activities of NASA so that safe manned space flight can be re- Science and Technology has conducted a thorough investigation of the Challenger accident.
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Union Calendar No. 600 99th Congress, 2d Session – – – – – – – – – – – – – House Report 99-1016 INVESTIGATION OF THE CHALLENGER ACCIDENT REPORT OF THE COMMITTEE ON SCIENCE AND TECHNOLOGY HOUSE OF REPRESENTATIVES NINETY-NINTH CONGRESS SECOND SESSION OCTOBER 29, 1986.-Committed to the Committee of the Whole House on the State of the Union and ordered to be printed 64-420 0 U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 1986
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COMMITTEE ON SCIENCE AND TECHNOLOGY DON FUQUA, Florida, Chairman ROBERT A. ROE, New Jersey GEORGE E. BROWN. JR.. California MANUEL LUJAN, JR.; New Mexico ROBERT S. WALKER, Pennsylvania JAMES H. SCHEUER, New York MARILYN LLOYD, Tennessee TIMOTHY E. WIRTH, Colorado DOUG WALGREN, Pennsylvania DAN GLICKMAN, Kansas ROBERT A. YOUNG, Missouri HAROLD L. VOLKMER, Missouri BILL NELSON, Florida STAN LUNDINE, New York RALPH M. HALL, Texas DAVE McCURDY, Oklahoma NORMAN Y. MINETA, California BUDDY MAcKAY,’. Florida TIM VALENTINE, North Carolina HARRY M. REID, Nevada ROBERT G. TORRICELLI, New Jersey F. JAMES SENSENBRENNER, JR., CLAUDINE SCHNEIDER, Rhode Island SHERWOOD L. BOEBLEKT, New York TOM LEWIS, Florida DON RI’ITER, Pennsylvania SID W. MORRISON. Washinaton Wisconsin RON PACKARD, California – JAN MEYERS, Kansas ROBERT C. SMITH, New Hampshire PAUL B. HENRY, Michigan HARRIS W. FAWELL, Illinois WILLIAM W. COBEY, JR., North Carolina JOE BARTON, Texas D. FRENCH SLAUGHTER, JR., Virginia DAVID S. MONSON, Utah RICK BOUCHER, Virginia TERRY BRUCE, Illinois RICHARD H. STALLINGS, Idaho BART GORDON, Tennessee JAMES A. TRAFICANT, JR., Ohio JIM CHAPMAN, Texas HAROLD P. HANSON, Executive Director ROBERT C. KETCHAM, General Counsel REGINA A. DAVIS, Chief Clerk R. THOMAS WEIMER, Republican Staff Director CHALLENGER ACCIDENT REPORT STAFF TASK GROUP ROBERT C. K~HAM, General Counsel RADP~RD BYERLY, Jr. RONALD E. WILLIAMS PATRICIA G. GARFINKEL A. SCOTT CROSSFIELD CAROLYN C. GREENFELD DAVID D. CLEMENT SHIRLEY J. WATSON ROBERT E. PALMER GEORGE S. KOPP HARRY S. DAWSON, Jr. HARRIET J. SMITH NEUON L. MILDER CAROLYN J. RADABAUGH JAM= PAUL GLORIA J. DUNDERMAN ‘Ranking Republican Member. “Serving on Committee on the Budget for 99th Congress (11)
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LETTER OF SUBMITTAL U.S. HOUSE OF REPRESENTATIVES, Washington, DC, October 29, 1986. Hon. THOMAS P. O™NEILL, Jr., The Speaker of the US. House of Representatives, Washington, DC. DEAR MR. SPEAKER: By direction of the Committee on Science and Technology, 1 hereby submit the Committee™s investigative report on the Chal- lenger accident. The report was approved by the Committee on Oc- tober 7, 1986. The report was carried out under the direction of the Ranking Majority Member, Robert A. Roe, who chaired the hear- ings and instructed the Committee staff assigned to the investiga- tion. Sincerely, DON FUQUA, Chairman. Enclosure. (111)
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LETTER OF TRANSMITTAL U.S. HOUSE OF REPRESENTATIVES, COMMITPEE ON SCIENCE AND TECHNOLOGY, Washington, OC, October 29, 1986. To Robert A. Roe, Ranking Majority Member, Committee on Science and Technology. DEAR MR. CHAIRMAN: I am forwarding this investigative report on the Challenger Acci- dent prepared at your request. On your instructions, the staff has carefully reviewed the infor- mation made available to the Committee and prepared the neces- sary findings and recommendations. The task was enormous and has been done in a careful and painstaking manner. I am especial- ly grateful to all the staff which is listed on the inside cover of the report for their professional and thorough application to this im- portant report. We worked in a collegial manner and on a com- pletely bipartisan basis. I particularly want to thank the three group leaders, Ron Williams, Terry Dawson and Harriet Smith who headed up the respective subgroups for the Accident, the Tech- nical, and the Management Issues. Sincerely, ROBERT C. KETCHAM, General Counsel.
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vrrr V-G .. . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . VIII-B .. .. .. .. . . . VIIIC . . .. . VIII-D . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . , . . * . . . . . . . . . . , . . . . , . . , . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . VIII-H . VIII-I . .. VIII-J .. VIII-K . . . . . . .. . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. ,.,., ,,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. Page 285 286 288 290 292 319 321 327 369 376 278 280 384 387 393 395 406 417 425 428 434 438 442
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Union Calendar No. 600 99~~ CONGRESS REPORT 2d session } HOUSE OF REPRESENTATIVES I gg-io16 INVESTIGATION OF THE CHALLENGER ACCIDENT OCTOBES 29, 1986.-Committed to the Committee of the Whole House on the State of the Union and ordered to be printed Mr. FUQUA, from the Committee on Science and Teshnology, submitted the following REPORT I. INTRODUCTION On January 28, at 11:39 a.m., the Space Shuttle Challenger and its crew suffered a tragic accident during launch. That same day the House of Representatives adopted H. Res. 361 which expressed the profound sorrow of the House for the tragedy and offered con- dolences to the families of the Challenger crew members. During consideration of the resolution Chairman Fuqua informed the full House of Representatives that, in conformance with its oversight responsibilities, the Committee on Science and Technolo- gy would conduct a comprehensive investigation into the cause of this accident. This report is the result of the Committee™s inquiry. It contains the best efforts of the Committee to review the work of the Presi- dential Commission on the Space Shuttle Challenger Accident (hereafter referred to as the Rogers Commission) and the work of the National Aeronautics and Space Administration (NASA) in in- vestigating the causes of the accident, and reviewing the recom- mendations to resume safe flight. In addition to reviewing the five volumes of the Rogers Commis- sion Report, the Committee also had direct on-line access to the entire Rogers Commission data base, which included full-text and document retrieval capability. The findings and recommendations contained in this report are the product of the Committee™s own extensive hearing record, ™ Report of the Presidential Commission on the Space Shuttle Challenger Accident, Volumes I- V, Washington, D.C., June 6, 1986. (Hereafter referred to as Rogers Commission Report.) (1)
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2 which includes materials submitted for the record, staff investiga- tions, interviews, and trips. It should be understood that the role of this Committee is differ- ent from that of the four-month Rogers Commission. The Commit- tee, which authorized the funds and reviewed the lengthy develop- ment process which led to the successful Shuttle program, has a re- sponsibility to insure that the tragic accident, and those events that led up to it, are understood and assimilated into all levels and activities of NASA so that safe manned space flight can be re- sumed. In carrying out its annual authorizing responsibilities, the Com- mittee endorses the programs and activities of NASA, and func- tions as a key player in the legislative activities of our federal system. As part of the fulfillment of this role, the Committee has reviewed the report of the Rogers Commission, called upon numer- ous witnesses, and utilized many members of its staff to prepare and review the material that has produced this report. The Committee has been most fortunate in its work due to the diligent and thorough investigation undertaken by the Rogers Com- mission and the NASA investigation panels that supported the Commission. The Commission™s exhaustive efforts to achieve com- pleteness as it came to grips with a very complex technical and management system are very commendable, and will serve as a model for future Presidential Commissions. The Committee wishes to express its appreciation for the assist- ance of the House Administration Committee, the Rogers Commis- sion staff, and the Justice Department™s Office of Litigation Sup- port, Civil Division. Each of these groups was very cooperative and helpful in providing the access to, and equipment for, the Challeng- er accident data base needed by the Committee to do its work. In addition, the Committee very much appreciates the assistance of NASA personnel who responded to numerous requests for briefings and documents during the course of the investigation.
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11. CONCLUSIONS In execution of its oversight responsibilities, the Committee on Science and Technology has conducted a thorough investigation of the Challenger accident. Although the Committee™s concern and evaluation in this report are related specifically to the safe and ef- fective functioning of NASA™s Space Shuttle program, it should be understood that our larger objective and greater responsibility are to insure that NASA, as the Nation™s civilian space agency, main- tains organizational and programmatic excellence across the board. What we as a Committee, NASA as an agency, and the Nation as a whole, also must realize is that the lessons learned by the Chal- lenger accident are universally applicable, not just for NASA but for governments, and for society. We hope that this report will serve this much larger purpose. The Committee™s investigation included: ten formal hearings in- volving 60 witnesses; an extensive review of the report of the Rogers Commission along with its voluminous supporting appendi- ces and related reports by the investigation panels at NASA, as well as numerous briefings and interviews with NASA officials, contractor personnel, outside experts, and other interested parties. From the outset, the focus of the Committee™s investigation has been on understanding each of the following: What was the cause, or causes, of the Challenger acci- dent? Are there other inherent hardware or management-re- lated deficiencies that could cause additional accidents in the future? What must be done to correct all of these problems so that the Space Shuttle can be safely returned to flight status? The Committee found that NASA™s drive to achieve a launch schedule of 24 flights per year created pressure throughout the agency that directly contributed to unsafe launch operations. The Committee believes that the pressure to push for an unrealistic number of flights continues to exist in some sectors of NASA and jeopardizes the promotion of a fisafety firstfl attitude throughout the Shuttle program. The Committee, the Congress, and the Administration have played a contributing role in creating this pressure. Congressional and Administration policy and posture indicated that a reliable flight schedule with internationally competitive flight costs was a near-term objective. Pressures within NASA to attempt to evolve from an R&D agency into a quasicompetitive business operation caused a realign- ment of priorities in the direction of productivity at the cost of safety. (3)
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