Crash of a BAc 111-201AC in Milan

Date & Time: Jan 14, 1969 at 2032 LT
Type of aircraft:
Operator:
Registration:
G-ASJJ
Flight Phase:
Survivors:
Yes
Schedule:
Milan - London
MSN:
14
YOM:
1965
Country:
Region:
Crew on board:
7
Crew fatalities:
Pax on board:
26
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
13360
Captain / Total hours on type:
2153.00
Copilot / Total flying hours:
10973
Copilot / Total hours on type:
497
Aircraft flight hours:
8310
Circumstances:
On 14 January 1969 the crew flew from Gatwick to Rotterdam and return, following which they departed on a scheduled international flight Gatwick-Genoa-Gatwick. For this flight Captain A occupied the left-hand seat as pilot-in-charge, Captain B the right hand seat as co-pilot and Captain C the centre supernumerary seat as pilot-in-command, ultimately responsible for the correct operation of the aircraft. Before leaving Gatwick Captain A briefed Captain B concerning the co-pilot duties assigned to him. Although Captain C, as pilot-in-command, did not himself formally brief Captains A and B there was no doubt that they were aware of their respective tasks. On the flight from Gatwick to Genoa the aircraft was forced, due to unfavourable weather conditions at Genoa, to divert to Milan-Linate Airport where it landed at 1430 hours. Before commencing the return flight to Gatwick the crew had to await the arrival of the passengers from Genoa. This took place at 1930 hours. During the five-hour waiting period on the ground, the aircraft APU was kept in operation to ensure cabin heating and air conditioning. While Captain C tried unsuccessfully to sleep in the aircraft, Captains A and B inspected the aircraft and found ice on the wings and tail unit. The aircraft was subsequently de-iced. Before boarding the aircraft, Captains A and B made another external inspection of the aircraft and established that there was no ice on any part of it. The result of this inspection was duly reported to Captain C. Captains A and B carried out the pre-flight checks in accordance with the company checklist and verified that the take-off weight and aircraft loading were within the permitted limits. The crew occupied the same positions as during the previous flight, Captain A being in the left-hand seat, Captain B in the right-hand seat and Captain C in the jump- seat. In view of the weather, temperature and runway conditions, the crew decided to use the 18O flap setting, Spey 2 thrust (full thrust), engine anti-icing and the APU for cabin air conditioning. V1 and Vr were established at 117 kt and V2 at 127 kt. At 2018 hours, after clearance from Linate ATC, the engines were started and engine anti-icing selected "ON". There was a considerable layer of snow along the sides of the taxiways and runway, but they themselves were clear and usable. In view of the isolated patches of slush or water on the runway, Captain A considered it essential for the engine igniter switches to be selected "ON" during the entire take-off. At 2028 hours the aircraft was cleared to enter runway 18 and, after receiving the latest information concerning visibility and wind, it was cleared for take-off at 2031 hours. Before the brakes were released, a check was made of engine P7 pressures and of the other engine instruments which were found to be normal. At about 80 kt Captain A took over the aircraft's control column. The airspeed indicators showed regular acceleration and Captain A stated that just before 100 kt the engine instruments were also registering normally. V1 and Vr were called and the aircraft was rotated into the initial climbing attitude; immediately after or during this manoeuvre, a dull noise was distinctly heard by all the crew members. This noise was variously described by them as: "not like a rifle shot, not like the slamming of a door or something falling in the aircraft but more like someone kicking the fuselage with very heavy boots, an expansive noise covering a very definite time span with a dull non-metallic thud". The bang was immediately associated by the crew with the engines. After looking at the TGT gauges, and observing that No. 1 engine was indicating a temperature 20°c higher than that of No. 2 engine, Captain C said: "I think it's number one" or wards to that effect, and after a brief pause "throttle it". On receipt of Captain C's comment Captain A closed the power level of No. 1 engine. During or just after the explosion, he had completed the rotation manoeuvre and the aircraft was climbing at 12O of pitch with reference to the flight director. As a precaution, after closing No. 1 power lever he reduced the angle of climb to 6O. At the same time the co-pilot (Captain B) who had reached for the check list and was looking for the page relating to an engine emergency, became aware of a sharp reduction in the aircraft's acceleration; he noticed that the undercarriage was still down and he retracted it immediately. According to the crew the aircraft reached a maximum height of 250 ft, after which a progressive loss of momentum became evident. A maximum speed of 1401145 kt was achieved immediately after rotation, but it fell to 127 kt after No. 1 engine had been throttled back, These figures were consistent with those subsequently derived from the flight recorder. The crew said that the stick-shaker operated three times between 125 and 115 kt. The co-pilot had a vague recollection that the stick-push and the warning klaxon operated during the critical phase before impact. The pilot-in-charge remembered vaguely that someone said "raise the flaps", but no crew member remembers doing so or making the re traction. On looking out of the aircraft the crew saw the ground and the obstructions close at hand and realized that contact of the aircraft with the ground was inevitable and imminent. Captain A controlled the aircraft extremely well during the touchdown; the aircraft slid along the snow-covered surface, passing over small obstructions, and came to a halt 470 m from the point of first contact with the ground (see Fig. 1-11. The co-pilot operated both engine fire-extinguishers and Captain C ordered the pilots to leave the aircraft immediately via the side windows. During the ground slide an orange glow was seen to light up the glass panels of the windows for a short time. There was no fire. After closing No. 1 power lever, Captain A remembered having ordered the shutdown drill for this engine but he could not say for certain whether this wae dme. It was established, however, that Captain B closed both the HP cocks at the first sensation of ground contact.
Probable cause:
The accident must be attributed to a combination of factors following a compressor bang/surge in No. 2 engine immediately after take-off and the aircraft crashed because the crew, after fully closing No. 1 throttle in error, failed to recognize their mistake and, in addition, were not aware that the thrust of No. 2 engine had also been partially reduced after an inadvertent displacement of the relevant throttle lever. The following findings were reported:
- A segment of the HP turbine seal of No. 2 engine caused a compressor bang/ surge which led the crew to think that there was a serious engine malfunction. The loss of thrust attributable to this defect was negligible,
- Tests have shown that there were no defects or failures of the engine fuel system or fuel controls which could be associated with the loss of thrust over and above that resulting from the deliberate throttling of No. 1 engine,
- N° 1 engine was throttled back after an erroneous order or piece of advice and its throttle lever was pulled rearwards rapidly,
- The major loss of thrust in No. 2 engine was probably due to the displacement of the throttle lever by a crew member and to the fact that its partially open position remained unnoticed during the period of confusion preceding the emergency landing,
- The incorrect diagnosis of a malfunction of No. 1 engine after the bangleurge can be attributed to the hasty intervention of the pilot-in-command and this could be attributed to fatigue, aggravated by the long duty period,
- In rapidly throttling back No. 1 engine, the pilot-in-charge promptly executed without question what he thought to be an order instead of waiting until a greater height was reached and then taking any appropriate action,
- The judgement and actions of the pilot-in-charge were influenced by the presence of an experienced pilot designated as pilot-in-command, although the latter's specific task was the supervision of the co-pilot,
- If the aircraft pilot-in-command had been seated at the controls, he might have acted correctly; similarly, if he had been responsible solely for the supervision of the co-pilot and had not been designated as pilot-in-command, the pilot-in-charge would have had a wider and more responsible field of action and would very probably have complied with the company's prescribed drills.
Final Report:

Crash of a Boeing 727-113C in London: 50 killed

Date & Time: Jan 5, 1969 at 0134 LT
Type of aircraft:
Operator:
Registration:
YA-FAR
Survivors:
No
Schedule:
Kabul - Kandahar - Beirut - Istanbul - Frankfurt - London
MSN:
19690/540
YOM:
1968
Flight number:
FG701
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
54
Pax fatalities:
Other fatalities:
Total fatalities:
50
Captain / Total flying hours:
10400
Captain / Total hours on type:
512.00
Copilot / Total flying hours:
3259
Copilot / Total hours on type:
210
Aircraft flight hours:
1715
Circumstances:
The accident occurred on a scheduled passenger flight from Frankfurt when the aircraft was making an ILS approach for a night landing on Runway 27 at Gatwick Airport. The weather was clear except that freezing fog persisted in places including the Gatwick area. The runway visual range (RVR) at Gatwick was 100 metres. The approach was commenced with the autopilot coupled to the instrument landing system (ILS) but after the glide-slope had been captured the commander who was at the controls, disconnected the autopilot because the "stabiliser out of trim" warning light illuminated. At the outer marker the flap setting was changed from 1° to 30° and shortly afterwards the rate of descent increased and the aircraft descended below the glide-slope. Some 200 feet from the ground the pilot realised that the aircraft was too low and initiated a missed approach procedure. The aircraft began to respond but the descent was not arrested in time to avoid a collision with trees and a house that destroyed both the aircraft and the house and set the wreckage on fire. 48 occupants as well as two people in the house were killed. 14 others were injured. The aircraft was totally destroyed by impact forces and a post crash fire.
Probable cause:
The accident was the result of the commander inadvertently allowing the aircraft to descend below the glide slope during the final stage of an approach to land until it was too low for recovery to be effected. The following findings were reported:
- The deceptive nature of the weather conditions led the commander to an error of judgment in deciding to make an approach to Gatwick,
- The commander's decision to conduct an approach was not in itself a cause of the accident,
- Incorrect flap configuration at glide-slope interception led to a temporary out-of-trim condition during the automatic approach and the illumination of the stabilizer "out-of-trim" warning light,
- The commander interpreted the "out-of-trim" warning light as indicating a possible malfunction and disconnected the auto-pilot,
- Out-of-sequence and late selection of 30° flaps from 15° while the-aircraft was being flown manually resulted in an increase in the rate of descent, causing the aircraft to go rapidly below the glide-slope,
- The commander did not become aware of the deviation from the glide-slope until it was too late to effect a full recovery,
- The pilot's attention was probably directed outside the aircraft at the critical time in an attempt to discover sufficient visual reference to continue the approach rather than to the flight instruments,
- Monitoring by precision approach radar would have warned the pilots of the deviation in time, if corrective action was taken promptly, to avoid the accident.

Crash of an Airspeed AS.57 Ambassador 2 in Manston

Date & Time: Sep 30, 1968
Type of aircraft:
Operator:
Registration:
G-AMAG
Flight Type:
Survivors:
Yes
Schedule:
London - London
MSN:
5229
YOM:
1953
Location:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
After a touch-and-go landing at Gatwick Airport, the right main gear didn't lock up. The gear was recycled and the pilot then checked the gear visually and the gear appeared to be fully retracted. On gear extension for the next landing, the right main gear warning light remained on. The gear was recycled several times, but without success. Other attempts (high g turns, using the hand pump, and touching the runway) also failed. It was then decided to make a wheels-up landing on a foam carpet at Manston.
Probable cause:
The starboard undercarriage pin had fractured and fallen out of its housing. This permitted the assembly to drop under its own weight and, as a result it was mechanically impossible for the up-lock catch to disengage from the pin on the undercarriage leg.

Crash of a Beechcraft C-45B Expeditor near Plumpton: 1 killed

Date & Time: Jan 18, 1967 at 1440 LT
Type of aircraft:
Registration:
N102S
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Nice - London-Gatwick
MSN:
6158
YOM:
1944
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
1360
Captain / Total hours on type:
162.00
Circumstances:
The pilot, sole on board, was completing a ferry flight from Nice to London-Gatwick. While descending to Gatwick Airport in VFR mode, the pilot encountered poor weather conditions with rain falls and turbulences. While flying in clouds, he lost control of the airplane that plunges into the earth and crashed in a field. The aircraft was destroyed and the pilot was killed.
Probable cause:
The aircraft collided with high ground when the pilot was attempting to navigate at low altitude in poor visibility. Turbulent airflow in the lee of a ridge may have been a contributory factor. Investigators did not find any topographic maps for the UK in the aircraft. The pilot probably did not recognise the seriousness of the deteriorating weather situation in southern England until he crossed the coast and had to fly at low altitude to remain in visual contact with the ground.
Final Report:

Crash of a Douglas C-47B-25-DK in Mers-les-Bains

Date & Time: Dec 17, 1965 at 2340 LT
Operator:
Registration:
G-AMWX
Survivors:
Yes
Schedule:
Beauvais – London-Gatwick
MSN:
15846/32594
YOM:
1945
Flight number:
SX316
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
29
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
12548
Captain / Total hours on type:
4000.00
Copilot / Total flying hours:
1820
Copilot / Total hours on type:
250
Aircraft flight hours:
12815
Circumstances:
Flight 316 was a scheduled international flight from Beauvais, France to Gatwick, England. It took off from runway 23 at Beauvais at 1948 hours GMT. At 2009 hours it contacted London Airways reporting over Abbeville, with an estimated time of arrival at the Paris/London FIR boundary of 2020 hours. At 2030 hours at the request of London Airways the aircraft reported 2036 as its estimated time of arrival at Lydd, whereas taking the wind into account it should have been 2040 hours. In fact the aircraft reported over Lydd at 2040 hours and, on the basis of the radar observations of London Airport which followed the aircraft from 2036 hours onwards, the aircraft probably flew over this point at 2041 hours or 2042 hours. At 2040 hours the aircraft reported its estimated time of arrival at Mayfield as 2058 hours, a dead reckoning calculation which this time allowed for the wind. At 2040 hours London Airways asked the flight to confirm its estimated time of arrival at Mayfield. It was when the co-pilot began the VHF transmission to reply to this query that he first noticed that his transmitter was not working, then that the No. 2 VHF, the ILS receiver, the radio compasses, the starboard generator and the two inverters had also failed. The aircraft lighting, however, was still working. The pilot-in-command handed over the controls to the co-pilot and went to inspect the main electrical panel. As he did not have the necessary tools, he was unable to remove the main radio fuse in order to inspect it. He checked the circuit breakers on the radio electrical panel and found that they were in the normal position. He also noted that the inverters were no longer working. On returning to his seat he asked the co-pilot to make the same checks. The co-pilot changed some fuses but he also was unable to remove the main fuse which he found was very hot. As he had no means of radio communication or navigation, the pilot-in-command considered that he could not continue on his route to Gatwick without incurring a collision risk and, more particularly, that it would be dangerous for him to try to descend to within visual reference of the ground, in view of the cloud bases of 120 to 200 m in the meteorological forecasts. He therefore decided to turn on to a southerly heading in order to descend below cloud over the sea and then to determine his position by identifying a town on the south coast of England. At 2053 hours, London Radar observed the left-hand turn of approximately 90' made by the aircraft. According to the pilot-in-command, the aircraft maintained a magnetic heading of 2000 for 15 minutes, which corresponds to a true track of 1710. At about 2108 hours the aircraft, which was then about 20 miles from the English coast south of Hastings, went on to an easterly heading and came down to 2 000 ft using the Beauvais QNH (1 012 mbs). After flying for 5 minutes on this heading, the pilot-in-command was still without any visual contact with the ground and he returned to a southerly heading, considering that the cloud base over France would be appreciably higher than over England. He came down to 1 000 ft and finally saw the lights of a ship and then the lights of a town (Le Tréport) which he failed to identify. The aircraft arrived in the vicinity of Le Tréport at 2140 hours. After flying over the town a number of times the crew fired Very lights but saw no response on the ground, although local authorities and members of the aero club went to En-Mers/Le Tréport airport and illuminated the landing strip with car headlights. During this time the pilot-in-command saw a beach lit up by the lights of a promenade and suitably orientated for a landing, taking into account the direction of the wind at the time. The pilot-in-command then decided that unless he could determine his position with certainty and therefore be able to reach Beauvais in absolute safety, it was preferable to attempt an emergency landing on such a beach rather than run the risk of landing, short of fuel, in the open in the French countryside without any visual reference to the ground and with the danger of colliding with some unknown obstruction. After having flown up and down the coast, in an attempt to determine his position, he finally decided to land when the starboard engine showed signs of fuel failure. He immediately switched the starboard engine on to the port main tank, which contained about 20 gallons more than the starboard main tank. He made his last circuit at about 500 ft, with the landing lights on and the undercarriage up, and came in to land on a WSW heading in the area lit up by the promenade lighting, as near as possible to the shore. The landing was relatively soft, although at the end of the run the port wing tip struck a concrete groyne. The accident occurred at 2240 hours GMT. The location of the beach was 50° 04 N 01° 23 E. All 33 occupants were evacuated and five of them were slightly injured.
Probable cause:
The accident was due to the following causes:
(a) The design of the aircraft's electrical installation in which no provision was made to prevent the total interruption of radio communication and radio navigation in the event of a failure at the level of the single main supply fuse.
(b) The failure of the main supply fuse probably of insufficient rating and the fact that the crew was not able to rectify the failure.
(c) The inadequate attention paid by the crew to its dead reckoning navigation, both before and after the radio failure.
Final Report:

Crash of a Douglas DC-7C in Istanbul

Date & Time: Sep 28, 1964 at 0450 LT
Type of aircraft:
Operator:
Registration:
G-ASID
Survivors:
Yes
Schedule:
London – Istanbul – Singapore
MSN:
45161/757
YOM:
1957
Flight number:
CA355
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
89
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
9530
Copilot / Total flying hours:
1811
Aircraft flight hours:
20668
Circumstances:
Flight 355 took off from London for a flight to Singapore via Istanbul. The first approach to Istanbul runway 24 was abandoned because the pilot-in-command couldn't see the runway lights. Heavy rain continued as the pilot approached for the second time. VHF communications were lost during a short period of time because of a power failure in the tower transmitter and was restored when the plane was in the procedure turn. Lightning and heavy turbulence were reported during the descent and the runway was sighted when descending to 500 feet. The pilot made a slight correction to the right and ordered full flaps and power reduction to 20" boost. The plane sank quickly just short of the runway and more power was ordered, but the left main gear had struck the ground in line with the runway, 72 m short of the threshold. The plane bounced and touched down again 14 m further on. The left main gear as well as nose gear collapsed, causing the no. 1 and 2 engines to break off, followed by the entire left wing. The fuselage skidded 260 m down the runway and a fire developed.
Probable cause:
During the last approach, the pilot was too early in selecting full flap and reducing the power. Due to heavy rain and poor visibility, the height could not be controlled precisely. The order for full power was given too late; this created the undershoot condition.
Final Report:

Crash of a Bristol 170 Freighter 31M in Marville AFB: 8 killed

Date & Time: Dec 30, 1963
Type of aircraft:
Operator:
Registration:
9697
Flight Type:
Survivors:
Yes
Schedule:
London-Gatwick – Marville
MSN:
12830
YOM:
1947
Country:
Region:
Crew on board:
5
Crew fatalities:
Pax on board:
6
Pax fatalities:
Other fatalities:
Total fatalities:
8
Circumstances:
While on approach to Marville AFB, the airplane crashed in the Montmédy forest, few km north of the runway 12 threshold. Eight occupants were killed while three others were seriously injured.

Crash of a Vickers 651 Valetta C.1 in London-Gatwick

Date & Time: Sep 21, 1963
Type of aircraft:
Operator:
Registration:
G-APKR
Flight Type:
Survivors:
Yes
Schedule:
London - London
MSN:
338
YOM:
1949
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
After a flight of some two hours, made for the purpose of testing radio navigation equipment, the aircraft returned to London-Gatwick Airport, U.K.. Before, and during, the flight, undercarriage operation was normal, as was the functioning of the undercarriage light and horn warning system. During the approach, the undercarriage extended normally, and the green lights indicated that it was locked down. Some 50 yards after touch down, the aircraft began to sink on the starboard side and the captain noticed that the starboard green light was no longer showing. There were, however, no reds, and the horn was not sounding. The starboard main undercarriage leg eventually retracted and the aircraft swung off the runway to the right, on to the grass.

Crash of a Vickers 610 Viking 1B neara Py: 40 killed

Date & Time: Sep 12, 1963 at 0030 LT
Type of aircraft:
Operator:
Registration:
F-BJER
Flight Phase:
Survivors:
No
Site:
Schedule:
London-Gatwick – Perpignan
MSN:
216
YOM:
1947
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
36
Pax fatalities:
Other fatalities:
Total fatalities:
40
Captain / Total flying hours:
22800
Captain / Total hours on type:
4100.00
Copilot / Total flying hours:
17500
Copilot / Total hours on type:
750
Aircraft flight hours:
20547
Circumstances:
The aircraft left London-Gatwick Airport at 2013LT on a charter flight to Perpignan with 36 passengers and a crew of four on board. At 2315LT, the crew was cleared to continue direct to Perpignan maintaining the altitude of 9,500 feet. At 0008LT, the crew was cleared by Marseille Control to descend to FL65 and then FL55 seven minutes later. While approaching Perpignan, the crew was informed about the poor weather conditions at destination with thunderstorm activity. At this time, the crew informed ground that the radiocompas settings were inexploitable due to the violent storm. While cruising in low visibility, the airplane struck trees and crashed on the Roc de Planes, in the massif of the Mottes-Rouges, near the village of Py. The airplane disintegrated on impact and all 40 occupants were killed. The wreckage was found some 48 km southwest of Perpignan-Rivesaltes Airport at an altitude of 1,810 meters.
Crew:
Max-Marie Dunoyer de Lescheraine, pilot,
Léopold Marold, copilot,
Émile-Lucien Jamin, navigator,
Muriel Tiberghain, stewardess.
Probable cause:
The accident was caused by a navigation error on part of the flying crew, caused by several errors of judgement in flight. The crew failed to make precised reports between Limoges and Perpignan and failed to use properly the VOR of Toulouse and Istres. It was noted that the crew continued to the south at an altitude of 6,000 feet without knowing his real position. It is possible that fatigue may contribute to the accident.
Final Report:

Crash of a Douglas C-47B-30-DK on Mt Canigou: 34 killed

Date & Time: Oct 7, 1961 at 0200 LT
Operator:
Registration:
G-AMSW
Flight Phase:
Survivors:
No
Site:
Schedule:
London-Gatwick – Perpignan
MSN:
16171/32919
YOM:
1945
Country:
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
31
Pax fatalities:
Other fatalities:
Total fatalities:
34
Captain / Total flying hours:
5624
Captain / Total hours on type:
3682.00
Copilot / Total flying hours:
2267
Copilot / Total hours on type:
1764
Aircraft flight hours:
13658
Circumstances:
The aircraft was coming from Gatwick, England, and after reporting over Toulouse at about 0030 hours GMT it headed directly for Perpignan, France, at flight level 75. It was expected over the aerodrome at about 0112, and it was seen shortly before 0100 by various witnesses in the Prades area, during intermittent rain and wind of variable force. It struck the mountain side in level flight in the Canigou Massif at about 0100 hours. The wreckage, located at an elevation of 2 200 m at 1350 on the same day by a Search and Rescue Constellation, was destroyed by the impact and by fire. There were no survivors. Three crew and 31 passengers were aboard the flight.
Probable cause:
The accident was attributed to a navigational error, the origin of which it was not possible to determine for lack of sufficient evidence.
Final Report: