Crash of an Airbus A320-232 off Saint-Cyprien: 7 killed

Date & Time: Nov 27, 2008 at 1646 LT
Type of aircraft:
Operator:
Registration:
D-AXLA
Flight Type:
Survivors:
No
Schedule:
Perpignan - Frankfurt
MSN:
2500
YOM:
2005
Flight number:
GXL888T
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
5
Pax fatalities:
Other fatalities:
Total fatalities:
7
Captain / Total flying hours:
12709
Captain / Total hours on type:
7038.00
Copilot / Total flying hours:
11660
Copilot / Total hours on type:
5529
Aircraft flight hours:
10124
Aircraft flight cycles:
3931
Circumstances:
Flight GXL888T from Perpignan-Rivesaltes aerodrome was undertaken in the context of the end of a leasing agreement, before the return of D-AXLA to its owner. The program of planned checks could not be performed in general air traffic, so the flight was shortened. In level flight at FL320, angle of attack sensors 1 and 2 stopped moving and their positions did not change until the end of the flight. After about an hour of flight, the airplane returned to the departure aerodrome airspace and the crew was cleared to carry out an ILS procedure to runway 33, followed by a go around and a departure towards Frankfurt/Main (Germany). Shortly before overflying the initial approach fix, the crew carried out the check on the angle of attack protections in normal law. They lost control of the airplane, which crashed into the sea.
Probable cause:
The accident was caused by the loss of control of the airplane by the crew following the improvised demonstration of the functioning of the angle of attack protections, while the blockage of the angle of attack sensors made it impossible for these protections to trigger. The crew was not aware of the blockage of the angle of attack sensors. They did not take into account the speeds mentioned in the program of checks available to them and consequently did not stop the demonstration before the stall.
The following factors contributed to the accident:
• The decision to carry out the demonstration at a low height
• The crew’s management, during the thrust increase, of the strong increase in the longitudinal pitch, the crew not having identified the pitch-up stop position of the horizontal stabilizer nor acted on the trim wheel to correct it, nor reduced engine thrust
• The crew having to manage the conduct of the flight, follow the program of in-flight checks, adapted during the flight, and the preparation of the following stage, which greatly increased the workload and led the crew to improvise according to the constraints encountered
• The decision to use a flight program developed for crews trained for test flights, which led the crew to undertake checks without knowing their aim
• The absence of a regulatory framework in relation to non-revenue flights in the areas of air traffic management, of operations and of operational aspects
• The absence of consistency in the rinsing task in the airplane cleaning procedure, and in particular the absence of protection of the AOA sensors, during rinsing with water of the airplane three days before the flight. This led to the blockage of the AOA sensors through freezing of the water that was able to penetrate inside the sensor bodies.
The following factors also probably contributed to the accident:
• Inadequate coordination between an atypical team composed of three airline pilots in the cockpit
• The fatigue that may have reduced the crew’s awareness of the various items of information relating to the state of the systems.
Final Report:

Crash of a Gippsland GA8 Airvan in Cooinda

Date & Time: Sep 9, 2008 at 1500 LT
Type of aircraft:
Operator:
Registration:
VH-KNE
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Cooinda - Cooinda
MSN:
GA8-08-128
YOM:
2008
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The pilot was completing a local post maintenance test flight at Cooinda Airport. Shortly after takeoff, while in initial climb, the engine failed. The pilot attempted an emergency landing in the bush but the aircraft collided with a telephone pole and came to rest. The pilot escaped with minor injuries and the aircraft was damaged beyond repair.
Probable cause:
Engine failure for unknown reasons.

Crash of a PZL-Mielec AN-2 in Dmitrievskaya

Date & Time: Jun 28, 2008 at 1930 LT
Type of aircraft:
Operator:
Registration:
RF-00403
Flight Phase:
Flight Type:
Survivors:
Yes
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The pilot, sole on board, was performing a local test flight following an engine overhaul. En route, the engine lost power. The pilot attempted an emergency landing when the aircraft crashed in an open field located 6 km northeast of Dmitrievskaya, bursting into flames. The aircraft was destroyed and the pilot was seriously injured.
Probable cause:
Engine failure for unknown reasons.

Ground accident of a DC-9-31 in Caracas

Date & Time: Feb 12, 2008
Type of aircraft:
Operator:
Registration:
YV298T
Flight Phase:
Flight Type:
Survivors:
Yes
MSN:
48147/1048
YOM:
1981
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The aircraft was on a post maintenance delivery mission. A crew of two engineers was positioning the aircraft from a technical hangar at Caracas-Maiquetía-Simón Bolívar Airport to the main terminal. While taxiing on the ramp, the crew lost control of the aircraft that rolled to a grassy area and eventually collided with a drainage ditch. The left main gear collapse and the left wing was severely damaged. Both crew were uninjured while the aircraft was damaged beyond repair.
Probable cause:
Loss of control for undetermined reasons.

Ground accident of an Airbus A340-642X in Toulouse

Date & Time: Nov 15, 2007 at 1710 LT
Type of aircraft:
Operator:
Registration:
F-WWCJ
Flight Phase:
Flight Type:
Survivors:
Yes
MSN:
856
YOM:
2007
Country:
Region:
Crew on board:
9
Crew fatalities:
Pax fatalities:
Other fatalities:
Total fatalities:
0
Aircraft flight hours:
24
Circumstances:
The aircraft registered F-WWCJ was tested at a fixed point at Toulouse-Blagnac Airport. The current mission consisted of various test' systems with airline technicians who had ordered the plane. It unfolded engines in operation without chocks wheel. At the end of these tests, after having stopped and inspected the engines, the technicians restarted them for a new fixed point at high power, to find the source of oil seeps. About three minutes after power-up, the aircraft began to moving forward. The technician in the left seat noticed the movement and informed the test technician in the right seat. The latter acted on the brakes located rudder pedals then released the parking brake. The DFDR then shows a release of the brake command with the rudder bar. As the plane continues to advance, he tried to deviate from his course using the steering wheel. The nose gear quickly got in the way as the plane accelerated. The plane struck an inclined blast wall. Its front part broke and flipped over to the other side. Thirteen seconds elapsed between the start of the aircraft's movement and the shock with the wall. The aircraft was destroyed and all nine occupants were injured, four seriously.
Probable cause:
The accident was due to completion without chocks and on all four engines at the same time of a test during which the thrust was close to the capacity of the parking brake. The lack of a system for detecting and correcting drifts while carrying ground tests, in a context of industrial pressure and permanent sales force, encouraged a test to be carried out outside of the established procedures. The surprise led the ground test technician to focus on the brakes; therefore, he did not think of reducing the engines thrust.
Final Report:

Crash of a Cessna 340A in Chandler

Date & Time: Jun 1, 2007 at 1600 LT
Type of aircraft:
Registration:
N8688K
Flight Type:
Survivors:
Yes
Site:
Schedule:
Chandler - Chandler
MSN:
340A-0619
YOM:
1978
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
2799
Captain / Total hours on type:
62.00
Aircraft flight hours:
4790
Circumstances:
While on downwind the airplane experienced a loss of engine power and collided with houses and other obstacles during a forced landing on a residential neighborhood street. The pilot stated that he took off to troubleshoot a landing gear anomaly. He departed the airport area to the south. He cycled the landing gear and upon getting questionable indications in the cockpit of gear position he requested another aircraft confirm his landing gear configuration. Once he got the confirmation that all three wheels were down he proceeded back to the airport. About 2 miles away and approximately 1,800 feet agl the right engine began to lose power. He troubleshot the engine by attempting a restart, cycling the fuel pump off then on, and selected the right auxiliary fuel tank. The right engine did regain some power. He had lost some altitude during the process of troubleshooting the engine. He raised the landing gear to reduce drag, and entered right hand traffic for runway 17. At this point the left engine lost power, the airplane turned left, and he entered a descent to help maintain airspeed. He put the left propeller in feather, and switched to a new fuel tank, but the engine did not regain power. He did not have any altitude to exchange for airspeed and steered the airplane towards a clear residential street. The airplane impacted the roofs of at least two houses before colliding with the street. The pilot egressed through the rear of the airplane. An FAA inspector that examined the airplane wreckage stated that there was very little evidence of fuel onboard the airplane. The pilot stated that the left engine had failed due to fuel starvation and that he had fuel onboard but it was not in the right places.
Probable cause:
Fuel starvation due to the pilot's failure to adequately manage and monitor his fuel supply.
Final Report:

Crash of a Beechcraft 200 Super King Air in Leonardtown

Date & Time: Oct 12, 2006 at 1216 LT
Operator:
Registration:
N528WG
Flight Type:
Survivors:
Yes
Schedule:
Leonardtown - Leonardtown
MSN:
BB-151
YOM:
1979
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
7140
Captain / Total hours on type:
900.00
Copilot / Total flying hours:
1100
Copilot / Total hours on type:
59
Aircraft flight hours:
11077
Circumstances:
With all cockpit indications showing the landing gear was down and locked, the airplane touched down on the runway. Immediately after touchdown, the pilots heard the landing gear warning horn sound intermittently for several seconds, and then the right main landing gear collapsed. The airplane veered to the right, exited the runway, and came to rest. A post crash fire ensued, and the crew exited without injury. A postaccident examination of the airplane revealed that the collapsed right main landing gear had penetrated the right main fuel tank and the majority of the right side of the fuselage had been consumed by fire. Examination of the left and right main landing gear assemblies revealed, that both downlock plates had been installed backwards, providing only a fraction of the design contact area between the plate and throat of the downlock hook. Examination of the manufacturer's component maintenance manual, which was used for the assembly and installation of the left and right main landing gear, revealed no guidance regarding downlock plate orientation during installation.
Probable cause:
The airplane manufacturer's inadequate landing gear downlock plate maintenance orientation information, and the disengaged main landing gear.
Final Report:

Crash of a Spectrum FJ33 in Spanish Fork: 2 killed

Date & Time: Jul 25, 2006 at 1606 LT
Type of aircraft:
Operator:
Registration:
N322LA
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Spanish Fork - Spanish Fork
MSN:
01
YOM:
2006
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
2300
Captain / Total hours on type:
22.00
Copilot / Total flying hours:
3100
Copilot / Total hours on type:
16
Aircraft flight hours:
44
Aircraft flight cycles:
47
Circumstances:
The proto-type experimental light jet airplane was departing on a local maintenance test flight. Witnesses reported that the airplane entered a right roll almost immediately after liftoff. The roll continued to about 90 degrees right wing down at which point the right wingtip impacted the ground. During examination of the wreckage, the aileron control system was found connected such that the airplane rolled in the opposite direction to that commanded in the cockpit. The maintenance performed on the airplane before the accident flight included removal of the main landing gear (MLG) in order to stiffen the MLG struts. Interviews with the mechanics who performed the maintenance revealed that during re-installation and system testing of the MLG, it was discovered that the changes to the MLG struts impacted the Vbracket holding the aileron control system's upper torque tube. The V-bracket was removed and a redesigned V-bracket was installed in its place. This work required the disconnection of a portion of the aileron control system, including the removal of the aft upper torque tube bell crank from the torque tube. The mechanic who reinstalled the aft upper torque tube bell crank was under the incorrect assumption that there was only one way to install the bell crank on the torque tube. However, there are actually two positions in which the bell crank could be installed. The incorrect installation is accomplished by rotating the bell crank 180° about the axis of the torque tube and flipping it front to back, and this is the way the bell crank was found installed. With the bell crank installed incorrectly and the rest of the system installed as designed, there is binding in the system. This binding was noticed on the accident airplane during the inspection after initial installation. However, the mechanic did not recognize that the bell crank was improperly installed on the torque tube. Instead of fixing the problem by removing and correctly reinstalling the bell crank, he fixed the problem by disconnecting the necessary tie rods and rotating the upper torque tube so that the arm of the bell crank pointed up and to the left. This action reversed the movement of the ailerons. According to all of the personnel interviewed, there was no maintenance documentation to instruct mechanics how to perform the work since this was a proof-of-concept airplane. None of the mechanics who performed the work could recall if the position of the ailerons in relation to the position of the control stick was checked. Such a position check, if it had been performed by either the mechanics after the maintenance or by the flight crew during the preflight checks, would assuredly have indicated that the system was installed incorrectly.
Probable cause:
Incorrect installation by company maintenance personnel of the aft upper torque tube bell crank resulting in roll control that was opposite to that commanded in the cockpit. Contributing factors were the lack of maintenance documentation detailing the installation of the bell crank, the installing mechanic's incorrect assumption that the bell crank could only be installed in one position, and the failure of maintenance personnel and the flight crew to check the position of the control stick relative to the ailerons after the maintenance and during the preflight checks.
Final Report:

Crash of an Excel Jet Sport Jet I in Colorado Springs

Date & Time: Jun 22, 2006 at 0953 LT
Type of aircraft:
Operator:
Registration:
N350SJ
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Colorado Springs - Colorado Springs
MSN:
001
YOM:
2006
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
5307
Captain / Total hours on type:
11.00
Aircraft flight hours:
24
Circumstances:
According to the pilot, passenger, and several witnesses, during takeoff the light jet became airborne momentarily, and then banked aggressively to the left. It impacted the runway in a left wing low attitude and cartwheeled down the runway. An examination of the airplane's systems revealed no anomalies. Approximately 1.5 minutes before the airplane was cleared for takeoff, a De Havilland Dash 8 (DH-8) airplane departed. A wake turbulence study conducted by an NTSB aircraft performance engineer concluded that even slight movement in the atmosphere would have caused the circulation of the vortices near the accident site to decay to zero within two minutes, that is, before the time accident jet would have encountered the wake from the DH-8. The study states, in part: "Given the time of day of the accident, consistent reports of easterly surface wind speeds on the order of 6 to 7 knots, higher wind speeds aloft, and the mountainous terrain near Colorado Springs, it is unlikely that the atmosphere was quiescent enough to allow the wake vortices near the Sport-Jet to retain any significant circulation after two minutes. Furthermore, easterly surface winds would have blown the wake vortices well to the west of the runway by the time of the accident. Consequently, while in smooth air the wake vortices from the DH-8 that preceded Sport-Jet off of the runway may have retained enough circulation after two minutes to produce rolling moments on Sport-Jet on the order of the rolling moment available from the Sport-Jet's ailerons, it is most likely that the wake vortices were neither strong enough nor close enough to the Sport-Jet to cause the violent roll to the left reported by the pilot and witnesses to the accident."
Probable cause:
A loss of control for an undetermined reason during takeoff-initial climb that resulted in an in-flight collision with terrain.
Final Report:

Crash of a Lockheed C-130H Hercules in Kinshasa

Date & Time: Apr 14, 2006 at 1445 LT
Type of aircraft:
Operator:
Registration:
9T-TCB
Flight Type:
Survivors:
Yes
Schedule:
Kinshasa - Kinshasa
MSN:
4416
YOM:
1971
Region:
Crew on board:
7
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The crew was performing a test flight on this aircraft that was parked for 10 years at Kinshasa-N'Djili Airport. On landing, the left main gear collapsed and the aircraft came to rest. All seven occupants escaped uninjured while the aircraft was damaged beyond repair. The General Kikunda Ombala was PIC at the time of the accident.