Crash of a Cessna 208B Grand Caravan in Panama City

Date & Time: Aug 16, 2004 at 0835 LT
Type of aircraft:
Operator:
Registration:
HP-1397APP
Flight Phase:
Survivors:
Yes
Schedule:
Panama City – Chitré
MSN:
208B-0613
YOM:
1997
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
5
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Shortly after takeoff from Panama City-Marcos A. Gelabert Airport, while climbing, the crew encountered technical problem with the engine and declared an emergency. He realized he could not return to his departure point so he attempted an emergency landing on a road when the aircraft struck a tree and crashed 9 km weat of the airport. All seven occupants escaped uninjured while the aircraft was damaged beyond repair.

Crash of a Boeing 737-205 in Freetown

Date & Time: Aug 11, 2004 at 1423 LT
Type of aircraft:
Operator:
Registration:
3X-GCM
Flight Phase:
Survivors:
Yes
Schedule:
Freetown - Conakry - Banjul
MSN:
23469
YOM:
1986
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
119
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Due to poor weather conditions in Freetown, the flight was delayed for hours. Finally, the crew was cleared for takeoff from runway 12/30 which is 3,200 metres long. During the takeoff roll, the captain decided to abort for unknown reasons. Unable to stop within the remaining distance, the aircraft overran, lost its right main gear and right engine before coming to rest in a grassy area located 100 metres past the runway end. All 127 occupants were rescued, among them 50 passengers were injured. The aircraft was damaged beyond repair.
Probable cause:
The accident was the consequence of the non-application by the crew of the checklist prior to takeoff and the lack of coordination between the copilot, who was the pilot flying, and the captain.

Crash of a Douglas DC-9-14 in Mexico City

Date & Time: Jul 21, 2004 at 1933 LT
Type of aircraft:
Operator:
Registration:
XA-BCS
Flight Phase:
Survivors:
Yes
Schedule:
Mexico City – Durango – Torreón
MSN:
47043
YOM:
1967
Flight number:
JR706
Country:
Crew on board:
4
Crew fatalities:
Pax on board:
52
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
96300
Aircraft flight cycles:
102000
Circumstances:
Shortly after takeoff from runway 05L at Mexico City-Benito Juarez Airport, while in initial climb, the aircraft encountered windshear. It lost height and crash landed on the runway. Upon impact, the landing gear were torn off. Out of control, the aircraft veered off runway, lost its right wing and came to rest. All 56 occupants evacuated safely and the aircraft was destroyed.
Probable cause:
Loss of control upon takeoff due to windshear.

Crash of a Fokker F27 Friendship 200 in Chitral

Date & Time: Jun 16, 2004
Type of aircraft:
Operator:
Registration:
AP-AUR
Survivors:
Yes
Schedule:
Peshawar - Chitral
MSN:
10307
YOM:
1966
Flight number:
PK660
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
36
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
After landing on runway 02 at Chitral Airport, the aircraft was unable to stop within the remaining distance. It overran, lost its undercarriage and came to rest in a grassy and sandy area. All 40 occupants evacuated safely and the aircraft was damaged beyond repair.

Crash of an Avro 748-232-2A off Libreville: 19 killed

Date & Time: Jun 8, 2004 at 0938 LT
Type of aircraft:
Operator:
Registration:
TR-LFW
Survivors:
Yes
Schedule:
Libreville – Port Gentil – Franceville
MSN:
1611
YOM:
1967
Flight number:
GBE221
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
26
Pax fatalities:
Other fatalities:
Total fatalities:
19
Circumstances:
The aircraft departed Libreville-Léon Mba Airport at 0911LT on a flight to Franceville with an intermediate stop in Port Gentil with 26 passengers and four crew members on board. Few minutes after takeoff, the crew informed ATC about technical problem and was cleared to return to Libreville. In excellent weather conditions, the aircraft overflew the runway then crashed in the sea about 100 metres offshore. Eleven occupants were rescued while 19 others were killed, among them one crew member.
Probable cause:
Loss of hydraulic pressure on the right engine forced the crew to shut down this engine and to feather its propeller. On approach, the crew was unable to lower the gears because of the loss of hydraulic pressure.

Crash of an Embraer EMB-120ER Brasília near Manaus: 33 killed

Date & Time: May 14, 2004 at 1835 LT
Type of aircraft:
Operator:
Registration:
PT-WRO
Survivors:
No
Schedule:
São Paulo de Olivença – Tabatinga – Tefé – Manaus
MSN:
120-070
YOM:
1988
Flight number:
RLE4815
Location:
Country:
Crew on board:
3
Crew fatalities:
Pax on board:
30
Pax fatalities:
Other fatalities:
Total fatalities:
33
Captain / Total flying hours:
19069
Captain / Total hours on type:
5819.00
Copilot / Total flying hours:
11927
Copilot / Total hours on type:
4637
Circumstances:
While descending to Manaus-Eduardo Gomes Airport following an uneventful flight from Tefé, the aircraft was correctly established on the ILS when the crew was instructed by ATC to initiate a go-around and to follow a holding pattern as the priority was given to an ambulance flight. The crew made a left turn heading 060° and continued the descent after passing 2,000 feet when the aircraft struck the ground and crashed about 33 km from the airport. The aircraft disintegrated on impact and all 33 occupants were killed.
Probable cause:
Controlled flight into terrain after the crew continued the descent below 2,000 feet until the aircraft impacted ground. The following contributing factors were identified:
- The crew reported his altitude at 2,000 feet while the real altitude of the airplane was 1,300 feet,
- The crew continued the descent until final impact,
- The crew did not react to the GPWS alarm that sounded four times when the aircraft reached the altitude of 400 feet,
- No corrective action was taken by the crew,
- Lack of crew coordination,
- Poor approach planning that led the aircraft descending to a critical altitude,
- Lack of supervision,
- Operational deficiencies.
Final Report:

Crash of an ATR72-212 in San Juan

Date & Time: May 9, 2004 at 1450 LT
Type of aircraft:
Operator:
Registration:
N438AT
Survivors:
Yes
Schedule:
Mayaguez - San Juan
MSN:
438
YOM:
1995
Flight number:
AA5401
Country:
Crew on board:
4
Crew fatalities:
Pax on board:
22
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
6071
Captain / Total hours on type:
3814.00
Copilot / Total flying hours:
2000
Copilot / Total hours on type:
20
Aircraft flight hours:
19276
Aircraft flight cycles:
18086
Circumstances:
Flight 5401 departed Mayagüez, Puerto Rico, for San Juan about 14:15. The captain was the nonflying pilot for the flight, and the first officer was the flying pilot. The takeoff, climb, and en route portions of the flight were uneventful. At 14:37, as the flight approached the San Juan traffic area, the ATIS reported that winds were 060 degrees at 17 knots and gusting at 23 knots. Shortly thereafter, the captain briefed a Vref (the minimum approach airspeed in the landing configuration before the airplane reaches the runway threshold) of 95 knots and told the first officer to "stand by for winds." At 14:43 SJU Terminal Radar Approach Control cautioned the pilots of possible wake turbulence from a preceding Boeing. The captain told the first officer to slow down to about 140 kts. At 14:46, the local controller cleared the airplane to land on runway 08. The first officer turned the airplane left toward runway 08 and transitioned to the visual approach slope indicator. At 14:49, the captain stated, "you better keep that nose down or get some power up because you're gonna balloon." The airplane descended below the glideslope, causing a GPWS "glideslope" alert. The airplane was about 45 feet above ground level and traveling at 110 knots indicated airspeed when it crossed the runway 08 threshold. After the airplane crossed the runway threshold, the captain stated, "power in a little bit, don't pull the nose up, don't pull the nose up." At 14:49:39, the captain stated, "you're ballooning," and the first officer replied, "all right." The airplane touched down for the first time about 14:49:41 and about 1,600 feet beyond the runway 08 threshold with vertical and lateral loads of about 1.3 Gs and -0.10 G, respectively. Upon touchdown the captain stated, "get the power," and, 1 second later, "my aircraft." The first officer responded, "your airplane." The airplane had skipped to an altitude of about 4 feet and touched down again two seconds later about 2,200 feet beyond the runway 08 threshold. The airplane then pitched up to an angle of 9° while climbing to an altitude of 37 feet and the engine torque increased from 10 to 43 percent. About 14:49:49, the pitch angle decreased to -3°, and the engine torque started to decrease to 20 percent with the pitch angle decreasing to -10°. The airplane touched down a third time about 14:49:51 at a bank angle of 7° left wing down and about 3,300 feet beyond the runway 08 threshold and with vertical and lateral loads of about 5 Gs and 0.85 G. The ATR pitched up again to 24 feet and landed a fourth time about 14:49:56 (about 15 seconds after the initial touchdown) and about 4,000 feet beyond the runway 08 threshold. This time the airplane pitched down to -7° and that it was banked 29° left wing down. The airplane came to a complete stop on a grassy area about 217 feet left of the runway centerline and about 4,317 feet beyond the runway threshold.
Probable cause:
The captain’s failure to execute proper techniques to recover from the bounced landings and his subsequent failure to execute a go-around.
Final Report:

Ground accident of a McDonnell Douglas MD-82 in Trieste

Date & Time: Apr 20, 2004 at 1038 LT
Type of aircraft:
Operator:
Registration:
I-DAWR
Survivors:
Yes
Schedule:
Rome – Trieste
MSN:
49208/1190
YOM:
1985
Flight number:
AZ1357
Country:
Region:
Crew on board:
4
Crew fatalities:
Pax on board:
92
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
7988
Captain / Total hours on type:
3800.00
Copilot / Total flying hours:
5724
Aircraft flight hours:
41745
Aircraft flight cycles:
34235
Circumstances:
Following an uneventful flight from Rome-Ciampino Airport and a normal landing at Trieste-Ronchi dei Legionari Airport runway 09, the crew vacated the runway and continued via taxiway Bravo to the apron. The copilot was the pilot-in-command and he was facing sun while approaching the ramp. At the last moment, the captain noticed a dump truck on the right side of the taxiway. He took over controls and elected to turn to the left but the aircraft collided with the truck. The outer part of the right wing was torn off for about 3,5 metres and the fuselage was bent. Also, a fuel tank ruptured, causing a spill on the taxiway. The captain immediately stopped the airplane and all 96 occupants evacuated safely. It appeared that construction works were in progress near the taxiway Bravo. A Notam was not issued about this and the tower controller had not informed the crew either.
Probable cause:
The analysis of the technical, operational and organizational context in which the event took place (impact of the end of the right wing of the aircraft, during taxiing, against the rear body of a truck that was parked for work within the protection area of the taxiway that leads from the Bravo connection to the parking area) has allowed to determine the following causes, which are attributable to human and environmental factors.
- Failure to close the Bravo taxiway with the issue of the relative NOTAM of the works in progress.
- Failure of the Torre control to provide the pilots with essential information on the condition of the airport, as provided for by ICAO in ICAO Doc. 4444 PANS-ATM.
- Vertical and horizontal ground signs do not correspond to those specified in ICAO Annex 14.
- Failure to comply with the ENAC circular (APT-11), applicable for the type of work in progress at the airport.
- Insufficient surveillance of the airport area affected by the works by ENAC and the airport management company Aeroporto FVG.
- Lack of an airport Safety Management System .
- Inadequate surveillance of the external space during taxiing by the flight crew, resulting in incorrect assessment of the position of the aircraft with respect to the obstacle.
Final Report:

Crash of a Cessna 208B Grand Caravan in Lake Manyara

Date & Time: Mar 17, 2004 at 0615 LT
Type of aircraft:
Operator:
Registration:
5H-MUA
Flight Phase:
Survivors:
Yes
Schedule:
Arusha – Lake Manyara – Klein’s Camp – Grumet – Seronera – Lake Manyara – Arusha
MSN:
208B-0487
YOM:
1995
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
8
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
14000
Circumstances:
The aircraft was operating a scheduled flight starting from its base at Arusha. It was to call at Lake Manyara, Klein’s Camp, Grumet and Seronera before returning to Arusha via Lake Manyara. 5H-MUA took off from Arusha at 0530 hours. It was carrying one pilot and 3 passengers. The VFR flight to Lake Manyara was uneventful and the aircraft landed at Lake Manyara at 0555 hours. Five more passengers joined the flight here and 5H-MUA subsequently took off for Klein’s Camp at 0615 hours. During initial climb, the engine failed. The pilot feathered the propeller and attempted an emergency landing on a road. But he was forced to make an evasive manoeuvre because of a truck. The aircraft lost speed and height, collided with a stone wall beside the road and came tor rest. All nine occupants were rescued, among them five were seriously injured.
Probable cause:
Engine failure for undetermined reasons.
Final Report:

Crash of a Dornier DO.28D-2 Skyservant near Guayaquil

Date & Time: Mar 5, 2004 at 1755 LT
Type of aircraft:
Registration:
HC-CBK
Flight Phase:
Survivors:
Yes
Schedule:
Machala – Guayaquil
MSN:
4080
YOM:
1971
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
12
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
2977
Circumstances:
En route from Machala to Guayaquil, while cruising at an altitude of 6,000 feet in rain showers, the left engine lost power. The crew shut down the engine and feathered the propeller then decided to continue at an altitude of 600 feet and a speed of 80 knots. Several attempts to restart the left engine were unsuccessful when the right engine lost power as well. Unable to maintain a safe altitude, the crew attempted an emergency landing when the aircraft crashed in a river, some 23 km south of Guayaquil. All 14 occupants escaped with minor injuries and the aircraft was damaged beyond repair.
Probable cause:
A possible failure of the hydraulic pump on the left engine due to poor maintenance.