Air navigation services run by the Irish Aviation Authority (IAA) have not been adequately resourced and were still suffering from staffing shortages for at least two years after the Rescue 116 helicopter crash, The Sunday Independent reports.
A review for the Department of Transport also calls for a "just culture body" which is "robust" to be implemented as soon as possible to protect pilots and other crew members who make confidential reports on safety concerns.
And it criticises delays in separating the State aviation authority's conflicting functions of safety regulation and commercial operations.
The lack of accurate air navigation charts available to Irish Coast Guard helicopter search and rescue crews was one of the key issues highlighted after the Rescue 116 crash which claimed the lives of Capt Dara Fitzpatrick, Capt Mark Duffy, Paul Ormsby and Ciaran Smith off north Co Mayo on March 14, 2017.
The final report into the crash has still not been published as an unidentified stakeholder has been granted a review of the final draft report by Minister for Transport Shane Ross.
In late 2017, the IAA had invited search and rescue and other pilots to help correct aeronautical charts after it conceded charts published three months after the crash were inaccurate, with lighthouses in wrong locations and obscure symbols.
Although the IAA is responsible for providing aeronautical charts under State safety plans, it has said it does not guarantee their accuracy or completeness and disclaims all liability.
The review of the IAA technical and safety performance by Helios and Egis Avia consultants during the second and third quarters of 2019 found the IAA air navigation division staff were having to work "extended hours", as posts could not be filled after one inspector left and one took maternity leave.
The "slow pace" of separating safety regulation from money-making commercial activities within the IAA and the potential workload increase for IAA staff as a result of Brexit are other issues flagged in the review.
For more, read The Sunday Independent report here