Zone

Crash of an Airbus A320-231 in Jaipur

Date & Time: Jan 5, 2014 at 2110 LT
Type of aircraft:
Operator:
Registration:
VT-ESH
Survivors:
Yes
Schedule:
Imphal – Guwahati – New Delhi
MSN:
469
YOM:
1994
Flight number:
AI890
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
173
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
8322
Captain / Total hours on type:
5502.00
Copilot / Total flying hours:
2798
Copilot / Total hours on type:
2610
Aircraft flight hours:
55705
Circumstances:
On 05.01.2014, Air India Ltd. Airbus A-320-231 aircraft was scheduled to operate flight AI-889 (Delhi – Guwahati – Imphal) and return flight, AI-890 (Imphal – Guwahati – Delhi). Air India dispatch section at Delhi, which has received the roster of flight crew for the flights, had prepared the operational and ATC flight plans by using FWz flight planning software and taking into account the weight & weather (forecast winds). Same set of flight crew and cabin crew was rostered to operate the four sectors mentioned above. The flight was under Command of an ATPL holder with another ATPL holder as First Officer (FO) and 04 Cabin Crew members. The Commander was CAT III qualified and the FO was CAT I qualified. The FWz plan was prepared for VT-ESL, but later on the aircraft was changed to VT-ESH. As per the pilot in command as both the aircraft have bogie gear type of landing gear and the performance factor is also same for these aircraft, he had accepted the FWz plan of VT-ESL. As per the manager flight dispatch on duty, only first leg i.e. Delhi Guwahati was dispatched. Required fuel figures were informed to the engineering & commercial departments. Pilots were briefed with folders which in addition to flight plans contained current NOTAMs and meteorological information. The relevant information in these documents was highlighted for briefing to the flight crew. For the remaining sectors which were self briefing sectors flight plan and NOTAMs were given to the flight crew. As per the pre flight briefing register, both the crew members have visited the flight dispatch section for briefing and at around 10:40 hrs. IST have signed the dispatch register. The sectors Delhi – Guwahati – Imphal – Guwahati were as per schedule and were uneventful. As per the flight sector report, the transit time at Guwahati prior to Guwahati-Delhi sector was 50 minutes. The aircraft landed at Guwahati from Imphal at 11:15 hrs. UTC and 12.7 tons of fuel was uplifted. The filed alternates for the sector were Lucknow and Jaipur in that order. METARs of Delhi, Lucknow and Jaipur were provided at Guwahati. There was no specific briefing. Flight crew has taken the weather updates of destination and alternates before departure from Guwahati. Lucknow visibility at that time was 2000 meters with temperature and dew point of 18°C & 13°C respectively. The weather at Delhi (11:05 UTC) was RVR as 500 meters for runway 29, general visibility of 150 meters, with both temperature and dew point of 12°C. A speci was issued at 1130 UTC for Jaipur with winds 04 kts. visibility 3000m and haze. There was no significant clouding (NSC), temperature (T) 18°C & dew point (Dp) 13°C, QNH 1013. Pre flight walk around inspection was carried out by the crew at Guwahati and the aircraft was released by an Aircraft Maintenance Engineer which was accepted by the Pilot-in-command. There was no snag or technical problem with the aircraft. There was no component or system released under Minimum Equipment List (MEL). For its last leg, the aircraft departed Guwahati for Delhi at 1205 UTC with 173 passengers on board. The fuel requirement from Guwahati to Delhi with 179 persons on board was 12.2 tonnes. As per the commander of flight, additional 500 kgs of fuel was taken (total on board was 12.7 tonnes) considering the time of arrival in Delhi was that of traffic congestion and because of weather in Delhi. As per the Operational Flight Plan (OFP), there was 10 minutes of arrival delay at the destination. The aircraft was flown on managed speeds. Initially the flight was cleared by ATC for a lower level and was later on cleared to fly at cruising level of 340. The fuel was checked visually on the Flight Management System (FMS) and Fuel Page which was further cross checked with the OFP planned figures by the crew on way points but was not recorded on the Operational Flight Plan. As per the crew, the fuel consumed was marginally higher than planned. The time taken to reach the way points was also noted, which was almost the same as planned figures were. Enroute, there was no briefing about traffic congestion over Delhi by any of the ground stations of AAI. The crew, on reaching overhead Lucknow, has taken Lucknow weather and when the aircraft was in range of ATIS Delhi, Delhi ATIS weather was also copied. The aircraft was not equipped with Aircraft Communications Addressing and Reporting System (ACARS) but was provided with HF/VHF system. As per the flight crew no flight following was provided either by flight dispatch or the IOCC of Air India. Weather updates were not seeked by the crew from the flight dispatch nor were any updates provided by Flight dispatch to the aircraft during the flight except when crew had asked Delhi dispatch about Jaipur visibility before finally making the decision to divert to Jaipur. Flight crew did not seek any update of Delhi or Jaipur weather till the time the aircraft came in contact with Delhi ATC. While in contact with Delhi ATC, the flight was advised to join hold as Delhi visibility Runway 28 RVR had dropped to the lower end of CAT I operations at this point runway 29 was below minima. AI 890 was number 12 in sequence and continued to remain in the holding pattern for the next 20-25 minutes. During this period there was no attempt on the part of flight crew to seek Lucknow weather. Air India Flight dispatch has also not given any advice to the flight about Jaipur or Lucknow weather. The weather (visibility / RVR) reported on Runway 29 was below CAT I conditions so runway was not available for this flight at that moment as the First Officer was only Cat I qualified. As per commander of the flight, they did 03 holds each of 1.5 minutes leg and flew headings 360° and 180° before intercepting the localizer Runway 28 at 35 miles. RVR runway 28 also dropped below Cat. I minimas, therefore the crew discontinued approach and climbed to 8000 feet on runway heading before going on heading 180. As per the Commander, though the 1st planned diversion alternate was Lucknow which had visibility of 2000 m i.e. above minima, but change of diversion to Jaipur was made as after missed approach they were closer to Jaipur and they had inquired about the visibility from Dispatch for Jaipur, which was provided as 2000 m. At this stage the crew did not check complete weather of Jaipur. Minimum diversion fuel to Jaipur was 2.9 tonnes as per FWz CFP. AI-890 commenced diversion to Jaipur with ―Fuel on Board‖ of 3.1 tonnes. As per the Station Manager of Air India at Jaipur Airport, he received a call from their Executive Director, Northern Region at around 2040 hrs. IST on 05.01.2014 that due to Delhi weather, AI 890 had diverted to Jaipur. He then conveyed the same to the airport office and the concerned engineer. The aircraft came in contact with Jaipur for the first time when it was at 68 DME from Jaipur. At that time the crew came to know of the complete weather of Jaipur from ATIS as visibility of 900 m, Dew Point as 13°C, temperature as 13°C, and RVR of 1000m. At 60 miles and passing flight level 138, the crew intimated Jaipur that the aircraft is descending for flight level 100 as cleared by Delhi control, which was acknowledged by Jaipur ATC. The aircraft again informed Jaipur ATC its position at 55 miles, 50 miles and 42 miles from Jaipur which were also acknowledged by Jaipur ATC. During these contacts, weather of Jaipur was neither asked by the crew nor provided by the ATC. When the aircraft was at flight level 83, the crew asked ATC Jaipur to confirm that they can carry out ILS approach for runway 27 via 10 DME arc. While confirming the requested approach, Jaipur ATC has informed all the stations about the weather at that moment as visibility 400 m and RVR 1000 m. When the aircraft was at 30 miles from Jaipur, Jaipur ATC passed weather as visibility 400 m, RVR 1000 m and trend visibility becoming 350 m. The crew was asked to come overhead by Jaipur ATC. At 28 DME from Jaipur, the aircraft was maintaining 6000 feet and on request was cleared by Jaipur ATC to descend to 5000 feet. When the aircraft was at 25 DME, from Jaipur, ATC advised that the weather was deteriorating rapidly and visibility was 400 meters. The crew however intimated the ATC that they were committed to land at Jaipur due fuel. As per the crew the fuel on board at that point of time was 2.6 tonnes (approx.) and approach was commenced for Jaipur with a visibility of 500 m with trend reducing. The aircraft was no. 2 in approach at Jaipur and was cleared for VORDME arc ILS approach runway 27 at 25 nm. Crew had, as per them, checked Ahmedabad distance as 291 nm, with a fuel calculation of 2.7 tonnes and as sufficient fuel was not available for Ahmedabad so did not consider diverting to Ahmedabad at that moment. Crew has also stated that Udaipur watch hours were not available with them, Jodhpur is an Air Force field with restrictions and Delhi was packed so they continued approach to Jaipur knowing that visibility / RVR was rapidly deteriorating. Due to reducing visibility, Jaipur ATC asked all the aircraft inbound for Jaipur to come over head and join JJP hold. The crew of the subject flight asked for the weather which was provided as visibility 400 m & RVR 1000 m though RVR deteriorating to 550 m. The flight from the ―Arrival Route‖ flew the VORDME arc for ILS runway 27. The ATC had transmitted the RVR as 200 m and visibility as 50 m with trend reducing. Another scheduled flight ahead of AI-890 carried out a missed approach and diverted to Ahmedabad. When the aircraft was above MDA (1480 feet AGL), ATC reported RVR 50 m and cleared the aircraft to land subject to minima. Both the flight crew maintained that they had seen the runway lights. ILS approach was performed with dual AP until 200ft RALT. After descending below MDA on auto pilot, the commander disconnected the auto pilot. Captain performed the final approach manually. The aircraft deviated to the left of the runway centre line and touched down on soft ground (in kutcha) on the LH side of the runway. During touchdown and landing roll, the visibility was zero and crew were unable to see any of the reference cues. The crew had heard rumbling sound during landing roll. As per the commander, he did the manual landing as he was not sure if he could do auto-land on a ground facility which is CAT I certified airfield in actual zero visibility. The aircraft continued to roll/ skid on the unpaved surface and during this period the left wing impacted trees causing damage to the left wing. Thereafter aircraft turned right and entered the runway finally coming to a halt on the LH side of runway. There was no fire. ATC Jaipur informed the Airport Manager of the Airline at Jaipur that their flight AI-890 had blocked the runway and also requested them to send equipments / manpower to attend the aircraft and get the aircraft removed. The Station AME of the airline alongwith the Asst Officer (Comm.), who was at the tarmac were instructed by the Station Manager to move to the aircraft. As per the AME, the visibility was almost nil and they could not move without the help of ‗Follow Me‘ Jeep. The ATC was informed to arrange the jeep to escort the personnel upto the aircraft. The AME after reaching the aircraft observed that the no. 1 main wheel of the aircraft had decapped/ damaged and the port side wing was damaged. The fuel remaining on board was 2400 kgs. The disembarkation of passengers was carried out on the runway itself and passengers were sent to the terminal building. Since the aircraft was not in a position to be either taxied or towed to the parking bay, the baggage of passengers was offloaded at the runway itself and sent to the terminal. One passenger suffered minor bruise on the knuckle of his right hand middle finger. He was attended to by the cabin crew in the aircraft and also by the doctor at the airport. Medical check-up of all the crew members including breathanalyser (BA) test was done by the medical officer, M.I. room Jaipur airport. The BA test was negative for all the crew members with a reading of 00.00. Since the aircraft was obstructing the runway, the airport was shut down for any further flight operations till the runway could be cleared. A NOTAM was issued to this effect. The aircraft was towed the next day to parking bay no.5 at terminal-1 by 1200 hrs and was later repositioned on a non-operational remote bay.
Probable cause:
The cause below has been given considering events as a combination of organizational factors and human error.
- The flight crew made an erroneous decision of diverting & continuing to an airfield with reducing visibility.
- The flight crew attempted a manual landing in below minima conditions.
- Lack of operational supervision and desired ground support to flight.
- Internal quality assurance not capturing the hazards which slipped through due complacency.
- Lack of oversight of the flight operations.
Final Report:

Crash of a Fokker F27 Friendship 100 in Guwahati: 34 killed

Date & Time: Oct 19, 1988 at 0856 LT
Type of aircraft:
Operator:
Registration:
VT-DMC
Survivors:
No
Schedule:
Silchar - Guwahati
MSN:
10173
YOM:
1961
Flight number:
PF703
Location:
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
31
Pax fatalities:
Other fatalities:
Total fatalities:
34
Captain / Total flying hours:
5673
Circumstances:
Vayudoot F27 aircraft VT-DMC was operating scheduled flight VDT703 Silchar - Guwahati on 19-10-1988. There were 34 persons on board including 3 crew members. The aircraft took off from Silchar at around 0810LT from runway 06. The weather report at that time was visibility 3 km with rain. After takeoff, the aircraft gave estimate time to Silchar tower of its passing the Point Hotel at 0820LT and the estimated time of arrival at Guwahati was at 0850LT. At 0823LT the flight reported over Point Hotel at FL105 and thereafter the aircraft was in contact with Guwahati control when the flight was cleared to change over to Guwahati control tower. At 0839LT the aircraft reported ATC that they are passing through FL55 for 40 and will call over VOR for ILS let down at out bound. At 0846LT the aircraft commenced procedure turn. At 0847LT the aircraft reported ATC that they are not getting glide path. At 0848:15LT the aircraft reported turning inbound after completing procedure turn. At 0848:45LT the aircraft reported outer marker inbond. The aircraft lost contact with ATC at 0853:30LT. The aircraft was destroyed due impact with a hill and post impact fire at a distance of more than 10 nautical miles from Guwahati Airport. All persons on board received fatal injuries.
Probable cause:
An error on the part of the pilot-in-command in obeying the localiser bar on the outbound leg when it is supposed to be disobeyed and which has resulted in disorientation of the pilot resultant effect of which is total non-adherence of the ILS let down procedure at Guwahati viz. failure to monitor the middle and outer locators, allowing the aircraft to descend below 2750 feet without intercepting the localiser and glide slope. The wrong clearance by ATC in asking the aircraft to report outer marker inbound when Captain-in-command reported non-availability of the Glide slope has misled the captain and as such has contributed to the accident. The possibility of sabotage or the aircraft outliving its age has been ruled out. The pilot failed to follow approved procedures, directives, instructions, etc.

Crash of a Douglas C-47 in Guwahati: 9 killed

Date & Time: Aug 23, 1980
Operator:
Registration:
HJ235
Flight Phase:
Flight Type:
Survivors:
No
Location:
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
7
Pax fatalities:
Other fatalities:
Total fatalities:
9
Circumstances:
Crashed shortly after takeoff from Guwahati Airport, killing all nine occupants.

Crash of a Douglas C-47A-90-DL near Hasimara: 15 killed

Date & Time: Mar 26, 1971 at 2039 LT
Operator:
Registration:
VT-ATT
Flight Phase:
Survivors:
No
Site:
Schedule:
Guwahati – Bagdogra – Calcutta
MSN:
20363
YOM:
1944
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
11
Pax fatalities:
Other fatalities:
Total fatalities:
15
Circumstances:
While cruising by night on a flight from Guwahati to Bagdogra, the aircraft deviated from the prescribed track for unknown reason and crashed in a mountainous area located near Hasimara, West Bengal. The wreckage was found six days later and all 15 occupants have been killed.
Probable cause:
Controlled flight into terrain.

Crash of a Fokker F27 Friendship 400 near Silchar: 39 killed

Date & Time: Aug 29, 1970 at 1445 LT
Type of aircraft:
Operator:
Registration:
VT-DWT
Flight Phase:
Survivors:
No
Site:
Schedule:
Silchar – Guwahati
MSN:
10336
YOM:
1967
Location:
Country:
Region:
Crew on board:
5
Crew fatalities:
Pax on board:
34
Pax fatalities:
Other fatalities:
Total fatalities:
39
Aircraft flight hours:
6271
Aircraft flight cycles:
5243
Circumstances:
After takeoff from Silchar-Kumbhirgram Airport, the captain failed to follow the published departure route. While climbing to an altitude of 5,600 feet, he initiated a right turn in clouds and rain when the airplane struck a mountain located 19 km northeast of the airport. The aircraft disintegrated on impact and all 39 occupants were killed.
Crew:
G. C. Dutta, pilot,
N. V. S. Reddy, copilot,
S. Das Gupta, flight engineer,
A. Bhattacharjee, steward,
S. B. Chaturvedi, steward.
Probable cause:
The pilot who had not made use of the Met. Forecast left by the relieved Commander at Silchar Airport did not follow the safer course of climbing overhead to the minimum sector altitude before setting course for Guwahati. He aggravated the situation by turning to the right without attaining the adequate terrain clearance, causing the aircraft to struck the ground.

Crash of a Douglas C-47A-25-DK in Guwahati: 3 killed

Date & Time: Jan 21, 1955 at 0729 LT
Operator:
Registration:
VT-COZ
Flight Type:
Survivors:
No
Schedule:
Calcutta – Guwahati
MSN:
13569
YOM:
1944
Location:
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
The aircraft took off from Calcutta-Dum Dum Airport on a scheduled freighter service flight at 0546 hours Indian Standard Time and set course for Guwahati, carrying a crew of three. At 0722 hours, the aircraft contacted Air Traffic Control, Guwahati, on radio telephony and reported flying under visual flight rules, 25 miles away from Guwahati Airport at an altitude of 6 000 feet. The Air Traffic Control Officer on duty passed the altimeter setting to the aircraft, cleared it to descend under VFR and instructed it to call when ten miles from the airport. The aircraft asked for a bearing on frequency 119.7 (Homer) at 0725 hours and a bearing of 045° class 'A' was given. This was confirmed as correct by the aircraft, which also reported being 15 miles from the airport at a height of 3 000 feet at that time. The next contact with Guwahati Tower was at 0727 hours when it reported being at a distance of 10 miles from the airport. Landing instructions were passed to the aircraft and it was asked to call again on joining circuit. There was no further communication with the aircraft. At approximately 0729 the duty officer at the tower noticed black smoke at the top of a patch of fog to the south of the airport. Repeated calls were made to the aircraft on 118.1 Mc/S and 6 440 Kc/S but no response was received. At about the same time persons in Tarapati village saw the aircraft hit some arecanut trees, crash in a field and burst into flames. The captain and the copilot died instantly and the radio officer died en route to the hospital. The aircraft was destroyed.
Probable cause:
The aircraft crashed in the course of a premature descent, during the final approach, as a result of hitting arecanut trees which were obscured from view by fog in the area. Some other points which call for observations have come out in the course of the evidence and though they do not directly pertain to the cause of this accident are well worth mentioning.
- Operational control was not exercised for this flight and the operator had not designated a representative for this purpose as required by Notice to Air- men No. 29 of 1952,
- The meteorological briefing of the pilot was not complete in as much as the terminal weather forecast for the alternate aerodrome was not obtained by him,
- The manuals used by the crew of this aircraft were not complete or up-to-date.
Final Report:

Crash of a Douglas C-47A-70-DL near Mairang: 3 killed

Date & Time: Apr 14, 1953
Operator:
Registration:
VT-AUJ
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Guwahati – Calcutta
MSN:
19149
YOM:
1943
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
In cruising altitude, the airplane went out of control, dove into the ground and crashed on the slope of a mountain located in the Khasi Mountain Range, near Mairang, about 60 km south of Guwahati. The aircraft was destroyed and all three crew members were killed.
Probable cause:
The port wing failed in the air due to an upload as a result of being subjected to loads greater than those for which it was designed.

Crash of a Douglas C-47A-30-DK in Guwahati

Date & Time: Nov 14, 1951
Operator:
Registration:
VT-CKU
Flight Phase:
Flight Type:
Survivors:
Yes
MSN:
13857/25302
YOM:
1944
Location:
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Shortly after takeoff from Guwahati-Borjhar Airport, while in initial climb, the aircraft stalled and crashed. All three crew members were injured and the aircraft was damaged beyond repair.

Crash of a Douglas C-47A-25-DK in Guwahati

Date & Time: Jan 25, 1950
Operator:
Registration:
VT-CPQ
Flight Phase:
Flight Type:
Survivors:
Yes
MSN:
13558
YOM:
1944
Location:
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Crashed during takeoff. The aircraft was written off and all three crew members were injured.