Crash of an Airbus A310-324 in Irkutsk: 125 killed

Date & Time: Jul 9, 2006 at 0744 LT
Type of aircraft:
Operator:
Registration:
F-OGYP
Survivors:
Yes
Schedule:
Moscow - Irkutsk
MSN:
442
YOM:
1987
Flight number:
SBI778
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
195
Pax fatalities:
Other fatalities:
Total fatalities:
125
Captain / Total flying hours:
10611
Captain / Total hours on type:
1056.00
Copilot / Total flying hours:
9771
Copilot / Total hours on type:
158
Aircraft flight hours:
59865
Aircraft flight cycles:
12550
Circumstances:
On July 8, 2006 an А310 airplane with state registration number F-OGYP (France), leased by ОАО Aviakompania Sibir, and with a flight crew consisting of the Captain and the co-pilot, was flying scheduled passenger flight С7 778 from Domodedovo to Irkutsk. Apart from the two cockpit personnel, there were 6 flight attendants and 195 passengers on board (of these, 2 worked for the company), which included 181 nationals of Russia, 3 of Germany, 3 of the PRC, 2 of Poland, 3 of Belarus, 2 of Moldova and 1 of Azerbaijan. The airplane's payload according to the flight manifest was 19,800 kg (which included about 80 kg of hazardous freight - perfume), its take-off weight 140414 kg (maximum permissible – 150,000 kg), and center-of-gravity position 25.5% (the range of permissible center-of-gravity positions for take-off is 18% - 32%). Upon completion of the pre-flight preparation, the crew took off from Domodedovo airport at 17:17 (17:15 – as per schedule) and after climbing set a course for its destination airport of Irkutsk (alternate airport Bratsk). The flight proceeded without incident and at 22:17 the crew initiated descent for an approach and landing at Irkutsk airport. At 22:43:40 the airplane landed without misalignment on runway 30 at Irkutsk airport. Before the flight, in accordance with Sibir’s MEL, the maintenance personnel deactivated the thrust reverser on the airplane's left engine after hearing the crew's observation about this thrust reverser's malfunction during a previous flight. After touchdown all spoiler sections prepared ("armed") by the crew for utilization were deployed and the autobrake in Low mode, previously selected by the crew, was activated. The pilot moved the right engine (no. 2) thrust reverser forward. However, simultaneously with the subsequent reduction of the reverse mode of engine no. 2, engine no. 1 started to speed up (forward thrust), which led to an increase in airplane speed and the onset of torque that pulled the airplane to the right. The crew failed to perceive the cause of what was happening. In spite of intense wheel-braking efforts, the airplane used up the entire length of the runway and overshot its end at a speed of about 180 kph. The airplane then continued to travel on wet soil. At a distance of about 300 m from the departure threshold of the runway, the airplane collided with a concrete barrier of the aerodrome and then with some garages located directly behind the barrier, after which the airplane, now seriously damaged, stopped. As a result of the destruction of the fuel tanks the fuel ignited and fire penetrated the airplane's interior. As a result of the accident, 125 individuals died, including the two pilots and three of the flight attendants. The airplane was practically completely destroyed by the fire.
Probable cause:
The cause of Sibir A310 F-OGYP accident was the erroneous and uncontrolled actions by the crew during rollout after landing in a configuration with one engine reverser deactivated. After touchdown, the Captain, while acting on the reverse thrust lever of the right engine, inadvertently and uncontrollably moved the throttle lever for the left engine, whose thrust reverser was deactivated, from the "idle" to the significant forward thrust position. Inadequate monitoring and call-outs of airplane speed and engine parameters by the Co-pilot made it impossible for the crew to perform the necessary actions, either by moving the left throttle back to idle or shutting down the engines. The crew had enough time to recognize the situation. The airplane went off the runway at the high speed of ~180 km/h, hit the concrete fence and buildings, crashed and caught fire. 125 people died as a result of the accident.
Final Report:

Crash of an Airbus A320-211 off Sochi: 113 killed

Date & Time: May 3, 2006 at 0213 LT
Type of aircraft:
Operator:
Registration:
EK-32009
Survivors:
No
Schedule:
Yerevan - Sochi
MSN:
547
YOM:
1995
Flight number:
RNV967
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
105
Pax fatalities:
Other fatalities:
Total fatalities:
113
Captain / Total flying hours:
5458
Captain / Total hours on type:
1436.00
Copilot / Total flying hours:
2185
Copilot / Total hours on type:
1022
Aircraft flight hours:
28234
Aircraft flight cycles:
14376
Circumstances:
On 2 May 2006 the Armavia A320, registered EK-32009, was undertaking passenger flight RNV 967 from Zvartnots (Yerevan, Armenia) to Adler (Sochi, Russia). Preliminary preparation of the crew was conducted on 23-24 May 2006 under the guidance of the airline’s Flight Director, in accordance with the requirements of ROLRGA RA-2000, Section 7.2.1. Pre-flight briefing of the crew was conducted on the day of departure, under the guidance of the Captain, in accordance with the requirements of ROLRGA RA-2000, Section 8.2.1 On 2 May 2006 at 19.30 the crew passed the pre-flight medical examination. The crew’s pre-flight rest period exceeded 24 hours. In accordance with ROLRGA RA-2000 and Work-Rest Norms for civil aircraft crews from the Republic of Armenia, each crew member is individually responsible for adherence to the pre-flight rest regime. It should be noted that it was difficult for the crew to take adequate rest during the day before the night flight, due to impairment of bio-rhythms. That is most likely why, in their cockpit conversations the crew members mentioned that they had not got enough sleep. In order to make their decision for departure, the crew obtained the observed weather data and the weather forecast for the takeoff, landing and alternate aerodromes that met the requirements for IFR flights. According to the documents submitted, the airplane takeoff weight and the centre of gravity were 62,712 kg and 29.9% mean aerodynamic chord, i.e. within the A320 FCOM limitations. There were 113 occupants on board: 105 passengers (including 5 children and 1 baby), 2 pilots, 5 flight attendants and 1 engineer. The airplane took off from Zvartnots airport at 20:47. Takeoff, climb and cruise were uneventful. The first communication between the Sochi approach controller and the crew took place at 21:10:20. At that moment the airplane was beyond the coverage area of Sochi aerodrome radar. Up until 21:17 the approach controller and the crew discussed the observed and forecast weather, and as a result the crew decided to return to Yerevan. At 21:26:37, after the decision had already been made, the crew asked the controller about the latest observed weather. At 21:30:49 the controller informed the crew that visibility was 3,600 m and the cloud ceiling 170 m. At 21.31.14 the crew decided to continue the flight to Sochi airport. The next communication with the approach controller was at 22:00:45. At that moment the airplane was descending to an altitude of 3,600 m heading to GUKIN point and was being tracked by the Sochi radar. The approach controller cleared the airplane for descent to 1,800 m and reported the observed weather at Sochi, as at 22:00, for runway 06, which was above the aerodrome minimum. Then the crew was handed over to the holding and tower controllers, and was cleared for descent to 600 m, as per aerodrome pressure QNH 1016 hPa, before entering the turn to final. While performing the turn to final, the runway extended centreline was overshot. Having eliminated the deviation, the airplane started descending along the glide slope, following the approach pattern. At 22:10:45 the crew reported extension of the landing gear and their readiness for landing. In response they were advised of the distance of 10 km and weather 4000 x 190, and were cleared for landing. However, about 30 seconds later, the controller advised the crew of the observed cloud ceiling at 100 m and instructed them to stop their descent and carry out a right turn and climb up to 600 m and also to get in touch with the holding controller. The last communication with the crew was at 22:12:35. After that the crew did not respond to any of the controller’s calls. At 22:13:03 the airplane struck the water, was destroyed and sank.
Probable cause:
The fatal crash of the Armavia A320 EK-32009 was a CFIT accident that happened due to collision with the water while carrying-out a climbing manoeuvre after an aborted approach to Sochi airport at night with weather conditions below the established minima for runway 06. While performing the climb with the autopilot disengaged, the Captain, being in a psychoemotional stress condition, made nose down control inputs due to the loss of pitch and roll awareness. This started the abnormal situation. Subsequently the Captain's inputs in the pitch channel were insufficient to prevent development of the abnormal situation into the catastrophic one. Along with the inadequate control inputs of the Captain, the contributing factors to development of the abnormal situation into the catastrophic one were also the lack of necessary monitoring of the aircraft descent parameters (pitch attitude, altitude, vertical speed) by the co-pilot and the absence of proper reaction by the crew to the EGPWS warning.
Final Report:

Crash of a PZL-Mielec AN-2R in Tersky: 4 killed

Date & Time: Apr 23, 2006 at 2019 LT
Type of aircraft:
Operator:
Registration:
RF-00451
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Tersky - Tersky
MSN:
1G218-05
YOM:
1986
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
4
Pax fatalities:
Other fatalities:
Total fatalities:
4
Circumstances:
Around 2000LT, the pilot departed Tersky on an unauthorized local flight with four passengers. While cruising at a height of about 50 metres, the aircraft went out of control and crashed in an open field located one km from the departure point. A female passenger was seriously injured while four other occupants were killed. The aircraft was destroyed.
Probable cause:
The pilot failed to prepare the flight according to procedures and did not follow the pre-takeoff checklist. As a result, he departed Tersky with the flaps and ailerons stilled locked.

Crash of an Ilyushin II-62M in Moscow

Date & Time: Mar 29, 2006 at 2051 LT
Type of aircraft:
Registration:
5A-DKR
Flight Type:
Survivors:
Yes
Schedule:
Mitiga - Moscow
MSN:
4053514
YOM:
1990
Country:
Region:
Crew on board:
6
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The crew departed Mitiga on a positioning flight to Moscow-Domodedovo where the airplane should follow an overhaul program. The airplane crossed the runway 32R threshold at a height of 12 metres and with an excessive speed of 304 km/h. At a height of about five metres, the captain instructed the flight engineer to reduce the speed and to bring back the speed levers to idle. This instruction was confirmed by the flight engineer then the captain asked for the thrust reversers to be activated. In a certain confusion, the flight engineer did not confirm this instruction and asked again the order. Possibly due to a certain distraction, the flight engineer failed to position the power lever in the correction position. As a result, the aircraft floated at a height estimated between 0,5 and one metre before it landed firmly 1,100 metres past the runway threshold at a speed of 258 km/h. Unable to stop within the landing distance available, the aircraft overran, lost its undercarriage and came to rest 680 metres further, broken in three. All six occupants were rescued, among them two were injured.
Probable cause:
The accident occurred as a result of erroneous actions by the flight engineer during operations to turn on the engine reverse when landing the plane, expressed in shifting the reverse buckets to direct thrust and putting the 1st and 4th engines to take-off mode after landing. The Commission concluded that the flight engineer’s erroneous actions were facilitated by:
- A low level of technological discipline in the crew due to the weak role of the captain as a leader in the crew, which was manifested in the crew members not fully fulfilling the "Instructions for the interaction and technology of the crew members of the IL-62M aircraft" and Aircraft Flight Manual during descent, approach and landing,
- Emotional relaxation of the crew at the end of a business trip and return to base,
- Lack of effective control, including according to the data of flight recorders over flight operations with LIBAVIA,
- In the "Instructions for the interaction and technology of the crew of the IL-62M aircraft" there are no control functions on the part of other crew members for the actions of the flight engineer at the stage of aircraft landing and the status of the reverse on/off alarm,
- The absence in the training programs of the simulator of exercises for practicing the actions of crew members in case of erroneous actions by the flight engineer when the reverse is turned on,
- Lack of equipment for the flight engineer’s workplace with a radio headset, lack of procedures in the "Instructions for Interaction and the Work Technology of the Crew Members of the Il-62M Aircraft" for the use of a radio headset for flight personnel in flights with a reduced crew,
- Excessive volume of the SSU speakers broadcasting external radio communications, which created additional difficulties when listening to the commands given by the captain,
- Fuzziness (illegibility) of the commands given by the PIC and the lack of response of the PIC to the non-confirmation of the commands given by him to the flight engineer.

Crash of a Cessna 208B Grand Caravan in Staroye: 8 killed

Date & Time: Nov 19, 2005 at 2233 LT
Type of aircraft:
Operator:
Registration:
P4-OIN
Flight Phase:
Survivors:
No
Schedule:
Voronezh - Moscow
MSN:
208B-1052
YOM:
2004
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
6
Pax fatalities:
Other fatalities:
Total fatalities:
8
Circumstances:
The single engine aircraft departed Voronezh at 2117LT on a special flight to Moscow-Domodedovo Airport with 6 pax and 2 pilots on board, ETA Moscow 2240LT. While approaching Stupino and descending to Domodedovo Airport by night, the crew encountered poor weather conditions with snow falls, poor visibility, icing conditions and turbulences. Passing Stupino at an altitude of 1,500 metres, the aircraft pitched up in an angle of 9° and at a speed of 102 knots, it nosed down 40° then entered an uncontrolled descent until it crashed at a speed of 226 knots in a wooded area located in Staroye, about 10 km from Stupino. The aircraft was destroyed by impact forces and a post crash fire and all 8 occupants were killed.
Probable cause:
Loss of control in icing conditions.

Crash of a PZL-Mielec AN-2TP near Sangar

Date & Time: Nov 18, 2005 at 1407 LT
Type of aircraft:
Operator:
Registration:
RA-02252
Flight Phase:
Flight Type:
Survivors:
Yes
Site:
Schedule:
Sangar – Segyan-Kyuel – Sangar
MSN:
1G234-06
YOM:
1989
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
10
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The aircraft was engaged in an ambulance flight from Sangar to Segyan-Kyuel and back. Because of poor weather the flight was delayed a couple of hours. At ETD, weather conditions at Sangar Airport was as follows: visibility more than 10 km, scattered clouds at 800 metres, overcast at 3,000 metres, temperature -22° C, dewpoint -23° C, pressure 765 mm Hg. Weather forecast en route included a few stratocumulus clouds between 1,400 and 1,700 metres, significant altostratus clouds between 2,700 and 3,500 metres. The mountainous area over which the Antonov was to fly moderate orographic turbulence was present in the layer from 900 to 1,700 meters, and possible downdrafts on the lee side of ridge in the same altitude range. These conditions were not reported to the crew. Then medical equipment with a weight of 400 kg and passengers arrived at the airport by ambulances. The captain expected seven passengers, but three additional passengers had arrived, without having tickets. The names were added to the passenger list and the copilot arranged the payment of the fare. No seats were available for two passengers, so they had to sit on some hand luggage in the aisle. At 04:46 UTC the aircraft departed from Sangar and climbed towards the mountainous terrain. The highest point along the route was at an elevation of 1,976 metres. The minimum safe altitude was 2,515 metres. The pilot climbed VFR and maintained visual separation from the snow-covered mountains. At an altitude of 1,300 metres the Antonov entered an area with strong turbulence. The aircraft was caught in a downdraft. In an attempt to stop the plane from descending further, power was added to nominal, then to the takeoff power. With rising terrain it was impossible to continue. The pilot decided to carry out a 180° turn to the left over downsloping terrain. This brought the plane downwind with a 30° bank instead of the recommended 20°. As a result, the rate of descent increased and after it rolled to an angle of 120°, the left lower wing contacted a cliff. The aircraft lost speed and crashed on the snow covered mountain. All 12 occupants were rescued, among them four were seriously injured. The aircraft was destroyed.
Probable cause:
The following findings were identified:
- The crew carried out a flight at a height lower than the minimum safe altitude,
- Incorrect estimation by the crew of the prevailing situation, which led to a late decision to return to the airport of departure under the conditions of orographic turbulence and airspace limited by mountains,
- Deficiencies in the flight instructions at the airport Of Sangar, due to the absence a.o. of an altitude diagram of the route of flight, which would have shown that it was impossible for the airplane, according to its technical flight characteristics, to gain enough height within 10 km after takeoff,
- The incorrect weather forecast along the flight course, in which the orographic turbulence was not provided,
- The erroneous actions of the crew in the process of the downwind turn with a bank angle of 30° while carrying out the delayed decision to return to the airport of departure, leading to an increase in the vertical rate of descent.

Crash of an Antonov AN-24RV in Yuzhno-Sakhalinsk

Date & Time: Nov 2, 2005
Type of aircraft:
Operator:
Registration:
RA-46618
Survivors:
Yes
MSN:
3 73 087 05
YOM:
1973
Country:
Region:
Crew on board:
0
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Upon landing at Yuzhno-Sakhalinsk Airport, the nose gear collapsed and punctured the ground floor just behind the cockpit. The aircraft came to rest on the main runway following a course of few dozen metres. All occupants escaped uninjured while the aircraft was damaged beyond repair.

Crash of a PZL-Mielec AN-2 in Labozhskoe

Date & Time: Oct 19, 2005 at 1057 LT
Type of aircraft:
Operator:
Registration:
RA-40943
Flight Phase:
Survivors:
Yes
Schedule:
Nes – Oma – Nizhnyaya Pesha – Naryan-Mar
MSN:
1G216-43
YOM:
1985
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
13
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
While cruising at an altitude of 130 metres, the engine failed. The crew elected to make an emergency landing in the tundra near Labozhkoe, 47 km west from Naryan-Mar, when the aircraft impacted trees and crashed in a wooded area. A passenger was injured while all other occupants escaped unhurt. The aircraft was written off.
Probable cause:
Engine failure for unknown reasons.

Crash of a PZL-Mielec AN-2R near Ekimchan: 3 killed

Date & Time: Sep 4, 2005 at 1255 LT
Type of aircraft:
Operator:
Registration:
RF-00901
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Ekimchan - Udskoye - Chumikan
MSN:
1G171-22
YOM:
1976
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
The aircraft departed Ekimchan on a flight to Chumikan with an intermediate stop in Udskoye, carrying two pilots, one passenger and a load of food. Eight minutes after takeoff, while flying in poor weather conditions, the single engine aircraft struck the slope of Mt Bryus (1,767 metres high) located in the Selemja Mountain Range, some 19 km east of Ekimchan. The wreckage was found 12 days later, at an altitude of 1,560 metres. All three occupants were killed.
Probable cause:
Controlled flight into terrain after the crew decided to continue the flight under VFR mode in IMC conditions. It is possible that the crew lost his sense of orientation shortly after takeoff.

Crash of a Dassault Falcon 20C in Moscow

Date & Time: May 20, 2005
Type of aircraft:
Operator:
Registration:
RA-09007
Survivors:
Yes
MSN:
136
YOM:
1968
Country:
Region:
Crew on board:
0
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Aircraft lost power on both engines while on approach to Moscow-Vnukovo airport. The crew decided to divert to Sheremetievo Airport when the undercarriage collapsed on landing. The aircraft veered off runway and slid in a grassy area before coming to rest. Nobody was injured but the aircraft was damaged beyond repair.
Probable cause:
It is believed that the engine lost power on approach because of the poor fuel quality.