Case Study of The Space Shuttle Disasters (PLG1)

This module we will look at both the Challenger crash that happened in 1986 and the Columbia crash that happened 17 years later. What you will do in this module is pick one of these crashes and analyze it using a Fault tree analysis. Watch both videos first, then decide which crash you want to focus on. Then read the rest of the information for the crash you want to use to accomplish your case study. Be advised, the discussion topic this week will discuss some issues from both of these crashes so you will need to be familiar with some of the issues that occurred in both.
Videos
First, view the following videos:
Challenger:
Challenger Disaster Live on CNN (2:23 – YouTube) (Links to an external site.)

Challenger Accident Investigation (1986) (44:45 – YouTube) (Links to an external site.)

This NASA video is almost 45 minutes, but the analysis starts at 15:00 minutes if you want to fast forward to that point. Click the picture to link to YouTube for video.
Columbia:
Seconds from Disaster, Season 2, Episode 1, Columbia’s Last Flight (50:10 – Alexander Street via the Hunt Library) (Links to an external site.)
https://search-alexanderstreet-com.ezproxy.libproxy.db.erau.edu/view/work/bibliographic_entity%7Cvideo_work%7C2662989
This excellent video analysis of the crash of the Space Shuttle Columbia is about 50 minutes long. However, the analysis portion starts at 23:54 if you want to fast forward to that point.
Readings
Second, read the following sources:
Challenger:
Chapters 4 and 6 of the Presidential Commission Report, also known as the Rogers Report, on the Challenger accident (NASA).
Chapter IV: The Cause of the Accident (Links to an external site.)
https://www.history.nasa.gov/rogersrep/v1ch4.htm#4.1
Chapter VI: An Accident Rooted in History (Links to an external site.)
https://www.history.nasa.gov/rogersrep/v1ch6.htm
Columbia:
Read the parts of the Columbia accident investigation that are applicable to your project. Chapter 2 is the flight sequence. Chapter 3 is the accident analysis. Chapters 5 – 7 discuss the issues at
NASA and compare some of the issues between the Columbia crash and the Challenger crash.
Columbia Accident Investigation Board: Report, Vol. 1 (Links to an external site.) (Alexander Street via the Hunt Library)
https://search-alexanderstreetcom.ezproxy.libproxy.db.erau.edu/view/work/bibliographic_entity%7Cbibliographic_details%7C2208208#page/1/mode/1/chapter/bibliographic_entity|bibliographic_details|2208208
Assignment Instructions
If you chose the Challenger crash accomplish the following:
Based upon the things you have read and watched on the causes of the Challenger explosion and your own thoughts on what may have contributed it, put yourself in the shoes of the engineering team developing the O-rings for the SRBs. Construct a fault tree analysis of the O-ring construction, keeping in mind the possibilities of temperature changes and other weather
considerations.
If you chose the Columbia Crash:
Based on the things you have read and watched on the causes of the Columbia reentry explosion and your own thoughts on what may have contributed to it, put yourself in the shoes of the engineering team developing the foam construction on the main fuel tank of the launcher. Construct a fault tree of the fuel tank foam construction, keeping in mind the possibility of foam coming
off during the launch and any other considerations you may deem important such as temperature, weather, or vibration.
From your fault tree, draw conclusions in the form of a one to two page summary about the risks you found, their criticality based upon the risk assessment matrix, and probable ways to mitigate the risks that your fault tree showed. Your summary should include an actual fault tree, showing correct transition gates, and a short narrative of the analysis. If you are unable to get a computer
program that will draw the gates correctly, it is OK to hand draw the fault tree out legibly and scan it in for submission. Sometimes it is more important to get the information to the boss quickly as opposed to spending the time finding a computer to build it on. As always, if you need to do more research to accomplish this task, feel free. Just be sure to cite your sources accordingly.
This assignment has two requirements that must be completed. The first is a fault tree presenting the data you selected to analyze (an example is found in the Ericson text). The second is a short narrative to the boss telling them why the items you show in your chart are important and need to be addressed. Both of these must be turned in for this case study.
Your Instructor will evaluate your analysis based on the Case Study Rubric.
Save your assignment using a naming convention that includes your first and last name and the activity number (or description). Do not add punctuation or special characters.
Your paper will automatically be evaluated through Turnitin when you submit your assignment in this activity.
Most of the modules in this class contain case studies that you will complete. As mentioned in the intro video, this class uses a building block process to introduce you to the techniques used by systems safety professionals to completely analyze a system. The specific directions for accomplishing these case studies are contained in each module.
General rules for all case studies – The case studies are designed to allow you to use the techniques you have read about each of the module readings. There are two basic requirements for each case study:
Every one of the case studies requires some form of a chart to be done. For example, in Module 2, you must construct a Preliminary Hazard List (PHL) just like the one shown in the samples in the class textbook. In Module 6, you must construct a full Fault tree analysis chart, again just like what is shown in the textbook. Now, if you don’t have a program that allows for building an FTA
chart and are having a hard time formatting it, then there is nothing wrong with drawing it out legibly and submitting it that way. Realize that sometimes rapidly getting the information presented to the boss for action is more important than taking the time to make it pretty.
A report to your boss outlining what you have found and your thoughts on it. Your report should include sections that tell the boss what you found, and analysis of why what you found is important and needs to be addressed, and finally what needs to be done to correct the issues you found or what is needed to bring it into compliance. This report should be a minimum of 1 to 2
pages in length and double spaced. These reports may require correctly APA formatted references and citations depending upon what information you used to draft your report.
Your assignment will automatically be evaluated through Turnitin when you submit your assignment in this activity. Turnitin is a service that checks your work for improper citation or potential plagiarism by comparing it against a database of web pages, student papers, and articles from academic books and publications. Ensure that your work is entirely your own and that you have
not plagiarized any material!
Hazard Analysis Techniques for System Safety
Edition: 2nd
Year: 2015
ISBN: 978-1-118-94038-9
Author: Clifton Ericson II
Publisher: John Wiley & Sons
Publication Manual of the American Psychological Association
Edition: 6th
Year: 2010
ISBN: 978-1-4338-0561-5
Author: American Psychological Association
Publisher: American Psychological Association
Note: For further information, see the APA website.
Note: The following materials are available for free. Links to these items are also located in the
activities within the course which require the specific sources.
Basic Guide to System Safety
Edition: 3rd
Year: 2014
ISBN: 978-1-1184-6020-7
Author: Clifton Ericson II
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Publisher: John Wiley & Sons
Note: This ebook is free through the ERAU Hunt Library.
Air Force System Safety Handbook (PDF)
Note: Available through the Air Force Safety Agency
System Safety and Risk Management: A Guide for Engineering Educators (PDF)
Note: Available through the CDC