Crash of a Cessna 208B Grand Caravan in Heyburn: 1 killed

Date & Time: Apr 13, 2022 at 0832 LT
Type of aircraft:
Operator:
Registration:
N928JP
Flight Type:
Survivors:
No
Site:
Schedule:
Salt Lake City – Burley
MSN:
208B-2428
YOM:
2013
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
1380
Captain / Total hours on type:
193.00
Aircraft flight hours:
5116
Circumstances:
The pilot flew two RNAV (GPS) runway 20 instrument approaches at the Burley Municipal Airport, Burley, Idaho in instrument meteorological conditions (IMC). The accident occurred during the second approach. For the first instrument approach, the pilot configured the airplane with flaps up and flew the final approach segment at speeds above the operator’s training standard of 120 knots indicated airspeed (KIAS).The pilot flew a low pass over the runway, most likely to assess the landing conditions in accordance with company policy, determined the conditions were acceptable, initiated the missed approach and requested to return flying the same approach. The pilot elected to not use flaps during the second approach but slowed the approach speed during the final approach leg. Reported weather had improved and visibility had increased to about 2.5 miles. During this approach, the airplane intercepted and remained on the glide path to the stepdown fix. The last automatic dependent surveillance - broadcast (ADS-B) equipment plot recorded the airplane about a mile past this fix, or about 0.6 nautical miles (nm) from the displaced threshold, on the glide path, and at an estimated 85 knots calibrated airspeed (KCAS), which was slower than the airplane’s 95-knot minimum speed for flaps up in icing conditions. Shortly afterward, the airplane descended about 130 ft below the glide path, striking an agglomerate stack atop a potato processing plant, fatally injuring the pilot and substantially damaging the airplane. A witness reported seeing the airplane come out of the clouds and immediately enter a steam cloud coming from six other stacks before striking the accident stack. A security camera at the processing plant captured the last moments of the airplane’s flight as it came into view in a wings-level, flaps-up, nose-high descent and just before it impacted the stack. While snow and visible moisture were present, the agglomerate stack was always in clear view during the Page 2 of 24 WPR22FA151 video, with only partial sections obscured. The witness’s account of hearing the engine noise increase and then the nose lift-up may have been the pilot’s attempt to avoid the obstacle. The Federal Aviation Administration’s (FAA) Aeronautical Information Manual advises pilots to avoid overflight of exhaust stacks; however, the accident stack was directly underneath the instrument approach course and overflight would be expected. Postaccident examination of the airplane, conducted hours after the accident, revealed no structural icing on the wings and empennage. Examination of the airframe and powerplant revealed no mechanical malfunctions or failures that would have precluded normal operation. The flaps were up, and a review of the manifest revealed the airplane was loaded within the specifications of the manifest and within the center of gravity limits. Between 2016 and 2017, the FAA conducted two aeronautical studies regarding the stack structures. In the first study, the FAA determined that many of the stack structures were a hazard to air navigation that required mitigation by the processing plant. As an interim measure, the FAA placed the runway 20 visual approach slope indicator (VASI) out of service because the stacks penetrated the obstruction clearance surface and were deemed hazardous to aviation. After determining that they needed to increase the height of the stacks, the plant then modified their proposal; the proposed height increase necessitated a second study. The second study determined the agglomerate stack and the row-of-six stacks exceeded the Code of Federal Regulations (CFR) section 77 standards and provided mitigating actions that included painting the stacks with high visibility white and aviation orange paint and equipping the stacks with red flashing warning lights. The control measures also included the permanent removal of the VASI. On the day of the accident, the agglomerate stack and row-of-six stacks had not been painted to the standard required by the FAA. The warning lights had been installed, and five of the row-of-six stacks were equipped with flashing red lights. The agglomerate stack warning light was stolen following the accident, so an accurate determination of its operating status could not be made. The existing paint scheme and the visible moisture emitted by the stacks provided a low contrast to the environmental background. This low contrast and the lack of a visual glide slope indicator may have caused difficulty for the pilot in maintaining a safe altitude during the visual portion of the approach to the runway. A white and aviation orange paint scheme, as identified in the regulations, may have offered a higher contrast and thus an adequate warning once the pilot transitioned to visual conditions.
Probable cause:
The pilot’s failure to maintain altitude during an instrument approach, which resulted in a descent below the approach path and impact with a vent stack. Also causal was the failure of the processing plant to correctly paint the vent stacks, which had been determined by the FAA to be a hazard to navigation due to their proximity to the landing approach path. Contributing to the accident was the likely distraction/illusion/obscuration created by steam from the processing plant, which intermittently obscured the runway.
Final Report:

Crash of a Boeing 757-27A in San José

Date & Time: Apr 7, 2022 at 1025 LT
Type of aircraft:
Operator:
Registration:
HP-2010DAE
Flight Type:
Survivors:
Yes
Schedule:
San José – Guatemala City
MSN:
29610/904
YOM:
1999
Flight number:
JOS7216
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
16381
Captain / Total hours on type:
6233.00
Copilot / Total flying hours:
10545
Copilot / Total hours on type:
2337
Aircraft flight hours:
39205
Circumstances:
The airplane departed San José-Juan Santamaría Airport runway 07 at 0940LT on a cargo service (flight JOS7216) to Guatemala City, carrying two pilots and a load of various goods. When the crew reached FL210, he declared an emergency and reported technical problems with the hydraulic system. The crew encountered a 'HYDRAULIC QUANTITY indication then a HYDRAULIC SYSTEM PRESSURE (L ONLY) second indication. At this time, the left autopilot and yaw damper disengaged. After being cleared to return, the crew followed a holding pattern and the airplane landed at a speed of 137 knots (Vref 130 kts) on runway 07. Following a normal touchdown, the crew initiated the braking procedure when the airplane started to veer to the right. It skidded to the right, made an almost 90° turn, descended a bank, lost its undercarriage and came to rest in a grassy area located about five metres below the runway elevation, broken in two. Both pilots evacuated with minor injuries.
Probable cause:
It was determined that the airplane suffered a major failure of the left hydraulic system in flight. This caused the autobrake, the left reverser, the rudder ratio and the nosewheel steering system to be inoperative. Only few spoilers were operative.
The following contributing factors were identified:
- Fatigue and stress on the individual cables in the cross-section of the flexible hydraulic retraction hose of the L/H MLG down-locking actuator.
- The probable inadvertent synchronized movement of the right Reverse Thrust Lever and left Engine Control Thrust Lever, as a reaction to muscle memory.
Final Report:

Ground fire of a Let L-410UVP-E3 in Bukavu

Date & Time: Feb 14, 2022 at 1600 LT
Type of aircraft:
Operator:
Registration:
9S-GFA
Flight Type:
Survivors:
Yes
Schedule:
Bukavu - Lulingu Tschionka
MSN:
87 19 21
YOM:
1987
Location:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The twin engine airplane departed Bukavu-Kavumu Airport on a cargo flight to Lulingu Tschionka, carrying two pilots and a load of 1,600 kilos of various goods. Few minutes after takeoff, a fire erupted in the cargo compartment and the crew elected to return for an emergency landing. The crew landed normally and was able to stop the airplane and the runway and to evacuate safely. The aircraft was completely destroyed by fire.

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

Date & Time: Feb 11, 2022 at 1230 LT
Type of aircraft:
Registration:
RA-33599
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Koryaki - Tymlat
MSN:
1G230-41
YOM:
1988
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
17136
Captain / Total hours on type:
2388.00
Copilot / Total flying hours:
376
Copilot / Total hours on type:
7
Aircraft flight hours:
3712
Circumstances:
The single engine airplane departed Koryaki on a cargo flight to Tymlat, carrying two pilots and a load of potatoes and roof tiles. Shortly after takeoff, while in initial climb, the airplane reached a critical angle of attack then entered a stall and crashed in a wooded area, bursting into flames. The wreckage was found about one km from the village. The airplane was totally destroyed by a post crash fire and both occupants were killed.
Probable cause:
The accident probably occurred as a result of its entry into subcritical angles of attack and stall mode after a takeoff with the maximum permissible weight and reduced power of the propulsion system. Most likely, the reduced power was due to the installation of a magneto switch prior to the PM-1 magneto switch to position “1” instead of position “1+2” as required in the flight manual.
The following contributing factors were identified:
- Long flight interruptions of both crew members before the emergency flight,
- Deficiencies in the training and interaction of crew members,
- Insufficient level of flight training, which resulted in a loss of control of the flight speed.
Final Report:

Ground fire of a Tupolev TU-204-100C in Hangzhou

Date & Time: Jan 8, 2022 at 0440 LT
Type of aircraft:
Operator:
Registration:
RA-64032
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Hangzhou - Novosibirsk
MSN:
145074 2 2 64032
YOM:
2002
Flight number:
4B6534
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Parked on the apron at Hangzhou-Xiaoshan Airport, the airplane was prepared for a cargo service to Novosibirsk with 8 crew members and a load of 20 tons of various goods on board. A fire erupted in the cargo compartment. The crew evacuated the aircraft and was uninjured while the aircraft was partially destroyed by fire and broke in two.

Crash of a Short 360-300 in Shabunda: 5 killed

Date & Time: Dec 23, 2021
Type of aircraft:
Operator:
Registration:
9S-GPS
Flight Type:
Survivors:
No
Schedule:
Goma - Shabunda
MSN:
3752
YOM:
1989
Region:
Crew on board:
3
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
5
Circumstances:
The aircraft departed Goma on a cargo flight to Shabunda, carrying two conveyors and three crew members. On approach to Shabunda Airport, the crew encountered poor weather conditions when the arcraft crashed 15 km from the airport. All five occupants were killed.

Crash of a Cessna 208B Grand Caravan in Fulshear: 2 killed

Date & Time: Dec 21, 2021 at 0926 LT
Type of aircraft:
Operator:
Registration:
N1116N
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Houston - Victoria
MSN:
208B-0417
YOM:
1994
Flight number:
MRA685
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
3500
Aircraft flight hours:
13125
Circumstances:
A Cessna 208B airplane collided with a powered paraglider during cruise flight at 5,000 feet mean sea level (msl) in Class E airspace. Based on video evidence, the powered paraglider operator impacted the Cessna’s right wing leading edge, outboard of the lift strut attachment point. The outboard 10 ft of the Cessna’s right wing separated during the collision. The Cessna impacted terrain at high vertical speed in a steep nose-down and inverted attitude. The powered paraglider operator was found separated from his seat style harness. The paraglider wing, harness, and emergency parachute were located about 3.9 miles south of the Cessna’s main wreckage site. Based on video evidence and automatic dependent surveillance-broadcast (ADS-B) data, the Cessna and the powered paraglider converged with a 90° collision angle and a closing speed of about 164 knots. About 8 seconds before the collision, the powered paraglider operator suddenly turned his head to the right and about 6 seconds before the collision, the powered paraglider maneuvered in a manner consistent with an attempt to avoid a collision with the converging Cessna. Research indicates that about 12.5 seconds can be expected to elapse between the time that a pilot sees a conflicting aircraft and the time an avoidance maneuver begins. Additionally, research suggests that general aviation pilots may only spend 30-50% of their time scanning outside the cockpit. About 8 seconds before the collision (when the powered paraglider operator’s head suddenly turned to the right), the Cessna would have appeared in the powered paraglider operator’s peripheral view, where research has demonstrated visual acuity is very poor. Additionally, there would have been little apparent motion because the Cessna and the powered paraglider were on a collision course. Under optimal viewing conditions, the powered paraglider may have been recognizable to the Cessna pilot about 17.5 seconds before the collision. However, despite the powered paraglider’s position near the center of his field of view, the Cessna pilot did not attempt to maneuver his airplane to avoid a collision. Further review of the video evidence revealed that the powered paraglider was superimposed on a horizon containing terrain features creating a complex background. Research suggests that the powered paraglider in a complex background may have been recognizable about 7.4 seconds before the collision. However, the limited visual contrast of the powered paraglider and its occupant against the background may have further reduced visual detection to 2-3 seconds before the collision. Thus, after considering all the known variables, it is likely that the Cessna pilot did not see the powered paraglider with sufficient time to avoid the collision. The Cessna was equipped with a transponder and an ADS-B OUT transmitter, which made the airplane visible to the air traffic control system. The operation of the powered paraglider in Class E airspace did not require two-way radio communication with air traffic control, the use of a transponder, or an ADS-B OUT transmitter and therefore was not visible to air traffic control. Neither the Cessna nor the powered paraglider were equipped with ADS-B IN technology, cockpit display of traffic information, or a traffic alerting system. Postmortem toxicological testing detected the prescription antipsychotic medication quetiapine, which is not approved by the Federal Aviation Administration (FAA), in the Cessna pilot’s muscle specimen but the test results did not provide sufficient basis for determining whether he was drowsy or otherwise impaired at the time of the collision (especially in the absence of any supporting details to suggest quetiapine use). Testing also detected ethanol at a low level (0.022 g/dL) in the Cessna pilot’s muscle specimen, but ethanol was not detected (less than 0.01 g/dL) in another muscle specimen. Based on the available results, some, or all of the small amount of detected ethanol may have been from postmortem production, and it is unlikely that ethanol effects contributed to the accident. The Cessna pilot likely did not have sufficient time to see and avoid the powered paraglider (regardless of whether he was impaired by the quetiapine) and, thus, it is unlikely the effects of quetiapine or an associated medical condition contributed to the accident.
Probable cause:
The limitations of the see-and-avoid concept as a method for self-separation of aircraft, which resulted in an inflight collision. Contributing to the accident was the absence of collision avoidance technology on both aircraft.
Final Report:

Crash of a Swearingen SA226AT Merlin IV in Manchester: 1 killed

Date & Time: Dec 10, 2021 at 2330 LT
Operator:
Registration:
N54GP
Flight Type:
Survivors:
No
Schedule:
Fairfield – Manchester
MSN:
AT-34
YOM:
1975
Flight number:
CSJ921
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
2257
Captain / Total hours on type:
118.00
Aircraft flight hours:
10633
Circumstances:
During an instrument approach at night in a twin-engine turboprop airplane, the pilot reported an engine failure, but did not specify which engine. About 9 seconds later, the airplane impacted terrain about ¼-mile short of the runway and a postcrash fire consumed a majority of the wreckage. During that last 9-second period of the flight, the airplane’s groundspeed slowed from 99 kts to 88 kts, as it descended about 400 ft in a slight left turn to impact (the airplane’s minimum controllable airspeed was 92 kts). The slowing left turn, in conjunction with left wing low impact signatures observed at the accident site were consistent with a loss of control just prior to impact. Postaccident teardown examination of the left engine revealed that the 1st stage turbine rotor had one blade separated at the midspan. The blade fracture surface had varying levels of oxidation and the investigation could not determine if the 1st stage turbine blade separation occurred during the accident flight or a prior flight. The 2nd stage turbine was operating at temperatures higher than the 1st stage turbine, which was consistent with engine degradation over a period of time. Additionally, the 2nd stage turbine stator assembly was missing vane material from the 6 to 12 o’clock positions, consistent with thermal damage. All of these findings would have resulted in reduced performance of the left engine, but not a total loss of left engine power. The teardown examination of the right engine did not reveal evidence of any preimpact anomalies that would have precluded normal operation. Examination of both propellers revealed that all blade angles were mid-range and exhibited evidence of little to no powered rotation. Neither propeller was in a feathered position, as instructed by the pilot operating handbook for an engine failure. If the pilot had perceived that the left engine had failed, and had he secured the engine and feathered its propeller (both being accomplished by pulling the red Engine Stop and Feather Control handle) and increased power on the right engine, the airplane’s performance should have been sufficient for the pilot to complete the landing on the runway.
Probable cause:
The pilot’s failure to secure and feather the left engine and increase power on the right engine after a perceived loss of engine power in the left engine, which resulted in a loss of control and impact with terrain just short of the runway. Contributing to the accident was a reduction in engine power from the left engine due to a 1st stage turbine blade midspan separation and material loss in the 2nd stage stator that were the result of engine operation at high temperatures for an extended period of time.
Final Report:

Crash of an Antonov AN-12BK in Irkutsk: 9 killed

Date & Time: Nov 3, 2021 at 1945 LT
Type of aircraft:
Operator:
Registration:
EW-518TI
Flight Type:
Survivors:
No
Schedule:
Yakutsk - Irkutsk
MSN:
8 34 61 07
YOM:
1968
Country:
Region:
Crew on board:
7
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
9
Captain / Total flying hours:
14625
Captain / Total hours on type:
11182.00
Copilot / Total flying hours:
5168
Circumstances:
The four engine aircraft was completing a cargo flight, carrying two passengers, seven crew members and a load consisting of foods. While on a night approach to Irkutsk-Intl Airport Runway 30, the crew encountered poor visibility due to snow falls. On final, at a height of about 240 metres, the captain decided to initiate a go-around procedure when the aircraft impacted trees, stalled and crashed in a wooded area, bursting into flames. The wreckage was found about 3,1 km short of runway 30. The aircraft was totally destroyed by impact forces and a post crash fire and all nine occupants were killed.

Ground fire of a Transall C-160NG in Dolow

Date & Time: Nov 3, 2021
Type of aircraft:
Operator:
Registration:
EY-360
Flight Type:
Survivors:
Yes
Schedule:
Mogadishu - Dolow
MSN:
F233
YOM:
1985
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The crew was completing a cargo flight from Mogadishu to Dolow. After landing, the crew stopped the aircraft on the runway and was able to evacuate the cabin before the aircraft would be partially destroyed by fire.