories are written as summaries of system failures from which I believe we can all learn. While many of these cases are not NASA related, each has certain aspects that are applicable to NASA. I encourage you to disseminate these to your organizations as a tool to promote discussion on the causes of system failures. Henry Petroski, author of "To Engineer is Human: The Role of Failure in Successful Design," argues that engineers must strive to anticipate the ways in which a design might fail, and these case studies are an excellent way of highlighting many of these failure modes.
This Situation Report looks at the emerging issue of counterfeit electronic components and their impact on Agency: project costs, performance, and schedules. It includes facts surrounding the counterfeiting of electronic components (i.e., circuit boards and computer chips), the proliferation of illegal offshore production, and the international brokerage of non-compliant parts.
February 25, 2009: A Boeing 737-800 lay in pieces on a freshly tilled farm field approximately 1.5 kilometers short of runway... more.
Peaceful. Typical. Nondescript. These words should have described San Bruno, California on September 9, 2010. But residents o... more.
The role of software in the control and operation of flight systems has grown dramatically since the landmark Apollo program ... more.
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On September 2, 2006, Nimrod MR2 XV230, a reconnaissance aircraft in the Royal Air Force, flew over Southern Afghanistan in s... more.
During the winter of 1982, the world's largest mobile offshore drilling unit, the Ocean Ranger, was drilling for oil off the ... more.
On February 24, 1997, six crew members on Mir Space Station faced significant danger when fire ignited in the solid fuel ox... more.
Communication lapses lie at the root of many mishaps and close calls and can set off complicated event chains that lead to di... more.
At the beginning of the evening rush hour on June 22, 2009, the Washington Metropolitan Area Transit Authority (WMATA) experi... more.
When NASA launched Hubble Space Telescope in 1990, astronomers boasted Hubble would probe the universe to a degree unparallel... more.
Like many organizations, NASA struggles with slips, trips and falls (STF). They are our primary source of injuries: In CY 201... more.
During a 36-hour period on August 29-30, 2007, six nuclear warheads were flown in U.S. airspace without proper authorization.... more.
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