The FCC this morning released its full report on the false missile alert in Hawaii, finding a “combination of human error and inadequate safeguards” and issuing a lengthy list of recommendations.

After the Jan. 13 false missile alert was sent by the Hawaii Emergency Management Agency, it took 38 minutes to correct, causing widespread panic because of a series of errors by local officials.

“The primary human error was a failure to hear and/or properly understand the instructions indicating that the exercise was a test,” the FCC report said. “The employee who triggered the false alert believed that the missile threat was real.”

In addition, according to the report, a misunderstanding between the midnight shift supervisor and day shift supervisor also led to the drill being run without sufficient supervision.

Inadequate safeguards for possible communications breakdowns between warning officers and supervisors was another contributing factor cited in the report. “Specifically, HI-EMA lacked procedures to prevent a single person from mistakenly sending a missile alert to Hawaiian public. Prior to the morning of January 13, 2018, HI-EMA did not require confirmation from a second warning officer before sending a ballistic missile alert.

“After HI-EMA transmitted the false alert, HI-EMA compounded the error by delaying to publicly and authoritatively correct the misinformation,” the report says.

A preliminary report by the agency was released on Jan. 30.

The final recommendations in today’s report include:

>> Conduct regular internal tests in a controlled and closed environment to maintain proficiency with alerting tools, to exercise plans and procedures, and to identify opportunities for improvement in a manner that does not affect the public.

>>Require more than one credentialed person to validate the message content prior to transmission of a ballistic missile alert or other high-impact alerts that affect a significant percentage of the population, as well as all tests.

>>To minimize the potential for confusion, limit employee permissions to create or modify any internal drill message. In addition, refrain from using phrases such as “This is Not a Drill” or “Real World” in test messages. Instead, test messages should be clearly identified as tests and use language such as “This is a test.” The script and content for actual emergency alerts versus test alerts should be clearly distinguishable.

>> Require supervisor approval and supervision of internal tests and proficiency training exercises.

>> Develop standard operating procedures for responding to false alerts within their jurisdictions. These standard operating procedures should specify that corrections to false alerts must be issued over the same systems used to issue the false alert … They should also include procedures for notifying the media about false alerts.

>> Carefully consider the use and frequency of no-notice drills and ensure appropriate supervision of no-notice drills.

>> Establish redundant and effective lines of communication with key stakeholders during emergencies … so that they can rely on planned workarounds in the event their phone lines become congested during emergencies.

Final Report and Recommendations: Hawaii Emergency Management Agency by Honolulu Star-Advertiser on Scribd