Crash of a Rockwell Shrike Commander 500S in Fortaleza

Date & Time: Jul 2, 2002 at 1640 LT
Operator:
Registration:
PT-KZD
Flight Phase:
Flight Type:
Survivors:
Yes
Site:
Schedule:
Fortaleza - Fortaleza
MSN:
500-3140
YOM:
1972
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
8000
Captain / Total hours on type:
2900.00
Aircraft flight hours:
9960
Circumstances:
The twin engine aircraft departed Fortaleza-Pinto Martins Airport on a local post maintenance test flight (50 hours), carrying two passengers and one pilot. After takeoff, while climbing to a height of 200 feet, the power on the left engine fluctuated. The pilot modified the position of the fuel selector but the situation did not change. As the aircraft was losing height, the pilot shut down the left engine and feathered its propeller when the aircraft rolled to the left, causing the left wing to struck a concrete wall. Out of control, the aircraft struck the roof of a house, then a second one and eventually crashed on a third residence. All three occupants were injured as well as one people on the ground.
Probable cause:
The fuel pump and the servo-injectors had faults which certainly contributed to the accident as the left engine was not properly supplied with fuel.
Final Report:

Crash of a Boeing 727-30C in Belo Horizonte

Date & Time: Mar 18, 2002 at 2218 LT
Type of aircraft:
Operator:
Registration:
PP-VLV
Flight Type:
Survivors:
Yes
Schedule:
Salvador - Belo Horizonte
MSN:
19009
YOM:
1967
Flight number:
VLO9051
Country:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
After touchdown on runway 16 at Belo Horizonte-Tancredo Neves-Confins Airport, the three engine aircraft went out of control, veered off runway at high speed, lost its undercarriage and came to rest. All three crew members evacuated safely while the aircraft was damaged beyond repair.

Crash of a Beechcraft 100 King Air in Buriti Alegre

Date & Time: Nov 25, 2001 at 1205 LT
Type of aircraft:
Registration:
PT-DNP
Flight Type:
Survivors:
Yes
Schedule:
Goiânia – Buriti Alegre
MSN:
B-56
YOM:
1970
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
5
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
13316
Captain / Total hours on type:
1500.00
Circumstances:
On final approach to Buriti Alegre Airfield runway 05, following an uneventful flight from Goiânia-Santa Genoveva Airport, the pilot attempted to lower the flaps twice but the circuit breakers opened. He decided to continue the approach in a flapless configuration when, on short final, the aircraft stalled and collided with a wall located 15 metres short of runway. On impact, the undercarriage were torn off and the airplane landed on its belly, slid for 500 metres and came to rest, bursting into flames. All six occupants escaped uninjured while the aircraft was destroyed by fire.
Probable cause:
The pilot decided to continue the approach in a flapless configuration and at an insufficient speed, which caused the aircraft to stall on short final.
Final Report:

Crash of an Embraer EMB-820C Navajo in Brasília: 1 killed

Date & Time: Nov 23, 2001 at 1645 LT
Operator:
Registration:
PT-RAZ
Flight Type:
Survivors:
Yes
Schedule:
Bom Jesus da Lapa – Brasília
MSN:
820-114
YOM:
1980
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
3000
Captain / Total hours on type:
2700.00
Aircraft flight hours:
2633
Circumstances:
Following an uneventful flight from Bom Jesus da Lapa, the pilot started the descent to Brasília Airport runway 29. On final approach, in a gear and flaps down configuration, the aircraft suffered an engine failure. The pilot elected to restart the engine when the aircraft deviated from the approach path to the right, lost height and struck a promontory located 61 metres from the runway threshold. Both occupants were seriously injured and the aircraft was damaged beyond repair. 23 days later, the passenger died from his injuries.
Probable cause:
No technical anomalies were found on both engines. The fuel selector was positioned on the auxiliary tanks who had sufficient fuel at the time of the accident. It was reported that the pilot elected to continue the approach on one engine, letting himself be carried away by the luck factor that he benefited in the past in other similar situations.
Final Report:

Crash of a Lockheed C-130E Hercules near Campo dos Afonsos AFB: 9 killed

Date & Time: Sep 27, 2001 at 1215 LT
Type of aircraft:
Operator:
Registration:
2455
Flight Type:
Survivors:
No
Site:
MSN:
4202
YOM:
1967
Country:
Crew on board:
9
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
9
Circumstances:
While descending to Campo dos Afonsos AFB, the crew encountered poor weather conditions with limited visibility due to fog and rain falls. Too low, the four engine aircraft struck the slope of a mountain located about 15 km southeast of the airbase. All nine occupants were killed.

Crash of a Britten-Norman BN-2A-27 in Bujari

Date & Time: Sep 22, 2001 at 1207 LT
Type of aircraft:
Operator:
Registration:
PT-KTQ
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Rio Branco - Rio Branco
MSN:
493
YOM:
1976
Location:
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
4
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
12000
Captain / Total hours on type:
300.00
Circumstances:
The twin engine aircraft departed Rio Branco with four passengers and one pilot on board. The goal of the flight was to carry four Japanese journalists who wanted to perform aerial views from various tribes located in the region of Santa Rosa do Purus. About 30 minutes into the flight, an oil leak occurred on the left engine that lost power. The pilot reduced his altitude and attempted an emergency landing when the aircraft crashed near Bujari, about 39 km from Rio Branco. The wreckage was found near motorway BR364 and all five occupants were slightly injured.
Probable cause:
The following findings were identified:
- It is likely that the pilot did not use the controls properly to maintain an adequate control of the airplane in a single-engine configuration while the airplane was operated within weight and balance limits,
- The left propeller retainer had been replaced by similar but not original equipment, using glue to ensure its tightness, which was non compliant with the engine manufacturer's procedures,
- The aircraft maintenance documents were not kept up to date by the operator,
- Poor flight preparation on the part of the pilot who did not notice that the maintenance documents were not up to date,
- The operator was not compliant with the current Brazilian Civil Aviation Authority legislation.
Final Report:

Crash of a Boeing 737-2C3 in Goiânia

Date & Time: Sep 16, 2001 at 1053 LT
Type of aircraft:
Operator:
Registration:
PP-CJN
Survivors:
Yes
Schedule:
São Paulo – Goiânia
MSN:
21012
YOM:
1974
Flight number:
RG2240
Location:
Country:
Crew on board:
5
Crew fatalities:
Pax on board:
62
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
68500
Aircraft flight cycles:
65500
Circumstances:
On final approach to Goiânia-Santa Genoveva Airport, the crew encountered poor weather conditions with a limited visibility due to rain. The aircraft landed about 500 metres past the runway threshold but as it was misaligned, the right main gear touched down on the left side of the runway. The crew attempted to steer the plane back onto the runway when the right main gear collapsed. The aircraft went out of control, lost its right engine then its nose gear and came to rest on the runway. All 67 occupants evacuated safely.
Probable cause:
Wrong approach configuration on part of the crew who continued the approach while the aircraft was not properly aligned with the runway centerline.

Crash of an Embraer EMB-820C Navajo in Curitiba

Date & Time: Jun 6, 2001 at 2010 LT
Operator:
Registration:
PT-EFU
Flight Type:
Survivors:
Yes
Schedule:
Guarapuava – Curitiba
MSN:
820-031
YOM:
1976
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
2600
Captain / Total hours on type:
592.00
Circumstances:
Following an uneventful cargo flight from Guarapuava, the crew started the descent to Curitiba-Bacacheri Airport by night and adverse weather conditions. After touchdown on a wet runway surface, the twin engine aircraft went out of control, overran and collided with a concrete wall. All three occupants were injured, one of the pilot seriously.
Probable cause:
The decision of the crew to land at Curitiba-Bacacheri Airport was not appropriate due to poor weather conditions. The crew underestimated the weather conditions at destination and should take the decision to divert to a more suitable terrain.
Final Report:

Crash of a Embraer EMB-820C Navajo in São Paulo: 1 killed

Date & Time: Jun 5, 2001 at 2030 LT
Registration:
PT-EHL
Flight Type:
Survivors:
No
Site:
Schedule:
Franca – São Paulo
MSN:
820-048
YOM:
1977
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
2000
Captain / Total hours on type:
600.00
Aircraft flight hours:
5289
Circumstances:
The aircraft departed Franca Airport in the evening on a cargo flight to São Paulo, carrying one pilot and bank notes. On a night approach to São Paulo-Congonhas Airport, the pilot cancelled the IFR flight plan when he encountered technical problems with the right engine. He shut down the engine and continued the approach to runway 35R without informing ATC of his situation. Too high on the glide, he apparently decided to initiate a go-around when he lost control of the aircraft that rolled to the left, lost height and crashed in a residential area, bursting into flames. The aircraft was destroyed and the pilot was killed. Two people on the ground were injured.
Probable cause:
It was determined that the hydraulic pump on the right engine failed in flight, forcing the pilot to shut the engine down. It was reported that the pilot continued the approach in a single-engine configuration without informing ATC and that the aircraft was too high on the glide and approaching with an excessive speed. The pilot improperly analyzed the aircraft's flight conditions after shutting down the right engine, causing the aircraft to enter an approach configuration that was not compliant with the published procedures.
Final Report:

Crash of a Boeing 707-331C in São Paulo

Date & Time: Mar 7, 2001 at 0030 LT
Type of aircraft:
Operator:
Registration:
PT-MST
Flight Type:
Survivors:
Yes
Schedule:
Belém – Brasilía – São Paulo
MSN:
18711
YOM:
1964
Flight number:
SKC9101
Country:
Crew on board:
3
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
4200
Captain / Total hours on type:
2543.00
Copilot / Total flying hours:
3858
Copilot / Total hours on type:
361
Aircraft flight hours:
70422
Aircraft flight cycles:
28047
Circumstances:
The aircraft was completing a cargo flight from Belém to São Paulo with an intermediate stop in Brasilía, carrying three crew members and a load of various goods such as mail and fish. While descending to São Paulo-Guarulhos Airport in good weather conditions at an altitude of 10,000 feet, the crew encountered technical problems with the trim system. Several manual controls and tests were conducted and the system worked before failing again between 6,000 and 4,700 feet. The captain decided to continue the approach but the aircraft became unstable and nosed down on short final. It landed hard on runway 09R, causing the undercarriage to be torn off. The aircraft slid for about 1,000 metres then veered off runway to the left and came to rest in a grassy area. All three crew members escaped uninjured while the aircraft was damaged beyond repair.
Probable cause:
The exact cause of the technical problems on the trim system could not be determined with certainty. The following contributing factors were identified:
- The decisions of the crew and more particularly of the captain during the last phase of flight were incorrect,
- The crew training program for emergency situation was incomplete,
- Improper use of flaps and slats on final approach made the situation worse,
- The captain did not follow the procedure determined for such an emergency situation and decided to continue the approach maneuver, increasing the risk margin and placing the airplane in critical operating conditions,
- Due to deviations from the published standard operational procedures, such as failure to complete the approach briefing and not following the approach checklist, the coordination among the flight crew was poor, leading to further deviations and putting the crew in a critical situation.
Final Report: